Examining policy related to PTSD assessment and the treatment offered in Colorado

Introduction: Examining policy related to PTSD assessment and the treatment offered in Colorado
Research conducted by McLay (2012) found that approximately 300,000 veterans returning from service in Iraq and Afghanistan might be suffering from Post-Traumatic Stress Disorder (PTSD). In addition, the study sought to examine the effects PTSD has on the veterans’ life, as well as the challenges faced when integrating into a non-combat setting or the general community. McLay (2012) and Ruzek (2011) found many shortcomings in the treatment of PTSD and other related conditions suffered by war veterans, which lead to unpopular social behaviors such as violence and withdrawal. This study seeks to explore the currently available PTSD treatment programs for returning veterans in Colorado and to explore potential policy and program improvements related to veteran’s access, PTSD treatment services, and sustainable compensation and benefits for those being treated with combat-related PTSD.
McLay (2012) identified that 58.5% of all service fellows returning from deployment in Afghanistan and Iraq meet the diagnostic criteria for PTSD. Ruzek (2011) stated that the Veteran Affairs Department was established to help those returning from war to adjust accordingly to the society. Together, with military hospitals and support from the government, the local Veteran Affairs has implemented special programs to assess, diagnose, and treat returning war veterans for PTSD.
This chapter will present a review of the essential literature regarding the lived experiences of veterans returning from active duty in Middle East to the state of Colorado who have been diagnosed with combat-related PTSD and subsequently received services related to the diagnosis (herein referred to as ‘veterans’. This approach has been motivated by the rationale that there exists a paucity of research pertaining specifically to service provision and quality in the state of Colorado. According to McLay(2012) previous research has focused on a larger national context, thus there is limited research that directly focuses on the issue of combat-related PTSD on war veterans returning to the State of Colorado. Through further analysis of current literature and research regarding combat-related PTSD I hope to be able to further advocate for the needs for funding, and health facilities to assist returning war veterans in the state of Colorado.

The Institute of Medicine (2008) and Ruzek (2011) found evidence of ill treatment of spouses and other family members and poor social behavior by returning war veterans, which illustrates supporting evidence that the current programs lack effectiveness in diagnosing and treating health problems, such as PTSD and depression in these service personnel. Ruzek (2011) identified problems such as reports of violence, illegal activities, substance abuse, and an increase in the number of arrests in these veterans. An examination of the available body of evidence indicates that current rehabilitation and psychiatric disability policies implemented by the Department of Veterans Affairs (VA) for combat related Post-Traumatic Stress Disorder (PTSD) is inefficient (McLay, 2012). Additionally, McLay (2012) found that despite efforts by the VA to design programs for compensating veterans who encounter physical and mental injuries that are war-related, there could be identified loopholes in the implementation of these policies.
Significance
The key significance of this study is to understand the treatment of returning war veterans from war and who currently live in State of Colorado and have clinical diagnoses of PTSD. Additionally, this study hopes to illuminate best practices for access to state and federal government programs, or to identify new program opportunities that will provide long-term treatment access. An in-depth investigation of PTSD treatment programs in the Colorado VA system will be utilized to examine the effects of these treatment programs on reducing the impact of PTSD and integrating the veteran into a productive work and social life. This study also seeks to bring to attention the negative impacts of war on those citizens who fight for the country and challenge those in charge to work towards establishing programs that will help veterans cope with the PTSD. Illustrating potential gaps in treatment access and continuing care may lead to program policy changes, which ultimately may support the veteran with integration in civilian life.
Background
After the terrorist attack on September 11, 2001, there were over two million American military personnel deployed to Iraq and Afghanistan (Ruzek, 2011). More than 1.3 million of these volunteers have returned home from service in the war-torn zone. Over 700 veterans from among the soldiers who have returned home after serving in the military accessed Veterans Affairs (VA) healthcare in Colorado between 2011 and 2012 (McLay, 2012). Research conducted by McLay (2012) identified that approximately 300,000 veterans returning veterans suffer from Post-Traumatic Stress Disorder (PTSD). However disorders are medically related to other social disorders among the returning service veterans, which include substance abuse among them and their families (Ruzek, 2011). Ruzek (2011) stated that spouses whose husbands are deployed in military service have recorded an increase in the diagnosis of PTSD, among other conditions. Lambert and Morgan (2009) found some children of military veterans have also recorded an 18% increase in behavioral disorders, which culminate from the PTSD condition of their parents.
Communication technology is a source of both positive and negative effects on the PTSD conditions of military service members. Ruzek (2011) posited that technology encourages military service members to communicate with spouses. Loved ones and family in a manner that relieves stress, access to information that portrays the problems experienced by family members may be a major source of the PTSD condition. However, McLay (2012) found that soldiers serving at war experienced onset of PTSD after hearing news of their family problems that they were powerless to solve. Therefore, their inability to do anything about these problems affects them to the extent of developing post-traumatic stress disorder what are the effects of being in combat and killing and seeing people killed in war, which has the potential to affect veterans when in non-combat zones or when returning to civilian life. In contrast, Lambert and Morgan (2009) found that constant communication with family members can also mitigate the effects of PTSD by calming solders even during the process of war. McLay (2012) argued that even though the VA was tasked with the implementation of policies for the treatment of combat-related PTSD, approximately 58.5% veteran’s still goes untreated with the condition and this affects their effort to adjust to the social life positively. Lambert and Morgan (2009) reported that medical practitioners are observing symptoms of PTSD in war veterans who seek treatment for medical conditions other than PTSD illustrating a potential under-diagnosis of the true PTSD picture for returning war veterans. Even though the VA rehabilitation policies for combat-related PTSD have been in operation for more than 60 years, there appears to be some unsatisfactory factors in the programs in addressing the problem as seen in the State of Colorado whereby some of the people who are treated for the condition still exhibit the condition at later stages after management. Some researchers claim that current VA programs are counter-therapeutic. Lambert and Morgan (2009) claimed that the current VA programs for PTSD and other mental illnesses illustrate traditional treatment, which has been overlapped by progress in medical research, such as the use of morphine and other anti-depressants in combination with various forms of psychotherapy.
