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Provider’s Perspective: Veteran Mental Health and the Invisible Wounds of War

Post author By headinghealth
Post date November 4, 2022
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Provider's Perspective: Veteran Mental Health and the Invisible Wounds of War

November 4, 2022

This post was written by Teressa Carter, a therapist at Heading Health with extensive experience serving and treating active-duty service members and their families

In celebrating Veteran’s Day, I am honored to create a space to salute all who have served, and the sacrifices made by members of the U.S. armed forces and their families to preserve our freedom. This day is very personal for me as my family, and I celebrate the service and sacrifice of both my maternal and paternal grandfather, as well as my father, who all served in the United States Army. My six-year-old son is reminded that his father is a hero, having served in the United States Marine Corps. Aside from my familial connections to the military, I have had the privilege and the honor of providing mental health services to active-duty service members and their families of all branches.

A Military Mental Health Crisis

Veteran’s Day allows us to explore and assess how we can better support our veterans, especially when navigating their mental health. Recent research suggests 11 to 20 percent of veterans experience post-traumatic stress disorder (PTSD) in a given year. Suicide rates of military service members and veterans are also at an all-time high, with deaths by suicide having increased by 25% during 2020.

Despite the prevalence of mental health needs, veterans often struggle to find and stick with care. One study found that among the veterans with mental health needs, 55 percent did not seek treatment from Veterans Affairs. Some of the more commonly cited reasons for avoiding or not continuing with treatment include:

Given all of this, it’s vital that veterans have the tools to receive and stick with effective care and that clinicians know how to reach out and provide support to service members in need.

Advice for Veterans in Need of Mental Health Care

If you are a Veteran in need of mental health treatment, you are not alone, and great support is out there. I strongly encourage veterans to reach out to someone, whether your medical provider, your VA liaison, family, or friends, who can support and assist them in finding the right mental health treatment for their needs. Here are some other tips:

Look for clinicians that have either military experience or experience training to treat military-related issues.
The VA or Military OneSource are great resources for finding treatment options.
Prepare for your first intake. There will be a lot of information gathering. This is also where you have the opportunity to interview the therapist to make sure this is a good fit for you and that you feel comfortable.
Remember, mental health treatment is a process and should not be rushed. Prepare for this by viewing your treatment as a journey.
Share your feelings, hesitations, limitations, and boundaries with your therapist.
Always remember that getting help is a sign of strength and resilience.

Tips For Therapists Treating Veterans

There are several steps mental health professionals can take to ensure they are effectively reaching out to veterans in need and providing them with adequate care.

Market Your Services to Veterans

The civilian mental health community should ensure they are marketing services to the veteran population. Here are some suggestions.

Add any military experience or previous work with the veteran population or armed services to your professional online profile.
Highlight if you have specialized training to treat conditions prevalent among veterans, such as PTSD, anxiety, depression, and addiction-related issues.
Advertise your services to agencies that cater to the veteran community, such as your local Veterans Affairs office, TRICARE, or Military OneSource. Make your services known and available through the base coordinator that assists Active-Duty service members transitioning to veteran status.

Build Rapport

In my career working with active-duty service members and veterans, I found building an initial rapport centered around trust, understanding, and respect was an absolute must. Here are 10 simple strategies I use to build rapport and develop a strong relationship with service members and veterans.

Always thank the service members for their sacrifices.
Share your background and personal experience with the military.
Be honest about where your gaps in knowledge or understanding of the military lifestyle are.
Emphasize your willingness to learn.
Be curious. Inquire about their branch of service, rank, years of sacrifice, and duty stations.
Explain that you are trying to obtain a deeper understanding of their unique service and experience.
Create a safe space. Make sure your clinical area is quiet, private, and free from sudden noises or distractions that could trigger PTSD symptoms. Invite your veteran clients to share as much or as little of their military experience as they are comfortable disclosing.
Allow veterans to speak freely and at their own pace.
Never say, “I understand.” This could trigger the veteran client to be upset if you do not have military experience, especially direct combat experience.
Refrain from using a lot of clinical jargon and acronyms. Veterans are used to clear, concise, and direct communication because of their military experience. Too much clinical jargon may create space for miscommunication and confusion.

Utilize Available Resources

An important aspect of providing mental health treatment to veterans is to have a working knowledge of available resources in the community and helping clients get connected to them. Here are some resources that may be helpful:

Address Family Needs

Mental health providers will also need to address family needs when working with veterans, as families have also served and sacrificed. Additionally, the family is transitioning with their service members. For example, families may be transferring medical, educational, and social services from on-base providers to civilian providers. As a result, they must adapt to new doctors and mental health providers. They may also be moving to new homes in new neighborhoods, meaning the children will be transferring schools and making new friends. Adjusting to these changes can be challenging and added support can be helpful.

