A. Kathryn Power, M.Ed

Family Safety: A Significant Concern for Returning Veterans and Their Families
Capitol Hill, Washington, DC, Cannon Caucus Room (CHOB 345)
October 24, 2008

Remarks submitted by A. Kathryn Power, M.Ed., Director, Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services

I grew up as a member of a military family. My father was a Navy Engineer. We lived in shipyards all across the west coast and the east coast for all of my upbringing. I’m a member of a military family and I went to five different elementary schools and four different high schools. So the issue of living in a military family is very important to me and I understand the risk and protective factors that go along with being with a family member, and also the resiliency issues for family members and what you have to really be aware of and think about. The second thing was that I married a Marine which my Navy dad never forgave me for. And, in marrying a Marine, we began to live the Marine life. He was an Infantry Officer so I’m a spouse of a military person as well. We were on active duty for several years and then he became a reserve officer and stayed in the Reserves for almost 25 years. And the third piece is that I, myself, am a military officer. I’m a Captain in the Navy Reserve so I have the experience of that professional opportunity as well as working with other members of the military across several years. So, for me, this is a very personal issue from that experience.

Winston Churchill once said that courage is what it takes to stand up and speak. Courage is also what it takes to sit down and listen. Before we can fully understand trauma, before we have the words we need to discuss it, and before we can offer appropriate treatment, we must be willing to listen to the lives of those who, for too, long have suffered in silence. I had the privilege to listen to trauma survivors when I began my work over 30 years ago. First as a rape crisis counselor and a domestic violence counselor, and then as a victim-services advocate. It was the most meaningful, transformative work of my life. I learned that given time and support, individuals have an enormous potential to recover - to recover from even the most unspeakable acts of violence against their body, against their mind, and their soul.

The survivors that I worked with inspired me to work tirelessly to help open the nation’s eyes to the impacts of trauma, whether it is trauma induced by criminals, by disasters, by terrorism, or by wars and the need to promote emotional health and recovery for every man, woman, and child who has been affected by traumatic events.

Trauma is increasingly seen as an almost universal experience of public mental health and human service recipients. Addressing trauma is increasingly recognized as essential for recovery.

Over the past 15 years, SAMHSA has recognized the need to address trauma as a fundamental obligation for effective public health and substance abuse service delivery. We have both elevated the visibility of this critical public health issue and have provided helpful tools for States and communities to promote recovery and healing for trauma survivors.

With our partners in the private sector, such as Witness Justice, and in the public at DOD and DVA we must recognize the prevalence of trauma, acknowledge its impact, and provide the evidence-based services that address trauma in a context that is trauma-informed and recovery-oriented. We know that trauma is universal, highly disabling, and largely ignored.

According to a recent study by the Rand Corporation, about one-third of the 1.64 million service members who have deployed in support of Operation Enduring Freedom or Operation Iraqi Freedom have major depression, posttraumatic stress disorder, or traumatic brain injury, and about 5 percent report symptoms of all three.

A one-time traumatic event can lead to PTSD, but so can ongoing stress—harsh climates, austere living conditions, constant danger, and repeated deployments put our servicemen and women at risk.

Past experiences also increase risk. Individuals who have previously been traumatized run a high risk of being re-traumatized (during wartime), and some will develop PTSD as a result.

Most of the men and women who serve in our armed forces and the families they leave behind are incredibly resilient. Most of our servicemen have strong mental health that enables them to deal successfully with combat-related stressors and trauma. Indeed, writing about the experiences of family members, psychologist Michelle Sherman notes that while the adverse effects of trauma receive the greatest attention, many survivors of trauma experience positive changes termed Post Traumatic Growth. They become more aware of inner strength and courage. They build empathy for others. They grow spiritually and they appreciate the opportunity for a fresh start.

Sherman notes that mental health professionals can gently challenge their clients to explore the positive outcomes that may emerge when working through painful experiences. But as mental health professionals, we must also be aware that left untreated, particularly in service members who are vulnerable, trauma can impair future health, or productivity, family, and social relationships. Individuals whose mental health problems go unaddressed are at risk for substance abuse, homelessness, and suicide. We need to pay attention.