The administrative trends of the VA Department in the State of Colorado indicate an increase in the access for VA services as over 700 veterans seek these services. There are inconsistencies in evaluation procedures as reports showing a worsening of PTSD symptoms and decline in the use of VA mental health services indicate a deficiency in the ability of current policy to address the PTSD problem. Self-reports by war veterans indicate an increase in the recurring incidents of PTSD, as well as a lack of early diagnosis of the condition (Lambert & Morgan, 2009).
Combat is a very risky undertaking with several physical and psychological impacts on service members. PTSD is one of the most predominant impacts affecting most service members and veterans. Lambert and Morgan (2009) stated that the divorce rate of war veterans has increased from 2.6% to 3.6% between 2001 and 2009 compared to the national divorce rate of 3.6% (Center for Disease and Control and Prevention [CDC], 2013). Ruzek (2011) reported that in 2008 13,000 military marriages ended. The Veteran Affairs Department was thus transformed to include programs that would aid in formulating and implementing programs for vocational rehabilitation, disability compensation, and insurance for returning veterans to help the integration of service members into society. This study seeks to explore the current available PTSD treatment programs for returning veterans in Colorado and to explore potential policy and program improvements related to veterans’ access, PTSD treatment services, and sustainable compensation and benefits for those being treated with combat-related PTSD.
Theoretical Framework
Program theory forms the research basis for this study. This theoretical approach focuses on the root causes and underlying assumptions in a given program. Research conducted by Glaser(2011) stated , program theory provides solutions through developing a causal representation that links inputs and activities of a program to a chain of observed as well as intended results. McCann and Clark (2003) posited that causal representation is an effective guide to program evaluation criteria. Program theory is used to develop logic models that represent real life situation through qualitative analytical research techniques. Glaser (2011) argued that qualitative and analytical approaches are used to evaluate the situation at hand so that the program theory can be applied to derive its causal models and the intervention practices.
The applicability of the program theory in this research comes from its explanatory effectiveness using behavioral analysis techniques in areas such as health challenges found in the diagnosis and treatment of PTSD as well as content review and implementation of compensation policies for returning combat veterans who are suffering from PTSD. Ruzek (2011) further supported the use of program theory as a tool for information gathering to support analyses in an effort to devise models that will guide the intervention practices in a manner that addresses, reduces, and potentially eliminates the problem’s root cause as well as identification and potential reduction in observable damages to affected individuals. The symptoms and treatment of PTSD in returning combat veterans are judged from their behavioral disposition. Program theory aims at formulating causal models, which are based on conceptual ideas. Therefore, a quest to discover changes to the existing veteran treatment and compensation policies is set to benefit from this theory. This will be achieved through a qualitative approach of analytical induction regarding information collected based on observations in an attempt to formulate a causal model for the analysis and determination of intervention approaches purposes.
Program theory will be used to establish the relevance and effectiveness of the most significant policies that will be used for this study. However, according to McLay (2012), the extent of implementation of rehabilitation and compensation policies for the veterans is questionable due to the supposedly high number of veterans who remain untreated and those who do not seek treatment for secondary occurrence of PTSD due to the failure of losing disability. Therefore, program theory provides a framework for welfare analysis of the existing options and the options that should be selected based on a qualitative methodological approach to solve the treatment and compensation problems in the VA’s disability policy.
Literature Search Strategy
T. Lambert and Morgan (2009) posited that a qualitative approach is effective in ensuring inclusive and irrefutable coverage of this topic because it outlines the important ideas of the topic. In order to conduct the qualitative analysis, secondary data will be obtained from the VA website, as well as the medical department documentations upon receiving permission from the relevant government sources, which are guided by the public policy that necessitates the identity of the respondents to be protected and the data to be used only for research purposes. .
Possible Types and Sources of Information or Data
1. One-on-one interviews with returning combat veterans from duty in the Middle East.
2. Relevant and contemporary PTSD treatment programs literature regarding program access and program evaluation methods to returning veterans.
3. Epidemiological data available from the Veterans Affairs and Department of Defense website, as well as Colorado Department of Health, and Center for Disease Control and Prevention.
3. Information obtained through qualitative data analysis using appropriate software, such as NVivo 10, Dedoose, or others.

PTSD in Military Veterans
The current state of PTSD in Colorado will be discussed in through the research of McLay (2010, Ruzek (2011), (Leland, & Oboroceanu, 2010), and Chen (2010). Each researcher has identified ways to better diagnose PTSD in returning veterans. . McLay (2012) identified that 58.5% of service members returning from service in Iraq and Afghanistan might be suffering from Post-Traumatic Stress Disorder. What exactly does this mean? It means that over half of the returning war veteran population has been affected by PTSD, thus there is a critical need for the support of literature and research discussing the causes and effects, as well as, the diagnosis and treatment for those living with PTSD). Ruzek (2011) states examined the function and role that the Veterans Affairs Department ( VA) have with veteran rehabilitation exposed to PTSD.
