Psychological Care of Veterans
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Module4Lecture.pptxPsychological Care of Veterans: Module 4
Mental Health Treatment Approaches and Systems to provide psychological care to veterans
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Unsurprisingly, with a myriad of co-occurring health issues…
…Approaches that promote better health in veterans will often involve coordinated efforts from multiple professionals.
Medical professionals (physicians, nurses, etc.)
Mental health professionals (e.g., psychologists)
Allied health professionals (occupational therapists, physical therapists, etc.)
The over-arching theme: taking a “biopsychosocial” approach to promoting health and wellbeing
consider the Biopsychosocial Model…
In short, it is a model that is well-utilized and is a simple way to think about how biological (“bio”), psychological (“psycho”), and social (“social”) factors can impact health and behavior.
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Health/Behaviors
Biological factors
(e.g., genes)
Social factors
(e.g., social support)
Psychological factors
(e.g., benefit-finding)
Several systems have been guided by the implications of this model…
Generally-speaking, we are talking about “integrative care” settings (APA).
Several models exist and have been empirically supported and widely utilized (e.g., VA and its “PCMHI”/Behavioral Health wing hybrid model)
Collaborative Care Model
PCBH
PCMH
The bottom line: with some differences in how mental health is utilized across a clinic/hospital setting, mental health professionals are somehow integrated into delivering overall healthcare.
Let’s take a look at how integrated care systems might work
“Team Structure” (Used with permission from the University of Washington AIMS Center, 1/22/2021)
Primary Care-Mental Health Integration in the Department of Veteran Affairs By Dr. Pomerantz (SAMHSA): https://www.youtube.com/watch?v=AGaaiHQHfmE
Implementing Measurement Based Care in VA: https://www.youtube.com/watch?v=UTwIYZo-Ows
What about the therapies?
Indeed, while use of therapies used outside the VHA (i.e., from providers outside the VHA) may be more varied and not as well-documented, evidence-based/empirically-supported therapies, such as those listed below, tend to be used to treat veterans’ mental health needs:
Trauma-focused therapies: PE, CPT, EMDR (this varies, given the uncertainty for how EMDR seems to work for some and does not seem to work for others)
The “family” of CBTs: BT, CT, CBT, ACT, DBT
And certainly more, as some clinicians may be more well-versed in some empirically-supported treatments (e.g., IPT, PST, SST) AND empirical evidence is always accumulating…
General Concepts about the theory underlying these therapies: Trauma-focused
Classical and Operant Conditioning -> the “danger” of the reinforcement of avoidance
General Concepts about the theory underlying these therapies: CBTs
Thoughts, Feelings, Behaviors (and all the theories underlying each of these three…)
However, being too focused on the therapeutic technique is a pitfall
A ”common factor” across therapies that forms the foundation for any therapy to work…the therapeutic alliance, which has also been called…
working alliance
shared/felt bond
(mutual) trust
Without a therapeutic alliance in place, therapies are less likely to work.
Given the differences in “Culture” that we covered earlier, hopefully you can see how this may take several sessions just to establish a shared bond (quick anecdote when talking with a sniper).
Interested in learning about military culture and how to talk with veterans?
There are so many resources…
TED: Wes Moore: How to talk to veterans about the war: https://www.youtube.com/watch?v=5P04stEjJ9E
Community Provider Toolkit (VA): https://www.mentalhealth.va.gov/communityproviders/military_culture.asp
Military Culture Training
Speaking the Language
Military Ethos: Guiding Ideals and Core Values
Ret. Lt. Col. Dave Grossman: Book On Combat: The Psychology and Physiology of Deadly Conflict in War and in Peace and “Bulletproof Mind” presentation: https://www.youtube.com/watch?v=8RDCtMEHFLM
Researching via a good search engine…