Conclusion

As we gather to celebrate this upcoming holiday, please take a moment to acknowledge and honor the sacrifices of our veterans and active-duty service members. Please be an advocate in your community, workspace, and even your organization for increased support and resources for the veteran community. When you see a veteran, thank them for their sacrifice. Thank you to all who have served and the families that served along with them.

If you know a veteran who may be experiencing mental health issues, please help them get care. You can do this by enrolling in their local VA and requesting mental health services. If you feel a veteran is experiencing a crisis, please call the national suicide hotline (988).

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Complete our consultation form and an intake specialist will get in touch.

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Tags mental health, mental health treatment, mental illness, military, ptsd, therapy, veterans, veterans day

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Can Ketamine Treat PTSD?

Can Ketamine Treat PTSD?

November 3, 2022

Post-traumatic stress disorder (PTSD) is a debilitating psychiatric condition caused by exposure to a terrifying or traumatic event. Individuals with PTSD may experience flashbacks, nightmares, severe anxiety, and uncontrollable or intrusive thoughts about the event. About eight percent of the population will experience PTSD over the course of their life. This condition is significantly more common among combat veterans, with nearly a quarter developing it during their lifetimes.

The standard treatment involves some form of psychotherapy, oral anti-depressants, or some combination. Many psychotherapies (e.g., exposure therapy, cognitive behavioral therapy, cognitive processing therapy, etc.) require patients to confront aspects of the traumatic event or how they think about it. While these therapies can be effective, they can also be stressful, causing many to stop treatment early.

The FDA has approved two medications, sertraline, and paroxetine, for the treatment of PTSD. These medications have several drawbacks. They take four to six weeks to start working. They also come with many side effects that lead many to stop taking them. Even when patients stick with the medications, only around 30 percent achieve remission. While other medicines have been used, the evidence for their efficacy remains questionable. As a result, there is a desperate need for faster, more effective, and more tolerable treatments for PTSD.

Why Test Ketamine for PTSD?

Over the past few years, ketamine has been explored as a potential solution. Researchers have turned to this medication for several reasons. One reason has to do with how ketamine acts in the brain. Ketamine is an N-methyl-D-aspartate receptor (NMDA) receptor antagonist. This means that it increases the amount of glutamate (a chemical messenger in the brain) and brain-derived neurotrophic factor (BDNF), which helps neurons grow and form new connections.

Early animal studies indicate that glutamate and BDNF play important roles in PTSD. One study found low levels of glutamate in mice exhibiting PTSD-like behavior after exposure to stress. Other experiments have found that several brain regions associated with fear and mood regulation had shrunk in mice after similar stress tests, suggesting BDNF might help rebuild these atrophied areas.

Ketamine is also well-established as a rapid-acting antidepressant. Since depression is a prominent symptom of PTSD, it should help with this part of the condition.

The Studies

Initial Experiments

With all this in mind, researchers turned theory into practice and began testing ketamine as a treatment for PTSD in human participants. In a 2013 study, an army veteran who was given a single infusion of ketamine experienced rapid and robust relief of his PTSD symptoms that lasted 15 days.

Following this finding, another group of researchers conducted a randomized controlled trial (RCT), meaning they gave one group ketamine and another a placebo. They found that PTSD levels were significantly lower in the ketamine group 24 hours after the infusion, and the effects persisted for around seven days.

Experimenters, hoping to extend the amount of time before symptoms returned, tried giving subjects repeated infusions of ketamine. In one study, patients received six infusions over two weeks. Eighty percent of patients achieved remission for 41 days on average.

Ketamine With Psychotherapy

While 41 days is a significant amount of time, more sustained relief would be ideal. Instead of using more ketamine treatments, some researchers have explored whether the effect could be extended when combined with psychotherapy.

One of the commonly cited reasons for doing this is that PTSD is associated with deficits in what is known as “memory reconsolidation,” which occurs when a recalled memory is changed or altered in some way. Normal memories decay or degrade over time. Some theorists believe that for patients with PTSD, their trauma memories remain as clear and vivid as the day they were formed. Many therapies target this process of reconsolidation.