It is common knowledge that the Veteran Affairs Department (VA) was established to help those returning from war to adjust accordingly to the society (Ruzek, 2011), however many would concur that the VA has done poorly to help those veterans returning from war in the Middle East. McLay (2012) argues that even though the VA was tasked with the implementation of policies for the treatment of combat-related PTSD, approximately 58.5% veterans still go untreated with the condition and this significantly impact the ability of returning war veterans to assimilate back into civilian life. Although with support from the government, the local VA has done a poor job implementing special programs to assess, diagnose, and treat returning war veterans for PTSD. According to McLay (2012) “An examination of the available body of evidence indicates that current rehabilitation and psychiatric disability policies implemented by the Department of Veterans Affairs for combat related Post-Traumatic Stress Disorder is inefficient pg.54.”
Description of PTSD
To a great extent, the negligence of rehabilitation services to returning war veterans has resulted in disapproving social behavior by these veterans. The Institute of Medicine (2008) and Ruzek (2011) found evidence of ill treatment of spouses and other family members and poor social behavior by returning war veterans. In particular Ruzek (2011) reported increases in violence, illegal activities, substance abuse, and in the number of arrests in these veterans. Furthermore Ruzek (2011) states that social adjustment problems experienced by returning war veterans may provide supporting evidence that the current programs provided by the VA lack effectiveness in diagnosing and treating health problems, such as PTSD and depression in these service personnel. In relation, McLay (2012) found that despite efforts by the VA to design programs for compensating veterans who encounter physical and mental injuries that are war-related, there could be identified loopholes in the implementation of these policies.
Until the 1980’s PTSD did not have an official it was officially recognized in psychiatry, perhaps not in the military although the symptoms of post-traumatic stress were observed among veterans for hundreds of years, (Leland, & Oboroceanu, 2010). This has been particularly evident in those soldiers deployed to the Middle East. Chen (2010) stated that 12-13 % of Marines and soldiers who have returned from active duty have been afflicted in one way or another by psychological disorders.
One of these illnesses is Post Traumatic Stress Disorder (PTSD). The risk of this ailment has necessitated some level of focus on the different mechanisms that can be adopted to alleviate its impacts to Veterans. Lambert and Morgan (2009) reported that medical practitioners are observing symptoms of PTSD in war veterans who seek treatment for medical conditions other than PTSD, thus illustrating a potential under-diagnosis of the true PTSD picture for returning war veterans. Some researchers claim that current VA programs are counter-therapeutic. For instance, Lambert and Morgan (2009) mentioned that even though the VA rehabilitation policies for combat-related PTSD have been in operation for more than 60 years, some of the people who are treated for the condition still exhibit the condition at later stages after management. However, this argument cannot be substantiated because there exists no foolproof mental illness treatment and residual psychological stress can continue. The optimum results expected from such treatment is the ability of the victim to manage the stress in a better way.
Out of all these military personnel, about half of them fully transitioned to civilian life soon after the end of their tour (Frueh, & Smith, 2012). Sadly, this transition is expected to reveal the true psychological impacts of war. Combat related PTSD is a common psychological illness that veterans have to fight (Gold & Frueh, 1999). As long as there are soldiers in the battlefield, there is high potential for suffering from PTSD in the future. The examination of combat related PTSD has been relegated to the use of a checklist. This checklist is used to make the correct diagnoses yet keeping in mind, that people suffering from of PTSD show similar symptoms with people having other psychological illnesses (Richardson, Frueh, & Acierno, 2010).
According to McLay (2012) approximately 33% of the Veterans who seek medical attention have some level of anxiety disorder. Given this high rate, there is need for to probe further into the causes, effects and possible treatment of this disorder. Moreover, exposure to war enhances the potential of PTSD in the future. This is because during war, service members face traumatizing circumstances such as death of fellow service members, hostile working/living conditions and detachment from home. The Department of Veteran Affairs (VA) has been charged with the duty of providing healthcare to the veterans. This department has been instrumental in the provision of care and compensation for veterans who are suffering from combat related PTSD.
Ruzek (2011) determined that there has been rise in the demand of the treatment for combat related PTSD that is provided by the VA and more programs are needed in order to get more help for veterans. To be more elaborate, after the September 11, 2001 terrorist attack on American soil, there were over two million American military personnel deployed to Iraq and Afghanistan (Ruzek, 2011). McLay (2012) stated that more than 1.3 million of these volunteers have returned home from service in the war-torn zone. Over 700 veterans from among the soldiers who have returned home after serving in the military accessed Veterans Affairs (VA) healthcare in Colorado between 2011 and 2012 (McLay, 2012). Ruzek (2011) stated that PSTD is medically related to other social disorders among the returning service veterans, which include substance abuse among them and their families. Ruzek (2011) stated that spouses whose husbands are deployed in military service have recorded an increase in the diagnosis of PTSD, among other conditions. Lambert and Morgan (2009) established that some children of military veterans have also recorded an 18% increase in behavioral disorders, which culminate from the PTSD condition of their parents.

