3. • Shook Over Hell: unprecedented violence after Civil War
• SMI: 3X more in jail than hospitals
• Military: ‘Chapter’ discharges for ‘character disorders’
• Military demographics – older adolescents & young adults
• Impulsive, action-oriented, seeking gratification, etc.
• Self-medication – drugs & alcohol
• Suicide, accidents, PTSD, mTBI, troubling relationships, etc.
Slide 3 of 16
4. • David Phillips: Lethal Warriors
• At-risk cluster of risk factors
• One BCT & IN battalion
• Higher levels of intense combat exposure
• High op tempo
• Stigma
• Peer & personal pressure
• Low referral rates to Mental Health
• Increasing trend of ‘moral waivers’
Slide 4 of 16
5. Slide 5 of 16
Once an army is involved in war, there is a beast in every fighting
man, which begins tugging at its chains, and a good officer must learn
early on how to keep the beast under control, both in his men and
himself (1942).
8. • ALI Guidelines
• Diagnosed with a relevant mental condition or defect
• Unable to appreciate the criminality of his conduct
• Conform his conduct to the requirements of the law
• M’Naghten Rule
• “laboring under such a defect of reason, or disease of the mind…”
• Did not know the nature or quality of the act
• If he did not, did not know that the act was wrong
Slide 8 of 16
10. • 29 y/o former SGT – 2 tours in Iraq & Afghanistan
• Convicted for rape – sentence for 37 years
• h/o childhood sexual abuse & trauma
• Multiples concussions while in the Army
• PTSD, depression, ETOHism, etc.
• Illnesses aggravated as commercial diver
Slide 10 of 16
11. • Plea for murder – LWOP
• NGRI – for TBI & PTSD
• Troubled childhood
• 2 tours in Iraq & Afghanistan
• Suicidal, PTSD, depressed
• TBI – paralyzed & blind
• Rehab, RTD, & disabled
• No recall for events
Slide 11 of 16
Nicholas Kristof: When War Comes Home, New York Times, Nov 2012
12. Overall prevalence:
Pain 81.5%
TBI 68.2%
PTSD 66.8%
PTSD
P3 Multi-symptom
Disorder
TBI/Pain
Lew, Otis,Tun, Kerns, Clark, & Cifu, in review
Sample = 340 OEF/OIF outpatients at Boston VA
42.1%
5.3%
2.9%
16.5%
10.3%
12.6%
6.8%
12CLARK- 2009
16. • Patient-centered and integrative care
• Developments in neuroscience
• Findings in related areas of endocrinology, sleep medicine, pain
management, and physiology
• Information technology and predictive analysis
• Mental health parity and related legislation
• Political and social concerns over violence and suicide
• Growing frustration among patients and families in need of
comprehensive effective care
Slide 16 of 16
Notes de l'éditeur
Trends over the next 10 years
Patrick Kennedy – leading changes in mental health – predicts ‘chaos’
If we don’t lead – then we will be dragged along – military hat of when in charge, take charge’
Not a far cry from Guantanamo to legislation:
Focus the right spotlight on mental health
Our state of mind anchors or well-being, & anchors or personal & collective security
Torture is wrong & dehumanizing
Ignoring the less fortunate & marginalizing in our society is dehumanizing
We have a collective & community responsibility to uphold the fundamental principles of this democracy – founded in human rights – linking torture & securing our communities in a humane way – and speaking up against the violations of human rights.
Trends over the next 10 years
Patrick Kennedy – leading changes in mental health – predicts ‘chaos’
If we don’t lead – then we will be dragged along – military hat of when in charge, take charge’
Not a far cry from Guantanamo to legislation:
Focus the right spotlight on mental health
Our state of mind anchors or well-being, & anchors or personal & collective security
Torture is wrong & dehumanizing
Ignoring the less fortunate & marginalizing in our society is dehumanizing
We have a collective & community responsibility to uphold the fundamental principles of this democracy – founded in human rights – linking torture & securing our communities in a humane way – and speaking up against the violations of human rights.
