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PROVIDER RESILIENCY TRAINING

PTSD/mTBI Chain Teaching Program FAQ's

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Q1.  Describe the PTSD/mTBI chain teaching program; when and where it will be implemented; and how it will help Soldiers, leaders and military medical professionals.

A1.  The chain teaching program will be Leaders teaching Soldiers about the signs and symptoms of PTSD and mild TBI.  Gen. Casey kicked it off at the 4 star conference on 22 June 2007.  All Soldiers in the active Army will receive the training during the month of July and the entire force should be trained by the end of August.  It will help Soldiers and leaders by raising awareness, promoting treatment and reducing stigma.

Q2.  Where and how can Soldiers and their Families access this training information?

A2.  Soldiers will receive the training via their chain of command.  The training information also will be on appropriate websites to include AKO and the behavioral health website, http://www.behavioralhealth.army.mil/.

Q3.  When will the chain teaching begin and how long will it take?

A3.  We expect the program will be deployed on July 12, 2007.  The chain teaching should be completed in 90 days.

mTBI (CONCUSSION), POST COMBAT STRESS AND PTSD

Q1.  What is Post Combat Stress?

A1.  Post Combat Stress is the range of possible emotional adjustment outcomes along a continuum of stress reactions that may be experienced weeks or even years after Combat and Operational Stress exposure.  It includes increased functioning and positive change after enduring a trauma, and may include changes in personal strength, spirituality, relationships with others, and/or ability to appreciate life.  Post Combat Stress may also include negative outcomes such as Post Traumatic Stress Disorder (PTSD) which is a psychiatric illness that can occur following a traumatic event.  Post Combat Stress is not a mental health diagnosis, but a term used to describe the effects of combat and operational exposure experienced by Soldiers performing military duties.

Q2.  What is PTSD?

A2.  Post Traumatic Stress Disorder is a condition that often follows a terrifying physical or emotional event causing the person who survived the event to have persistent, frightening thoughts and memories, or flashbacks, of the ordeal.  Persons with PTSD often feel chronically, emotionally numb.  Once referred to as "shell shock" or "battle fatigue," PTSD is a mental health diagnosis that requires a credentialed healthcare provider to diagnosis.  If you think you have PTSD, see your healthcare provider.  Your chaplain may also be able to be a portal.

Q3.  What is mTBI (Concussion)?

A3.  Mild Traumatic Brain Injury is caused by blunt trauma to the head or acceleration/deceleration forces jogging the brain within the skull which may or may not produce a period of unconsciousness.  Mild TBI is defined as an injury to the brain as a result of any period of observed or self-reported: Confusion, disorientation, or impaired consciousness; Dysfunction of memory around the time of injury (amnesia); Loss of consciousness lasting less than 30 minutes.  No other obvious neurological deficits, no intracranial complications (e.g. hematoma / blood clot) and normal computed tomography (CT) findings should be present.

Q4.  How is TBI distinguished from mental health conditions, such as PTSD?

A4.  Traumatic brain injury is a neurologic injury with possible physical, cognitive, behavioral, and emotional symptoms.  Like all injuries, TBI is most appropriately and accurately diagnosed as soon as possible after the injury.  TBI is not a mental health condition.  The range of TBI includes mild, moderate, severe, and penetrating.  Well after the injury event, Soldiers may have residual symptoms from a TBI and new or emerging PTSD symptoms.  If the TBI has not been previously identified or documented, an accurate description of the traumatic events in theater usually allows a well-trained clinician to make a distinction between TBI and PTSD or other mental health conditions.

Q5.  What are signs/symptoms of PTSD?

A5.  Although the following signs and symptoms may indicate PTSD, please remember that they are also symptoms common for many Soldiers returning from deployments (post combat stress).  You should be concerned about these symptoms if they don't go away or if you find the symptoms are getting worse.  The key is if the symptoms are disrupting your normal functioning, affecting your quality of life.
Physical:  Fatigue, Vomiting or Nausea, Chest Pain, Twitches, Thirst, Weakness, Insomnia or Nightmares, Breathing Difficulty, Muscle Tremors, Grinding of Teeth, Profuse Sweating, Pounding Heart, Diarrhea or Intestinal Upsets, and Headaches
Behavioral:  Withdrawal, Pacing & Restlessness, Emotional Outbursts, Anti-Social Acts, Suspicion and Paranoia, Inability to Rest, Loss of Interest in Hobbies, Increased Alcohol Consumption, and Other Substance Abuse
Emotional:  Anxiety or Panic, Guilt, Fear, Denial, Irritability, Depression, Intense Anger, Agitation, and Apprehension

Q6.  What are signs/symptoms of mTBI (Concussion)?

A6.  Headache, confusion, dizziness, blurred vision or tired eyes, ringing in the ears, change in ability to smell or taste, sensitivity to sound or light, irritability, fatigue, a change in sleep patterns, mood changes, and trouble with memory, concentration, attention, or thinking.

Q7.  How can Post Combat Stress, PTSD or mTBI (Concussion) affect me or my job or my family?