Prevalence PTSD, in general, in the military, in military veterans, in veterans returning from the middle east
According to Seal, Bertenthal, 2007 states of the nearly two million soldiers returning from OEF/UIF approximately 25% of soldiers utilizing medical benefits through the Department of Veteran Affairs (VA) have a diagnosable mental health disorder. Of the 25% of soldiers utilizing medical benefits, 56% are diagnosed with multiple mental health disorders. This shows that most veterans returning from Middle East have been diagnosed and shows the need for help with disorders. Cook (2009) states the most common disorders experienced by veterans of OEF/OIF are depression, anxiety, problematic drinking, drug use and post-traumatic stress disorder. Seal 2007 states among the most prevalent is PTSD, with approximately 1/6 veterans of OEF/OIF meeting the screening id criteria. This clearly more needs to be done and more help needs to be given to veterans and active duty returning from Middle East to Colorado. Cook (2009) states beyond the impact on daily life, veterans who screen positive for PTSD are four times as likely to report suicidal ideation as their peers without PTSD. Furthermore if a veteran experienced a co-occurring disorder in addition to PTSD, their risk increased to 5.7 times. Thomas (2010) states the prevalence of PTSD in OEF/OIF veteran’s ranges from 9% to 31% depending on the level of impaired functions reported, with approximately 20% to 30% meeting diagnostic criteria of the DSM-IV-TR 3 months after deployment. It is estimated that 2.0-3.1 billion dollars every year is spent on PTSD treatment for veterans. (Jaycot, 2008) According to McLay (2012), the advent of invisible wounds is something that is an inevitable occurrence for most of the soldiers who go to battle. With reference to conflict in the Middle East, the President has pointed out his intention of realizing full withdrawal of the United States forces in the Middle East (Laffaye, Rosen, Schnurr, & Friedman 2013). This may mean that the U.S. forces will now be able to return home.
The psychological impacts of war are very deep and thus there is need to address these conditions. PTSD is usually identified with other psychological issues such as anxiety disorders (McLay, 2012). Wessley (2010) stated that the exposure to combat has the potential to amplify the risk to PTSD. This is especially in reference to exposure to combat in the Middle East (Department of Veterans Affairs Veterans Benefits Administration, 2012). The Department of Veterans Affairs (VA) is tasked with the special responsibility for the provision of services to veterans’ that have military related mental health problems. This department was initially created to meet the requirements and demands of the about 3.1 million Vietnam veterans through the creation of more than 200 windows of community outreach programs which are now accessible to veterans of other wars and conflicts (Department of Veterans Affairs, 2005). The Vietnam war that took place in the both 1970s and 1980s was characterized by a series of 140 specialized PTSD treatment programs, in addition to its network of general mental health programs (Grubaugh, Elhai, Monnier, & Frueh, 2004).
Between 11 September 2001 and April 2006, there were approximately 2 million American soldiers who had been deployed to the Middle East (McNally, 2011). Additionally, more than half a million of these soldiers have been able to make a transition to civilian life. The Office of the Government Accountability Office (GAO) has expressed concern that the VA has sufficient capacity to meet the psychosocial needs of veterans. This is especially with regard to those who have served in Afghanistan and Iraq. Although the VA has increased funding to meet the needs of these veterans, the GAO states that there is stress regarding the data on the recent surge in demand for treatment of PTSD (Department of Veterans Affairs Veterans Benefits Administration, 2012).
Andrews et al, (2007), states there has been increase demand for PTSD treatment due to the increased number of soldiers returning from the conflict in the Middle East. During the earlier periods particularly during the Gulf war, there was less demand for PTSD treatment as compared to the veterans returning from the war in the Middle East. This can be attributed to the fact that there were more soldiers involved in the war in the Middle East and that VA has sensitized the veterans about PSTD and has developed programs to counter its effects (Murdoch et al., 2003). For troops serving in a combat zone, there are countless who are exposed to extreme stress every day. This is irrespective of the level of volatility of the specific war. The level of advancements of the sophisticated weaponry in use in contemporary wars has amplified the psychological impacts of war. With the increasing use of Improvised Explosive Devices (IEDs), the increased numbers of suicide bombers and the overall difficulty in identifying the enemy have amplified the impact of war on the soldiers (Gawande, 2004). The nature of the war in the Middle East is a good example of the deterioration of the conditions of armed combat.
When soldiers return home after long periods in the battlefield their degree of adjustment to the daily life can be a difficult and a stressful undertaking. Other than the risk of suffering from anxiety disorders, veterans have the risk of falling into drug abuse to reduce the effects of psychological impacts of combat in the battlefield. This is complemented by the increased risk of depression and suicide. The VA has pointed out that there are specific populations that stand the highest chance of suffering from PTSD. The first of these populations is the female population (Fear et al, 2010).Also, research has showed the Hispanic population has a more significant risk of suffering from PTSD than other cultures. Veterans who are single also have a high risk of suffering (Rosen, 2010). Those veterans who have served for a significant amount of time are also at risk (McNally, 2011) as a more serious injury or traumatic brain injury has been found to be a significant and potent predictor of the eventual advent of PTSD, which is more likely to occur when veterans remain in a combat zone for extended periods of time.
A recent RAND study found that approximately one in five veterans who were deployed in either Iraq or Afghanistan were afflicted by PTSD or some other form of major depression (Murdoch, et al., 2005). These rates are similar to those of that have been arrived at by Franklin et al. (2002) in their research. In much more specific terms, research conducted by Hoge and colleagues (2004) showed that 16 to 17% of those veterans who participated in the Operation Iraqi Freedom (OIF) and 11% of veterans returning from Operation Enduring Freedom (OEF) had met the selection criteria of at least one mental disorder. Further research has shown that the prevalence of mental health issues was identified in about 19% of the total of soldiers who were deployed in Iraq (Arbisi, Murdoch, Fortier, & McNulty, 2004). On the same note, about 11% of those who were deployed to Afghanistan were characterized by the same symptoms. OIF / OEF VA health care facilities, received 25% of mental health diagnoses, with 56% of those meeting criteria for two or more psychiatric diagnoses (Hoge et al., 2004).