Ketamine is associated with neurogenesis. Recent studies have found that neurogenesis is important in reconsolidation. As a result, researchers have tested whether therapy might extend the effects of ketamine. One study which combined ketamine with prolonged exposure therapy found that after 90 days, the ketamine group had lower PTSD symptoms when compared to the group that received a placebo.

Prevention Vs. Treatment

Aside from comparing ketamine with and without therapy, researchers have tested its effects on PTSD when administered at different stages in the PTSD process. A recent meta-analysis compiled all the research on combat veterans and found some surprising results. Most notably, they found that when given during the early stages of PTSD (1-3 months after the traumatic event), ketamine exacerbated their symptoms. However, when administered beyond this stage, ketamine was consistently helpful. Exactly why the timeline is so important is unclear.

Conclusion

Ketamine appears to be a powerful treatment for PTSD. With that said, there are some caveats. When administered on its own, the effects are short-lasting. Repeated infusions can extend the benefits, but only to around 41 days. Psychotherapy may prolong the therapeutic results further, but more research will need to be done to confirm this. Lastly, the treatment may not work for all PTSD patients, especially those who experienced their trauma more recently.

If you feel you need to see a mental health professional or could use help deciding which service is right for you, please give us a call at 805-204-2502 or fill out an appointment request here. We have a wide variety of providers, including therapists, psychiatrists, nurse practitioners, and nutritional therapists who can see you in as little as one day via teletherapy.

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Tags ketamine, mental health, mental health treatment, mental illness, post-traumatic stress disorder, psychotherapy, ptsd

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Upcoming Events and Content in Honor of Veteran’s Days

Post author By Julia Lopez
Post date October 28, 2022
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Upcoming Events and Content in Honor of Veteran's Day

October 28, 2022

During the week of Veterans Day, Heading Health will be hosting events and publishing articles to honor our military veterans. We will be taking a close look at the mental health issues veterans face, highlighting providers who specialize in treating veterans and gathering insights from their experience, as well as discussing the therapeutic potential of psychedelics as treatments for service-induced mental health conditions.

Check out the details of these events and others in the Austin area below.

Heading Health Speaker Series: What Now? How Veterans Can Overcome Post-Deployment Hurdles to Happiness

In the Heading Health Speaker Series events, we highlight perspectives from our team of mental health professionals to learn from their unique backgrounds, experiences, and viewpoints.

In our Veteran’s Day edition, nutritional therapist Sally Twellman will interview Femi Olukaya, a therapist and military veteran, and Teressa Carter, a social worker with experience serving and treating active duty service members. They will explore the difficulties veterans face when integrating back into civilian and family life, the problems this can cause, and what we can do to soften the landing and ease their transitions back home.

This event will be recorded and available to stream on YouTube. Stay tuned for more details.

Articles

Provider’s Perspective: Why Veterans Struggle to Seek Mental Health Care and What to Do About It

Despite the prevalence of mental health issues among veterans, many struggle to seek out help. In this article, Teressa Carter, will take a deep dive into this problem, offer suggestions for veterans and active military members unsure of whether or how to seek care, and provide advice for clinicians to help them perform patient outreach and build rapport with military clients.

Ketamine for PTSD

Estimates suggest that 10-20 percent of veterans have post-traumatic stress disorder (PTSD), characterized by flashbacks, nightmares, and severe anxiety caused by exposure to a terrifying event. Recent research shows that ketamine may help veterans recover from this debilitating illness. This post will summarize the research, highlight key findings, and explore what this means for future treatments for PTSD.

Other Events in the Austin Area

The Rebirth: A Veterans Day Celebration Exploring Psychedelic Medicine

This three-part event will highlight the healing power of psychedelics for veterans. Specifically, it will include:

A showing of the documentary film From Shock to Awe, which covers the lives of U.S. military combat veterans and highlights the transformational impact psychedelics have had on their mental health
An expert panel which will discuss the importance of psychedelics and the urgent need to increase accessibility to these alternative treatments.
A chance to hang out, listen to music, and catch up with friends at famed music club, Antonne’s

This event will take place on Friday, November 11, from 3:00 PM – 11:00 PM CST.

Get your tickets here.

The Mission Within: Psychedelics & Healing the Wounds of War

Founded by Dr. Martin Polanco, The Mission Within offers psychedelics such as ibogaine, 5-MeO-DMT, and psilocybin to treat veterans with traumatic brain injury (mTBI), PTSD, depression, and addiction as a result of experiences during military service.

In this panel, you’ll hear from veterans who participated in The Mission Within and how psychedelics helped them overcome service-related trauma and heal their relationships with loved ones.