Memorable quote from GEN Marshall
Burden of senior leadership – containing the violence.
Medics speak “truth to power.”
Trends over the next 10 years
Patrick Kennedy – leading changes in mental health – predicts ‘chaos’
If we don’t lead – then we will be dragged along – military hat of when in charge, take charge’
Not a far cry from Guantanamo to legislation:
Focus the right spotlight on mental health
Our state of mind anchors or well-being, & anchors or personal & collective security
Torture is wrong & dehumanizing
Ignoring the less fortunate & marginalizing in our society is dehumanizing
We have a collective & community responsibility to uphold the fundamental principles of this democracy – founded in human rights – linking torture & securing our communities in a humane way – and speaking up against the violations of human rights.
Trends over the next 10 years
Patrick Kennedy – leading changes in mental health – predicts ‘chaos’
If we don’t lead – then we will be dragged along – military hat of when in charge, take charge’
Not a far cry from Guantanamo to legislation:
Focus the right spotlight on mental health
Our state of mind anchors or well-being, & anchors or personal & collective security
Torture is wrong & dehumanizing
Ignoring the less fortunate & marginalizing in our society is dehumanizing
We have a collective & community responsibility to uphold the fundamental principles of this democracy – founded in human rights – linking torture & securing our communities in a humane way – and speaking up against the violations of human rights.
Avoided suicide by joining the French Foreign Legion
Support setting up Veterans Courts
Educating defense attorneys about PTSD/TBI/moral injury.
Trends over the next 10 years
Patrick Kennedy – leading changes in mental health – predicts ‘chaos’
If we don’t lead – then we will be dragged along – military hat of when in charge, take charge’
Not a far cry from Guantanamo to legislation:
Focus the right spotlight on mental health
Our state of mind anchors or well-being, & anchors or personal & collective security
Torture is wrong & dehumanizing
Ignoring the less fortunate & marginalizing in our society is dehumanizing
We have a collective & community responsibility to uphold the fundamental principles of this democracy – founded in human rights – linking torture & securing our communities in a humane way – and speaking up against the violations of human rights.
Trends over the next 10 years
Patrick Kennedy – leading changes in mental health – predicts ‘chaos’
If we don’t lead – then we will be dragged along – military hat of when in charge, take charge’
Not a far cry from Guantanamo to legislation:
Focus the right spotlight on mental health
Our state of mind anchors or well-being, & anchors or personal & collective security
Torture is wrong & dehumanizing
Ignoring the less fortunate & marginalizing in our society is dehumanizing
We have a collective & community responsibility to uphold the fundamental principles of this democracy – founded in human rights – linking torture & securing our communities in a humane way – and speaking up against the violations of human rights.
Lew, et. al. Prevalence of chronic pain, PTSD, &persistent postconcussive symptoms in OIF/OEF veterans. Nov 2009.
Treated according to the “door you walk through.”
Observations of 25 years ago – motivated to set up service lines & primary care clinics at BACH & EAMC.
Challenges of implementing models for integrated care – legacy barriers of specialties, separate departments, & academic medicine.
Focus on age & stage – goals & objectives – natural orientation of veterans – imprint of military experience.
Goals & objectives – set the “mission” for the stage of life.
Application of GST – homeostasis & end state.
Guns & dangerousness
30,000 deaths annually – a public health problem
20,000 deaths – suicide
>300,000 over past 10 years – 6X the combat deaths in Vietnam
Advocate for care for soldiers & veterans
Support for the Murphy Bill
Trends over the next 10 years
Patrick Kennedy – leading changes in mental health – predicts ‘chaos’
If we don’t lead – then we will be dragged along – military hat of when in charge, take charge’
Not a far cry from Guantanamo to legislation:
Focus the right spotlight on mental health
Our state of mind anchors or well-being, & anchors or personal & collective security
Torture is wrong & dehumanizing
Ignoring the less fortunate & marginalizing in our society is dehumanizing
We have a collective & community responsibility to uphold the fundamental principles of this democracy – founded in human rights – linking torture & securing our communities in a humane way – and speaking up against the violations of human rights.