Mental health disorders work in conjunction with a combination of physical health issues that impact the general functioning of the body. For example, those with PTSD often have difficulty in many functional areas such as sleep, social interactions and physical activity as well. These are best exemplified by deteriorating quality of social relationships. Frueh et al. (2005) established a link between PTSD and physical health. In a recent study of new returnees, the manifestation by symptoms of PTSD increased in severity. This was coupled by lower ratings of general health, more sick visits, and more missed days of work calls. This was the noted situation even after taking into account those who have been wounded or injured (Gade, 2013).

Impact, general social , for the military, for the veteran, for the veterans’ family
Combat is a very risky undertaking with several physical and psychological impacts on service members. Lambert and Morgan (2009) stated that the divorce rate of veterans has increased from 2.6% to 3.6% between 2001 and 2009 compared to the national divorce rate of 2.7% (Center for Disease and Control and Prevention [CDC], 2013). Ruzek (2011) reported that in 2008, 13,000 military marriages ended. The Veteran Affairs Department was thus transformed to include programs that would aid in formulating and implementing programs for vocational rehabilitation, disability compensation, and insurance for returning veterans. This was meant to help them to integrate well with the society and enable them have better relationships with their friends and family in order to reduce divorce rates. With divorced among the veterans being caused by strained relationships with those close to them, proper integration as part of PSTD treatment will effectively reduce the divorce rates. It is important for veterans to learn about PTSD treatment programs for returning veterans in Colorado and to explore potential policy and program improvements related to veterans’ access, PTSD treatment services, and sustainable compensation and benefits for those being treated with combat-related PTSD so that they can effectively cope with war related PTSD. War has been existent in society since time immemorial. There will always be some form of conflict in the world. With this come the numerous impacts of war on both the general public and the soldiers who witness, first hand, the atrocities of war. Physical wounds are not the only injuries suffered by the soldiers. Mental illnesses are also a pertinent factor in the life of a soldier in the battlefield (Angrist, Chen, & Frandsen, 2010). Communication technology is a source of both positive and negative effects on the PTSD conditions of military service members. Ruzek (2011) posited that technology encourages military service members to communicate with their spouses, loved ones and family in a manner that relieves stress and allows the family members to get closer to the service members in a multiplicity of ways. Access to information by a soldier in was that portrays the family back at home is experiencing some problems may be a major source of worry. This satiation can worsen when the service member cannot make contact with their family members. However, McLay (2012) found that soldiers serving at war experienced onset of PTSD after hearing news of their family problems that they were not in a position to solve while serving in a combat zone. Therefore, their inability to do act on these problems affects them to the extent of developing post-traumatic stress disorder, which has the potential to affect veterans when in non-combat zones or when returning to civilian life. In contrast, Lambert and Morgan (2009) found that constant communication with family members could also mitigate the effects of PTSD by calming solders even during the process of war.

Symptoms

The level of capability of the mental health staff at the VA Hospital, in terms of funding is determined by the annual appropriations made by Congress and allocation decisions in local health centers (Spoont et al, 2008). As such, to increase capability and effectiveness of the VA mental health program despite the need to cut costs, there is need for consistent high performance and access to care over a longer period of funding time. This would allow for better treatment of veterans and allow for the veterans to get the treatment they deserve.
During military service, soldiers engage in war where they have the potential of witnessing a number of potentially traumatic events. In these situations, those who are exposed are placed in dangerous psychological situations. As such, the psychological state of the soldier is then placed in a critical condition (Frueh et al., 2003). For one to meet the criteria necessary for a positive diagnosis for PTSD, one needs to have experienced or have been exposed to at least one potentially traumatic event. Alternatively, the person must have episodes characterized with fear, terror and even helplessness.
In general, people who have a positive diagnosis of PTSD need to have a number of key symptoms. One of these is the persistent reliving or re-lives the event. In this way, the patient experiences nightmares, intrusive thoughts, flashbacks and mental and physical stress reactivity in response to a trauma pins. The second symptom is the clear avoidance of anything that will remind them of the past traumatic event (Engelhard, 2007). This is inclusive of people, thoughts, feelings and even conversations that have some form of similarity or are in reference to particular components of the past traumatic event.
The third symptom is that of numbing of the emotions of the individual and the patient would be estranged from social interactions. The patient will thus appear emotionally withdrawn or depict behavior change (Leland & Oboroceanu, 2010). This means that the patient will not enjoy the things that had previously been a source of pleasure. The fourth symptom has to be that of arousal symptoms. The problems most frequently reported are increased anger or irritability and insomnia. Other symptoms include agitation, constantly alert, with difficulty concentrating and feeling nervous or nervous.
PTSD Treatment Modalities
PTSD is an extremely complex disease that requires a comprehensive approach to healing. Treatments methods that can be effective in relieving its symptoms include; medications, talk therapy, relaxation, stress reduction and nutrition and regular excursive. The use of herbal medicines such as norepinephrine in the treatment of PTSD ought to be handled with caution (Smith et al., 2008). Research also shows that alpha-and beta-blockers may useful to relieve nightmares, and tense muscles (Stiglitz & Bilmes, 2008).
An extreme result of long-term PTSD that goes untreated or even inadequately treated can lead to fluctuation of hormone levels. If the veteran continues to be exceptionally isolated and is devoid of energy to do simple tasks, it is important that there be an examination of the extent of hormone disruption. This is as per the instructions of specialists including endocrinologists and naturopaths. The blood and saliva are often used, and often contradict each other in the testing phase. Blood tests must be specific, and often the test show negative results. This is even when there is an evident perpetuation of the symptoms.
