The role of psychologists in the care of Iraq and Afghanistan veterans in primary care settings.

Abstract

Although military personnel serving in Iraq and Afghanistan are at high risk of developing mental health problems, many report significant barriers to care and few seek help. Integrated primary care is a comprehensive model of health care that aims to improve access to care and provides a framework to assess and meet the complex psychiatric needs of newly returning veterans by embedding mental health specialists within primary care. We describe the role of psychologists in a Department of Veterans Affairs (VA) integrated primary care clinic that serves veterans of Iraq and Afghanistan. Psychologists based in primary care can assist veterans with reintegration to civilian life by providing rapid mental health assessment, normalizing readjustment concerns, planning for veterans' safety, implementing brief interventions within primary care, facilitating transition to additional mental health care, and informing veterans of other available psychosocial services. A case example demonstrating the psychologist's role highlights the benefits of an integrated care model. Implications of employing this model include reduction of symptoms and impairment by reducing stigma and barriers to seeking mental health care, increased motivation to engage in treatment, and implementation of early interventions. This model may also be beneficial in the civilian health care sector with groups that are at high risk for mental health problems, yet experience barriers to care, particularly stigma.

Perceptions of the Absence and Reintegration of a Prisoner of War Father from the Perspective of His Children as Adults

“…Notably, previous literature suggests that the phenomena discussed by participants might occur in families of soldiers returning after prolonged deployment in enemy countries (who were not taken captive)-a similar, albeit less extreme form of ambiguous loss. In particular, although every culture is characterized by a specific pattern, the families described herein share many similarities with the families of soldiers returning from Iraq and Afghanistan, in terms of their emotional states and the practical challenges they face (Hoge et al 2004;Maguen et al 2010). We believe that future studies can reveal a more detailed picture of families' responses to such situations of ambiguous loss, and to the treatment they may require in order to cope.…”

“…Psychological assistance can assist family members in coping with these challenges when the POW returns home (Maguen et al 2010;Charles, Castro, Messer, McGurk, Cotting, & Koffman, 2004). Likewise, such programs might assist families in dealing with being in the public eye, and in reconciling the image of the parent with that of the famous 'war hero'.…”

Reducing Barriers to Mental Health and Social Services for Iraq and Afghanistan Veterans: Outcomes of an Integrated Primary Care Clinic

“…Prior reports have suggested that OEF/OIF veterans may prefer to receive mental health services within a primary care setting 21,31 . Thus, clinicians at the SFVAMC developed the OEF/OIF Integrated Care Clinic to offer new OEF/OIF veteran patients, even those with negative mental health screens, the option of a same-day brief mental health and social services assessment in primary care 21 .…”

“…These included: (1) monitoring rates of VA post-deployment mental health screening, (2) same-day mental health evaluations of veterans screening positive for PTSD and depression, and (3) limits on wait times for initial mental health appointments. In addition, on April 1, 2007, the SFVAMC OEF/OIF Integrated Care (IC) Clinic was established which offered integrated, colocated primary care, mental health and social services as described elsewhere and below 21 . Since the establishment of the SFVAMC IC clinic in April 2007, most new OEF/OIF veteran patients initiating primary care have been scheduled for an initial IC visit, consisting of three optional 50-minute sessions with a team of primary care, mental health, and social services providers.…”

A multisite randomized controlled effectiveness trial of cognitive processing therapy for military-related posttraumatic stress disorder

“…Indeed the nature of the events to which military personnel are exposed in more recent deployments is becoming increasingly complex. Distinguishing enemy combatants from noncombatants is often difficult, particularly where the conflicts are taking place in urban environments (Maguen et al, 2010). As such, military personnel are not only exposed to a high likelihood of direct contact with enemy combatants but also at significant risk of being responsible for deaths of noncombatants (Hoge et al, 2004).…”