A7.  For some, there may be no effects but there may be greater effects in others.  Often times we see people isolating and withdrawing from others.  Their concern about whether or not something is wrong with them or their fears that others "won't understand" causes Soldiers to pull away from those who may be able to support them the most.  Soldiers may also have significant issues with irritability, anger or aggression which affects them both on the job as well as at home.  Soldiers may also begin abusing alcohol or drugs in an effort to "escape" from their troubles, to try and calm down or to try and get rid of other symptoms.  Some Soldiers become hyper-alert, trying to secure their environments like they did while they were deployed.  Still others engage in high-risk behaviors, such as driving too fast or recklessly, in an effort to get back the adrenaline rush they had while in the theater of operations.  With Concussion, they may also forget to do things, and may not be able to function successfully in demanding situations such as work.

Q8.  How long can the effects of Post Combat Stress, PTSD or mTBI (Concussion) last?

A8.  For many the symptoms will go away within a year or less.  For some, the effects can be for a lifetime.

Q9.  Can Post Combat Stress, PTSD or mTBI (Concussion) get better on their own?

A9.  Bottom line is that if a Soldier has any of these conditions, they should seek help.  Post Combat Stress, PTSD and mTBI can heal on their own; however, they heal quickest when treated early and properly.

Q10.  Can I get Post Combat Stress if I was never hospitalized or personally injured?

A10.  Yes.  If you have experienced an event or been involved with the aftermath of an event that created intense fear, helplessness or horror involving actual or threatened death.  If left untreated, and symptoms continue to worsen, Post Combat Stress can result in the diagnosis of PTSD.

Q11.  Can I get mTBI (Concussion) if I was never knocked out?

A11.  Yes.  Frequently mild TBI is the result of repeated exposure to mild explosions or moderate explosions resulting in significant pressure changes in HMMWVs.  If you were knocked around, jolted or felt significant pressure changes as a result of a nearby explosion it's possible you could have mTBI.

Q12.  How do I know if I have Post Combat Stress, PTSD or mTBI (Concussion), or something less serious, or nothing at all?

A12.  See your healthcare provider.  If you are having symptoms that are interfering with your ability to function at home, at work, or while out with others or if your symptoms are leading to dangerous thoughts or behaviors then you should seek help.  You can go to your unit Chaplain, your installation Department of Behavioral Health (or Community or Division Mental Health), Social Work Service or go see your Primary Care Manager who can get you connected with the right person to assess and/or treat you.  It is important to inform your healthcare provider of any events that are consistent with causing mTBI (Concussions) such as having survived an IED attack or any other possible head injury.  This will allow your healthcare provider to determine the best cause of your symptoms.  Remember, Concussions are actual physical injuries while Post Combat Stress and PTSD are emotional reactions.  The symptoms may be somewhat similar, but the cause is very different and may require different types of treatment.  You can also find additional information at www.behavioralhealth.army.mil, www.militaryonesource.com External Link, Opens in New Window, or you can do an anonymous online survey at www.militarymentalhealth.org External Link, Opens in New Window.  For information on mTBI (Concussions), visit the Defense and Veterans Brain Injury webpage at www.DVBIC.org External Link, Opens in New Window.  There are also numerous resources regarding both PTSD and mTBI on various Websites online.

Q13.  What if I'm not sure if I have a problem?

A13.  The bottom line is that if you suspect you may be experiencing problems, you should see your healthcare provider.  However, not everyone who experiences a traumatic event has problems.  In fact, many people involved in traumatic events grow from the experience.  But if you find yourself having struggles at work, in your relationships or in other important parts of your life as a result of the traumatic event, it's important to seek a professional assessment.  You can seek assistance from your unit Chaplain, your installation Department of Behavioral Health (or Community or Division Mental Health), Social Work Service or go see your Primary Care Manager who can get you connected with the right person to assess and/or treat you.  You can also find additional information at www.behavioralhealth.army.mil, www.militaryonesource.com External Link, Opens in New Window or you can do an anonymous online survey at www.militarymentalhealth.org External Link, Opens in New Window.  For information on mTBI (Concussions), visit the Defense and Veterans Brain Injury webpage at www.DVBIC.org External Link, Opens in New Window.

Q14.  What If I'm not sure if a buddy has a problem?

A14.  If you are concerned about your buddy, first talk with him or her about your concerns.  If you see some of the signs and symptoms of Post Combat Stress or mTBI (concussions), try to get them to seek assistance on their own.  If they do not want to seek assistance but you are concerned about any type of dangerous behavior toward themselves or others, you can contact your Chain of Command, your unit Chaplain or installation Behavioral Health resources.  Remember, Never Leave a Fallen Comrade!

ABOUT GETTING HELP FOR POST COMBAT STRESS, PTSD OR MTBI

Q1.  Where do I get help for Post Combat Stress, PTSD or mTBI (Concussion)?