Although soldiers are relived when war ends, it is unfortunate that the psychological traumas that these witnessed, first hand, do not end. As such, the health status of those in the military and the veterans comes into question. The advent of psychological traumas essentially inhibits the probability of success of these troops in future battles. One potent approach in meeting the psychological needs of those suffering from combat related PTSD is the need for social interaction with other veterans. It has been found that in such settings, the afflicted veterans are able to voice out their issues and concerns. In the long run, these meetings have become extremely potent in providing relief from the psychological impacts of war (Freeman, Powell, & Kimbrell, 2008). As such, aside from the medical approach that ought to be adopted, there is need to appreciate the role of interaction with other veterans suffering from combat related PTSD. Veterans tend to feel more secure when interacting with their fellow veterans.
Modality I
Over time, people with PTSD develop fears memories of their traumatic event. These memories may be in the environment. For example, to connect with traumatic events some images, smells, sounds, or thoughts and feelings. These memories may also be in the form of memories, nightmares or intrusive thoughts. Since these memories often cause significant difficulties, a person may fear and avoid.
The core purpose of exposure therapy rests on its capacity to aid in the lessening of the degree of apprehension and anxiety that has been associated with these memories, which also avoided. This approach entails the intentional exposure of the patient to the traumatizing memories with the goal of forcing direct confrontation. This can be actively exposing remember someone to pictures that remind the individual of particularly traumatizing events. Additionally, this can also be achieved by the use of imagination.
In dealing with fear and anxiety, the patient can learn that anxiety and fear will diminish when there is direct confrontation. This then eventually sees the reduction of the extent to which these memories act as a threats and sources of fear (Sayer, Spoont, Nelson, Nugent, 2004). Exposure therapy is generally associated with patient education by the use of a variety of relaxation techniques. In this way, the patient can better manage their anxiety and fear when it occurs (rather than avoidance).
Modality II
The basic objective of the formation of stress inoculation (SIT) is a patient needs to gain confidence in his/her ability to help cope with anxiety and fear that is sourced from traumatic memories. In SIT approach, the therapist helps the client to realize that things are reminders to fear and anxiety (also known as “clues”). Additionally, patients then are able to discover an assortment of coping strategies (Bachynski et. al., 2012). These are usually extremely useful in dealing with anxiety management. These are best exemplified using muscle relaxation strategy. It is the role of the therapist to assist the patient in learning and understanding how soon the symptoms with depart. In this case, the patient is put into action immediately to recognize the newly acquired coping strategies and identify clues to the patient. This allows the patient anxiety and stress attack early, before it gets out of control.
Modality III
Cognitive processing therapy (CPT) is a form of PTSD treatment that has been attributed to Resick and Schnicke (Monson et. al., 2006). This method was particularly guided by the need o offer PTSD treatment to those who have suffered from sexual assault. Given its effectiveness to this regard, it is a potent approach in the treatment of combat related PTSD. CPT has been designed to span for 12 sessions (Jackson et. al., 2011). The workings of CPT are such that it combines elements of both cognitive therapies coupled with exposure therapy.
CPT is like cognitive therapy, the developers of the approach adopted the notion that the symptoms of PTSD following a conflict between pre-trauma beliefs about self and the world, best exemplified by the notion that nothing bad has happened, coupled with posttraumatic information. These conflicts are “stuck points” referred to and processed by the next component in CPT which entails the writing down about the trauma.
Just in similarity to the exposure therapy, CPT, the patient is compelled to relive the otherwise traumatizing experience. The patient is asked to provide specific details regarding the traumatizing event. The patient is then asked to read aloud the story several times in and out of the session. The therapist helps the client identify and plug points and errors of judgment, sometimes called “cognitive restructuring.” These errors in judgment can, for example: “I am a bad person” or “I’ve done something to deserve it” The therapist can help the patient deal with these errors or points blocked by the customer to collect evidence for and against this mentality.
Typical Treatment modality for military veterans
All the applications presented here were found to be effective in treating PTSD. The exact procedure that is to be followed for a particular case of PTSD is largely dependent on that the patient feels is comfortable. There are some patients who will feel a heightened level of anxiety when compelled to relive the memories of trauma by writing down the details of a past traumatic experience. In such a particular scenario, the use of SIT might be the best approach to employ. The patient can learn more about cognitive-behavioral treatments for PTSD, helping to reduce the symptoms of post-traumatic stress disorder. This is best exemplified by prolonged exposure, cognitive therapy treatment, and seeking safety.
Each veteran deserves and all types of medical and psychological support. Veterans should have a VA doctor or physician, ask about symptoms they are experiencing discuss and advice regarding treatment. If you do not ask, you could spend on you and miss treatment options. Do not fear the discussion of the medical use of marijuana, many veterans are using right now. One problem with PTSD is that the desire or need for treatment can occur years after the trauma. With this being said, veterans have the right to be given the different available alternatives for long-term treatment. This is coupled with the access to long-term treatment.
The use of marijuana as a potent treatment alternative is at best described as being otherwise controversial. The US has been able to pass laws legalizing the use of marijuana purely for medical purposes. As such, its medicinal capabilities have been ascertained by this move. It has to be understood that this is not a guaranteed solution, but there is sufficient evidence to show that marijuana is a treatment that ought to be continued. This is in appreciation of the positive impacts of marijuana in inhibiting the symptoms of PTSD and other related psychological disorders.
The state of New Mexico has been at the forefront of legalizing the use of marijuana. Those suffering from PTSD have now been given the legal right to use marijuana in the treatment of their condition. This trend has been as a result of numerous researches on the effects of marijuana on the reduction of intensity of the symptoms of PTSD (Frueh et. al., 2007). It has been found that marijuana has been used more for PTSD treatment when compared to its use in the treatment of other ailments.
