For mental health providers, building trust and establishing a connection with their patients is essential. When a patient’s employment history includes military service, understanding cultural impacts and service-related experiences can help providers to create a safe environment for assessment and treatment.

As the number of Veterans seeking care outside of VA grows, it is more important than ever for clinicians to consider the influence of military and Veteran culture on a patient’s behaviors and perceptions about seeking health care treatment.

These behaviors and perceptions can especially impact those diagnosed with posttraumatic stress disorder (PTSD) and those at high-risk for suicide.

Understanding the impact of military culture

“From understanding the bigger picture of a shared mission and structure to knowing whether to address them as ‘soldier’ or ‘sailor’, having military competence and sensitivity can drastically affect a patient’s response to care,” said Dr. Abigail Angkaw, licensed clinical psychologist, and consultant with the VA’s PTSD Consultation Program.

Dr. Abigail Angkaw, licensed psychologist with VA’s PTSD Consultation Program, consults with a provider.

Angkaw also shared the importance of understanding the era of military service when assessing and treating patients. “Each Veteran will bring unique experiences from their service in the military.

“Vietnam-era Veterans were not welcomed home from their service in a positive way. They may have distrust for the health care system or feel that they are not understood,” she said.

There are also growing subpopulations of Veterans that may present unique stressors. “Women Veterans may return from deployments with experiences of military sexual trauma, feelings of isolation, and long periods of separation from their children.

“Understanding these experiences can help address challenges in a safe and effective manner,” she added.

For treatment, knowing how to connect a plan of care to a patient’s military or Veteran experience can also improve outcomes.

Collaborative safety plan

Using a tool like the collaborative safety plan, which includes a list of experiences or stressors that can trigger thoughts of suicide paired with prioritized coping strategies and contacts for social support, can reduce the risk of suicide during a crisis.

“Safety planning, from a military perspective, is like a preparedness exercise,” said Dr. Kaily Clark, licensed psychologist and consultant with VA’s Suicide Risk Management (SRM) Consultation Program. “We encourage Veterans to practice their plan in advance of needing to use it.”

Clark encourages providers to remind their patients that they are in a safe space and that their military experience can sometimes be an asset to their recovery. “When you can build trust and leverage their strengths developed during military service as well as a connection to their network of Veterans, you can tailor treatment to the individual,” she added.

VA’s evidence-based training and resources

This spring, Angkaw will partner with Clark and her SRM colleagues as well as the Uniformed Services University (USU) Center for Deployment Psychology to train non-VA providers on the unique aspects of military and Veteran culture and highlight common clinical issues faced by these populations.

The training, which is already at capacity, will discuss PTSD and suicide risk screening and assessment, as well as give providers evidence-based tools and best practices to apply in their practice.

Both consultation programs hope to collaborate on future events for non-VA providers, but in the meantime, Angkaw hopes that this training will also introduce non-VA providers to additional resources like the free PTSD and SRM consultation programs.

Training will also provide guidance on how to apply tools like the PTSD Checklist and VA/DoD Clinical Practice Guidelines (CPGs) in their practice.

“I want them to feel confident and better equipped to treat Veterans by understanding their background and experiences. I want to give them tools that we believe can help save Veterans’ lives,” Angkaw said.

Erin Healy is a health writer supporting communications for the Suicide Risk Management Consultation Program.

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Published on Feb. 25, 2021

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One Comment

  1. Thomas Busse March 21, 2021 at 4:33 pm

    “PTSD” was created by CIA psychiatrist Robert J. Lifton basically as a way to personalize and pathologize normal human reaction to witnessing war crimes. Both the characterization of the phony disease and the diagnostic criteria are the result of Lifton’s fraud and deception – specifically crafted to deflect criticism away from war and war activities and onto the individual. Psychology is already a largely bogus profession as it is (90% of all published psychological research is false), but when clinical practice and research is constructed on a foundation that was intended to be shaky and incorrect, then everything else the “experts” say is based on circular reasoning. There is this toxic idea out there that being normal is being pathological and the result is a self-fulfilling prophecy “I’m sick” rather than “war is sick.” I don’t see how anybody is every going to help anyone unless we get past this mass delusion.

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