Paralleling the civilian sector, I think this is most important, paralleling the civilian sector only about half of the service men and women who need mental health resources actually seek them. It is very similar to what goes on in the civilian sector.

Last year alone, 121 active duty soldiers took their own lives, the highest number on record since the Army began tracking suicides in 1980. Attempted suicides are up, too, numbering 2,100 in 2007—six times the rate in 2002. This is one of the reasons that SAMHSA added a feature to the National Suicide Prevention Lifeline so callers can identify themselves as veterans and be connected to VA professionals. Thus far, more than 55,000 calls have been received, connecting over 22,000 veterans with direct support.

The common responses to trauma also may affect family relationships with partners and children. Three out of five service members have a spouse, a child, or both. Trauma survivors often experience considerable social anxiety, which causes them to withdraw from everyday outings and family events. Frequently, they deal with significant anger, which can alienate them from their families, who experience their loved one as unpredictable, hostile, and frightening. Finally, many survivors become emotionally numb to avoid facing the pain associated with the trauma they experienced, which may cut them off from positive feelings and family support, as well.

We can help our returning soldiers and their families make this transition because we know what to do to help them recover from the invisible wounds of war. Relative to just ten years ago, we now have a wide range of models designed to help service providers meet the needs of individuals that have been traumatized by war, natural or manmade disasters, or interpersonal violence and abuse.

Many of these effective and promising models are compiled in the recently released report from the National Center for Trauma-Informed Care, and Helga is a member of that board, called Models for Developing Trauma-Informed Behavioral Health Systems and Trauma-Specific Services, which was prepared in conjunction with the National Association of State Mental Health Program Directors. To be effective, any model for treating individuals affected by trauma must begin with the understanding that trauma is not a disease. Trauma is a public health issue that affects the quality of lives of individuals, of their families, and of our Nation as a whole.

A public health model focused on recovery from trauma must be characterized both by trauma-specific diagnostic and treatment services and by a “trauma-informed” environment capable of sustaining these services.

We learned from SAMSHA’s Women, Co-occurring Disorders, and Violence Study, which was the first large-scale evaluation of trauma interventions, that integrated treatment—for example, group and individual therapy that addressed trauma, mental health, and substance use conditions together—was the key element associated with better outcomes.

Clinical psychologist Roger Fallot, Director of Research and Evaluation at Community Connections in Washington, DC, has written extensively about this topic. Trauma-informed systems; he tells us these things: incorporate knowledge about trauma—including its prevalence and impact—in all aspects of service delivery; are hospitable and engaging for survivors; minimize revictimization; and facilitate recovery.

SAMHSA is not alone in our efforts to address trauma in the lives of our servicemen and women. DOD is launching an estimated $25 million project to discover the best treatments for combat-related PTSD. Called the STRONG STAR Multidisciplinary Research Consortium, this project will include eight randomized clinical trials of several treatment conditions, with active duty and veteran participants.

DVA, as well, recognizes both the problems of trauma among our Nation’s veterans and its obligation to help. Military sexual trauma counselors at VA facilities meet with female veterans in private areas so they can safely hear a woman’s feelings of fear, anxiety, shame, anger, and embarrassment and can connect her to the resources she needs to heal.

In addition, we can point to the wonderful work of the more than 200 community-based Vet Centers located in all 50 States, the District of Columbia, Guam, Puerto Rico, and the U.S. Virgin Islands. The Vet Centers are staffed by small multidisciplinary teams of dedicated providers, many of whom are combat veterans themselves.

We must welcome our servicemen and women home with gratitude, respect, and the full support of the mental health community behind them. We must understand the prevalence of trauma, recognize its impact, and be prepared to offer evidence-based practices that help people recover not only their emotional and physical health, but also their hopes and dreams. I really welcome the opportunity today to have further dialogue.