It is possible to use marijuana to alleviate PTSD. The issue surrounding the use of marijuana surrounds its legality in the society. The federal government has been split regarding the need for marijuana and its overall effect in medical terms. The verity of the issue is that this drug is a potent treatment alternative and as such ought to be widely embraced in the treatment of PTSD. The actuality that it is mostly used for PTSD treatment ought to be sufficient evidence as to its overall power and need in the treatment of PTSD.
Although marijuana listed as a drug in the United States before drug prohibition and was widely used for dozens of conditions, Congress has chosen to temporarily place in Annex I. This was then to be subject to the findings of a government study. The study, conducted by a National Commission on Drug Abuse, ultimately concluded that the harmful effects of marijuana were so limited for light to medium users that there is not even a criminal offense in the use. Unfortunately, the medication status of Annex I have largely remained even in the contemporary environment.
The relevant officials are of the notion that this drug is illegal and as such this status quo has to be sustained. These officials refuse to appreciate the findings of studies that show that there is not illegal impact in the use of the drug. These officials have wrongly pointed out that there is no evidence that marijuana is of medicinal value. Officials persistently refuse to allow private companies to use marijuana for research to demonstrate that it actually has a medicinal value. As such, there are seemingly endless obstacles for researchers wishing to conduct potentially favorable studies planned. Devoid of the findings of these researches, there cannot be any substantiation of the adopted notion that marijuana is indeed dangerous to the health of those who consumer this drug.
Given that past and present men and women have been severely affected to the extent that they even taken their own lives to the point, there is need to at least explore the different treatment options for PTSD. This is where the need for marijuana comes into the equation. Often, family and / or couples therapy can be used as a preventive measure to observe family members helping in understanding the process of reintegration into civilian life as well as some of the symptoms of readjustment that family members may be included in their lives.
Return to work or school can be a difficult experience for veterans. This is especially given that many may have difficulty relating to the authorities. Many situations in which they perceive that the authority has made decisions that were not in their best interest, and, therefore, naturally reactive seen in this context. Concentration difficulties may also interfere with work or school functioning and therapies that can help treat trauma be useful in this regard; Provide the veteran with a dining experience can handle help reduce disability in this area.
Veterans who served in the framework of Operation Iraqi Freedom / Operation Enduring Freedom’ have been given five years free treatment at their local VA hospital. Many hospitals have VA PTSD Clinical Team (PCT), which refers to a wide range of treatments to offer returning veterans. A San Francisco VA Medical Center, we offer a full PTSD diagnosis, therapy based on skills, inclusive of stress management and anger, therapies based on the exposure, exposure therapy such extended therapy and cognitive processing, couples / family therapy and OIF / OEF adaptation groups. The prolonged exposure and cognitive therapy treatment are two treatments based on evidence that has shown that there are indeed positive results that can be expected from the use of these approaches (Tolin, Steenkamp, Marx & Litz, 2010). A particularly encouraging finding is that there is a national effort geared towards the enhancement of the capacities of the mental health professionals in the country so that they can be equipped to provide one or both of these treatments.
One of the biggest challenges that mental health professionals are faced with is the provision of services to members returning from active military deployment. This is especially from the Middle East. This is coupled with the obstacles and barriers created by stigma. In a study of people with a positive test for mental illness, those who were screened positive for a mental disorder twice as often as those who fail the selection criteria for PTSD report stigma and barriers to care for their mental health care.
There are various rationales that motivate returning veterans to desire privacy in the seeking of mental health care. This is inclusive of social oriented fears. This is to the extent that 65% fear the stigma associated with seeking mental healthcare. As such, there is need for setting up of support systems that encourage returning veterans to seek mental healthcare. This is crucial for those who are suffering from PTSD.
Services Needs and Provison for military veterans
There is no denying that PTSD is a treatable ailment. One must just ensure that the appropriate approach is being employed in the treatment process. VA offers treatment for PTSD for almost all veterans. This provision of services is by specialists of PTSD and PTSD specialized programs. However, sometimes there are obstacles on the way of veterans receiving care they need. Stigma about anxiety disorders is still very real, and often the victim is afraid to admit the problem in another. This is especially if he or she suspects it will be viewed negatively by members who do not understand mental illness. Even for those who initially received treatment, the success of the adopted treatment approach is determined by the commitment of the patient to the healing approach. A 2010 study showed that less than 10 percent of veterans in Iraq and Afghanistan PTSD diagnosis ended 10 recommended for treatment sessions of 12 weeks.
One of the most pertinent issues that have plagued treatment is that of paucity of data. This is with regard to the treatments that patients receive and the nature of impacts of treatment approaches to the patients. The VA is the department that has been tasked with meeting the health needs of the veterans. As such, it is the key body that handles the treatment of combat related PTSD of the veterans. This department has helped millions of veterans in the treatment of PTSD. Despite this critical role, there is no potent data regarding the overall effectiveness of the treatments being used by the VA. Given the need to ensure that there is analysis of the current treatments so as to provide ground for future revisions of policy, it is rather surprising that no such data exists. The VA is under fire recently because of agitation; new patients always had access to future health care. The lack of data regarding the current impact of the treatment alternatives means that the potential for changes in the adopted treatment approach is rather disappointing (Department of Veterans Affairs, 2012).
