More than two million people are serving either in active duty in the armed forces or in the reserves. And the United States is home to more than 18.6 million living veterans.
Service members and veterans experience high levels of post-traumatic stress disorder (PTSD), risk, suicide, depression, and grief. How can behavioral health professionals do a better job of serving those who serve?
The concept of cultural humility goes beyond the idea of cultural competence. It begins with listening to and honoring the stories and experiences of people whom we interact with. And it involves honoring their wisdom and experience. Cultural humility has no end point; it is an ongoing process of listening, responding, and striving to center on the client as the expert on their own experiences and life.
Many behavioral health professionals are familiar with cultural humility when it comes to working with clients from marginalized groups. But this approach also applies to active and former service people. Cultural humility is an important foundation upon which to build rapport, trust, and safety. It also promotes communication and collaboration in clinical settings.
The military is a culture, after all. So if we don’t know much about their world, we need to start by asking.
In the Connecticut Women’s Consortium training, “Serving Those Who Serve,” Amy B. Otzel, LPC, LMHC, explores approaches to serving active and retired military personnel. Otzel emphasizes that many initial screenings and intake processes neglect the question that is perhaps most important to those who serve: “Are you a military member, veteran, or family member?”
Asking shows that you care about this important aspect of someone’s life and paves the way for a productive therapeutic relationship.
Not everyone is certain of their military status — or ready to disclose it — but asking the question early in the relationship may shape the direction of future conversations. It can also aid in the ability to mobilize additional resources, including referrals.
There are six branches of the U.S. armed forces: Army, Air Force, Navy, Marines, Coast Guard, and Space Force. All but the Space Force have a reserve component, and the Army and Air Force have National Guards.
The military ranks are structured as officers, warrant officers (except in the Air Force and Space Force), and enlisted personnel.
A veteran is someone who served in an active armed service capacity and was discharged or released under conditions other than dishonorable. Veterans are entitled to a number of benefits: federal, state, community, nonprofit, and university/college.
The eligibility for veterans’ benefits varies depending on the program, their status, the discharge type, length and period of service, and a number of other factors.
A military family member is the dependent of a current military service member, military retiree, or 100% service-connected disabled veteran. That could be a current married spouse, unmarried biological, adoptive, or stepchildren up to the age of 21 or 23, other minors of legal guardianship, financially dependent parents, in-laws, or stepparents.
There are many reasons why service members and veterans experience high levels of stress. Operational stressors include accidents, injuries, and fatalities; numerous deployments; and relationship separations. Bioecological stressors include seasonal and time zone changes, sleep disruptions, chemical and toxin exposures, and food and water access.
If military members suspect they have been exposed to environmental hazards, the
U.S. Department of Veterans Affairs tracks exposures and connects veterans to benefits.
Social stressors are also common among service members. They may experience relationship strain, financial and economic difficulties, relocation and cultural assimilation difficulties, challenges to personal space and privacy, and concerns about the chain of command and colleagues.
Women are the fastest-growing group of veterans. As of 2020, there were nearly two million women veterans, 10% of the total. Because of outdated stereotypes, women are less likely to view themselves as veterans, yet they face many obstacles to health and wellness. For example:
Military sexual trauma (MST) is pervasive in the military, and sexual assault and harassment cause unspeakable damage to veterans and their families. The Department of Defense defines sexual assault as “intentional sexual contact, characterized by the use of force, threats, intimidation, abuse of authority, or when the victim does not or cannot consent.”
Treating active and veteran service members means understanding the fundamentals of post-traumatic stress disorder. The VA estimates that 7 out of every 100 veterans (7%) will have PTSD. It is more common among women than men, and more common among Vietnam veterans than veterans of other conflicts.
PTSD is different in every person, but in general, it is a mental health condition that develops after someone experiences or witnesses a life-threatening event. It can develop immediately or take years to produce symptoms. The four most common symptoms of PTSD are:
The key word in PTSD is trauma. People who serve have often experienced trauma and require trauma-specific or trauma-informed care.
The VA has many PTSD measures available for clinicians. These screens can help pinpoint the types of trauma experienced and inform treatment plans.
Suicide among service members and veterans is unacceptably high. The 2022 National Veteran Suicide Prevention Annual Report shows that in 2020, there were 6,146 veteran suicide deaths in the United States. Suicide was the 13th leading cause of death among veterans overall and the second leading cause of death among veterans under age 45.
Suicidal thoughts and behaviors need to be addressed immediately. If a veteran is in crisis, they should call the 988 crisis line and select 1. Or they can text 838255. Even people not enrolled in VA health care are eligible for emergency mental health care if they meet certain conditions.
The VA’s guide for family and friends lists the following signs that someone may be considering suicide:
The Veterans Self-Check Quiz is a safe, confidential way to assess risk.
When behavioral health professionals approach those who serve with compassion and cultural humility, they can help them understand how to process and heal from their trauma. Sometimes that starts with asking questions to learn more about the person’s experiences. You could ask:
The list is not comprehensive, but it can help clinicians understand where the person is in their healing journey and meet them where they are to develop a plan for therapy.
For current and former members of the military, adjusting to civilian life can be challenging. As behavioral health clinicians work to create an atmosphere of trust, presence, cultural humility, and alliance, they can help clients create a new sense of purpose: a wellness mission.
This reframing can inspire service members to live in the present and reframe their trauma. The result can be new (and healthier) operating orders, better connections, and empowerment.