This event will take place on November 3, from 6:45 PM – 8:30 PM CST.

RSVP here.

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Complete our consultation form and an intake specialist will get in touch.

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Tags anxiety, depression, ketamine, mental health, mental health treatment, mental illness, post-traumatic stress disorder, psychedelic, ptsd, veteran's day

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What To Expect At Your First Psychiatrist Appointment

Post author By headinghealth
Post date January 28, 2022
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What To Expect At Your First Psychiatrist Appointment

January 28, 2022

Whether it is over the phone or in person, seeking help for your mental health can be daunting if you do not know what to expect. This article will give you some useful pointers to empower you to work in collaboration with our psychiatrists on starting your journey to recovery.

1. Come prepared

Before your appointment, it might be useful to take some time to think about the reason for your visit. What symptoms or struggles are impacting you the most? How and when did they start? If possible, keep a diary of your symptoms over a couple of weeks. This is helpful to monitor their frequency, intensity, identify a particular time of day, potential triggers, and things that make you feel better, etc. Sleep patterns, appetite, and weight fluctuations are equally valuable sources of information for your doctor.

It is also useful to gather some details about your childhood from your family, including your birth, your developmental milestones (at what age did you start walking, talking, etc.), your behavior as a child and how you did in school. Ask your relatives if there is a history of mental illness in your family – this may be a sensitive subject but can be relevant as you might be more susceptible to certain conditions.

If you have been referred by another healthcare provider, bring your consultation letters including previous diagnoses, treatments, and medications you have been on. Make sure to bring hospital discharge letters if you had previous admissions or inpatient treatment.

2. What you are likely to talk about
If this is your first contact with a psychiatrist, the appointment is likely to take about an hour.

At first, your healthcare provider may give you the opportunity to talk freely about your presenting complaint. After that, you will be asked a series of more detailed questions on your childhood, education, family, current situation, medical history, etc. They might ask you questions on some of the more intimate aspects of your life, including relationships, sexuality, illicit drugs, or if you ever had trouble with the law. This enables your psychiatrist to make a 360° assessment of your mental health and how it affects you in your daily life. If you feel uncomfortable answering certain questions, do not hesitate to let your doctor know. Do not forget that professionals are bound by confidentiality and none of the information you disclose will be shared with your relatives or the authorities.

Depending on the reason for your visit, they might ask very detailed questions about treatments and therapies you have already tried, including over the counter and herbal or non-conventional treatments – did they help? What side effects did you suffer from? Why did you stop? This will allow your doctor to tailor his approach to give you the best chance of positive outcomes. Finally, give your psychiatrist any information that has not come up in questions, but you believe to be relevant to your circumstances – you know yourself best.

3. Outcome of your consultation
For someone suffering from debilitating symptoms, getting to put a name on your illness might feel therapeutic. It enables you to give an identity to the enemy you are battling, and to connect with other individuals going through the same journey. However, it is important to understand that your provider might not be able to give you a diagnosis at the time of the first consultation. Many diagnostic criteria rely on temporality, i.e., length of time you have been suffering from symptoms, and sometimes a positive diagnosis can only be made retrospectively, many months down the line. Whilst this might be frustrating, it is paramount not to rush as being given a certain label can have long-lasting consequences in terms of treatment you will be offered or will not qualify for.

However, your psychiatrist might still be able to provide you with a working diagnosis or provisional diagnosis to allow treatment planning whilst waiting for all the diagnostic criteria to be filled.

Coming to the end of your consultation, you will make a plan in conjunction with your psychiatrist about how to go forward. You might be offered a combination of therapy, medication, and other treatments such as TMS or novel agents. Remember you are the main actor of your recovery, and the decision on what treatment modality you believe will suit your circumstances is ultimately yours, guided by the advice of your psychiatrist. They will explain in detail the modalities, side effects, and evidence behind every option, to allow you to make an informed decision. You might wish to take more time to read through patient leaflets, do your own research, or talk about it with your next of kin. Other things to discuss are the frequency of follow-ups and monitoring and making a contingency plan for you to refer to in case your mental health deteriorates, such as urgent helplines and contact numbers.

If you have further questions about scheduling with a psychiatrist, another mental health provider, or how to best prepare for your appointment, give us a call at 512-777-2591 and we would be happy to assist you.

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Complete our consultation form and an intake specialist will get in touch.

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Tags anxiety, depression, medication management, ocd, psychiatrist, psychiatry, ptsd, telehealth