It has been noted that the VA has at least minimal care requirements established at national level. It is still unclear whether the staff meets the standards. Health records system computer from the VA allows clinicians to monitor patients receiving drugs, but it would be better if the system was able to track the types of therapy used to allow. A new model was said to be available to clinicians a while back. This, however, has not been to fruition.
Services provision
The nature of service in the military is such that it is at best described as difficult, demanding and increasingly dangerous. Despite these dangers, there is significant challenge with regard to the return to civilian life. This transition presents substantial challenges to both men and women of the military. A research conducted on this transition found out that a significant percentage of veterans find it extremely difficult to make a smooth and effective transition to the life of a civilian (Murdoch, et. al., 2011). While veterans of more than seven in ten (72%) reported having had an easy time readjusting to civilian life, say 27% of the season has been difficult for them to readjust (Karlin et. al., 2010).
According to this study, rather having an easy time adjusting to their post-military life from being an enlisted personnel, former combatants graduates did not realize smooth transition from life in the military to the daily lives of a civilian. A research conducted on this transition found out that those veterans who were commissioned officers and those who had obtained a university degree, had a clear understanding of their missions (Schnurr, Lunney, Bovin & Marx, 2009). This then enabled them to experience fewer difficulties in the transition to civilian life than those who do not fully understand their duties or tasks. Veterans who had a traumatic experience during their time or had suffered a serious service-related injury have a much more difficult time in making a smooth transition. This is especially when other factors are held in a constant ratio.
Consequences during psychological trauma are particularly striking. The situation in which a veteran served has been found to determine their ability to successful transition to civilian life. This is ascertained by the actuality that those veterans who served in the period immediately after 9/11 found it more difficult to transition as compared to veterans from other war eras.
There has been a higher inculcation of religion into the military lives of soldiers. This has increased with a dramatic rate. This is measured by frequent attendance at religious services. For this population, adjustment to the civilian life has not been found to be significantly difficult. After the analysis, a veteran who participated in the last religious services at least once a week has a 67 % chance that they will experience a successful and smooth transition into civilian life. On the other hand, for those who did not attend religious prayer services, they experienced a 43% of a successful and smooth transition into civilian life. The attendance of religious meeting is not a significant determinant of the level of success one is to realize in transition to civilian life.
In the wholesome context, 43% of veterans say they have had time to “very easy” readjust their post-military life, and 29% assert that transition was “pretty easy. ” 21% of the veterans, however, point out that it was a little difficult to transition into civilian life (Frueh et. al., 2012). Only about 6% stated that they faced major problems (Tuerk, et.al. 2011). Of the 18 variables tested, veterans, emotional or physical trauma suffered during his time are at greater risk of difficulties readjusting to civilian life (Murdoch, Hodges, Cowper, Fortier & Van Ryn, 2003). After the analysis, an emotionally painful experience reduces the chances that a veteran would be experience relatively easy return to civilian life. By and large, the research was of the finding that severe physical injuries and the exposure to emotionally traumatic events have become increasingly common factors in the contemporary military life of a veteran.
The survey also located some specific problems that service members who are transitioning to civilian life face such as emotional trauma or serious injuries suffered in the service side. This is to the extent that about 56% of all the veterans have pointed out that they experienced a traumatic event, saying they had flashbacks or repeated painful memories of the experience (Sayer, Clothier, Spoont & Nelson, 2007). On the same note, about 46% pointed out that they experienced some level of stress during their transition. It has to be understood that those who suffered from PTSD had a higher potential of experiencing a much more difficult transition.
Depending on the model, not serving in a combat zone reduces the chances that a veteran will face difficulty in their transition. It has been found that 785 of all those who did not serve in combat experienced smooth transition to civilian life (Marx, et. al., 2012). Analysis of research has found that using statistical regression analysis showed that four variables were significant predictors of positive transition experience of a veteran: Place as an officer, a clear understanding of the tasks during the service, a graduate of the university, and said post-9/11 veterans who attend religious services frequently (Dohrenwend et. al., 2006).
The most potent factor in dictating quality of transition is that of serious injury and /or emotional trauma. The effects of these elements were such that it assured a significant difficulty in transitioning to civilian life. as such, given the lack of serious injury and a lack of emotional trauma, veterans have a good probability of successful and smooth transition into civilian life.
Unmet needs – what are the gaps in service, what are barriers to treatment , what anticipated trends in the near future(3 -5 years)
The number of veterans to obtain disability compensation for post-traumatic stress disorder (PTSD) has witnessed significant increase. This is by an astonishing 80% in recent years. The U.S. Department of Veterans Affairs (VA) currently provides over $ 4 billion in compensation for veterans for the conditions suffered as a result of direct combat. This is best exemplified by PTSD.
There has been some level of concern regarding the treatment approaches that are being used by the VA. There are some inconsistencies that have been pointed out earlier. These are best exemplified by the lack of adequate and up to date data regarding the nature of efficiency of the adopted treatment approaches. VA Veterans Benefits Administration (VBA) has asked the Institute of Medicine and the National Research Council to convene a committee of experts for veterans with PTSD. This will enable clear answering of the different concerns which the veterans have regarding the treatment of PTSD. The chapter describes the effects of PTSD on veterans and the literature provides the information needed to better the help needed for veterans to succeed in life.

Last Completed Projects

Are you looking for a similar paper or any other quality academic essay? Then look no further. Our research paper writing service is what you require. Our team of experienced writers is on standby to deliver to you an original paper as per your specified instructions with zero plagiarism guaranteed. This is the perfect way you can prepare your own unique academic paper and score the grades you deserve.

Use the order calculator below and get started! Contact our live support team for any assistance or inquiry.

[order_calculator]