A1.  There are many ways to get help for Post Combat Stress, PTSD or mTBI (Concussion).  You can seek assistance from your unit Chaplain, your installation Department of Behavioral Health (or Community or Division Mental Health), Social Work Service or go see your Primary Care Manager who can get you connected with the right person to assess and/or treat you.
If you have a history of head injury, you should contact your primary care provider to rule out mTBI.  Remember, Soldiers can have both Post Combat Stress reactions and mTBI at the same time, but the two diagnoses are different.  It is important to provide a clear history of any head trauma you may have experienced when seeking help so that the diagnosis and support you receive is based on the best understanding of your condition.
You can also find additional information at www.behavioralhealth.army.mil, www.militaryonesource.com External Link, Opens in New Window or you can do an anonymous online survey at www.militarymentalhealth.org External Link, Opens in New Window.  For information on mTBI (Concussions), visit the Defense and Veterans Brain Injury webpage at www.DVBIC.org External Link, Opens in New Window.

Q2.  What kind of help is there for Post Combat Stress, PTSD or mTBI (Concussion)?

A2.  Similar to civilian practice settings, Soldiers receive an initial evaluation which will include a face-to-face interview and which may also include various types of cognitive and psychological testing.  After an assessment is complete, Soldiers may receive individual or group education or counseling, medical treatment, and sometimes, occupational functional assistance.  Medications may also be prescribed.  Some Soldiers may also receive a Case Manager to help them manage their appointments and administrative requirements.

Q3.  Is help with Post Combat Stress, PTSD or mTBI (Concussion) confidential?

A3.  Seeking medical assistance from a mental health care provider is not a career ender.  The Army is very proactive in encouraging Soldiers to get the help they need, and most Soldiers diagnosed with PTSD or mTBI are treated and can remain on active duty.  Today, we have a much better understanding of the psychological and physical effects of war.  Soldiers are being trained to look out for the mental health of their buddies in the same way that they look out for their physical health, and leaders are being trained to encourage Soldiers to get help.  The message is getting out that coming in to get help early is the best way to avoid long term problems.  Our intention is to return Soldiers back to duty.  Reference confidentiality, medical professionals keep everything as discreet as possible.  However, there may be times when a command needs to be advised about a Soldier's medical care.  This usually occurs when a Soldier is suicidal or homicidal.

Q4.  I didn't like the help I got.  Is there other help - yes!

A4.  Sometimes Soldiers don't like the help they are getting because counselors ask them to talk about things that are difficult or uncomfortable for them to think about.  This is part of the healing process and is often necessary in progressing in a helpful manner.  If after consistently making counseling appointments the Soldier does not feel that the help is beneficial, then he/she should discuss this with their counselor and explore other counseling options.

Q5.  I tried for a long time to get a counseling appointment, but couldn't.

A5.  What do I do? Due to ongoing deployment operations as well as Soldiers' increased willingness to seek treatment, counseling resources on many installations are often overextended.  Many military treatment facilities are hiring more staff, expanding their hours or redesigning their access to care.  If you are unable to get an appointment within 30 days or feel your issues require immediate assistance you have a couple of different options.  For emergency issues, such as thoughts of hurting yourself or others, you should go to your installation Emergency Room.  You can also access confidential counseling resources through Military OneSource at 1-800-342-9647.  Through Military OneSource you can get up to six free sessions, per issue, with a licensed professional.

ABOUT CAREER, COMMAND, AND CONFIDENTIALITY

Q1.  What do I do if I've been told by a leader that I can't go to a medical or counseling appointment?

A2.  All Soldiers are entitled to medical care.  While subordinate leaders may not prevent you from seeking care or going to appointments, mission may require that you seek a different date or time, if possible, to attend your appointments.
If your immediate leader or supervisor will not let you go to an appointment then you must go to your next level leader and request their assistance.  It is your right to get help and it is your leader's obligation to assist you with getting help.

Q2.  I've heard I can't get promoted if I am in counseling or if I have Post Combat Stress, PTSD or mTBI.  What about that?

A2.  Seeking medical assistance from a mental health care provider is not a career ender.  The Army is very proactive in encouraging soldiers to get the help they need, and most Soldiers diagnosed with PTSD are treated and can remain on active duty.  Today, we have a much better understanding of the psychological effects of war.  Soldiers are being trained to look out for the mental health of their buddies in the same way that they look out for their physical health, and leaders are being trained to encourage soldiers to get help.  The message is getting out that seeking early help is the best way to avoid long term problems.  Our intention is to return Soldiers back to duty.
There are no regulations or formal guidance that prevents Soldiers from getting promoted as a result of having a medical or mental health condition or for being in treatment for a medical or mental health condition.  In fact, being discriminated against for a medical condition is illegal.  Misconduct as a result of your condition, or failure to get treatment for a mental health condition which results in bad behavior, however, can impact your ability to get promoted.

Q3.  In my unit, Soldiers who go to behavioral health or counseling are treated poorly, or considered malingerers.  What do I do about that?

A3.  Army values say that all Soldiers should be treated with dignity and respect.  If you, your buddy or your subordinate is being treated poorly within your unit, you have an obligation to let the chain of command know about your mistreatment.  You may also speak with the IG about your concerns without fear of reprisal.  If you or your buddy is inaccurately accused of malingering, you should attempt to provide any documentation or testimony of others that could show the changes in activity or behavior following any type of traumatic event.  Your leadership should be aware of the seriousness of such allegations.  Feigning illness or physical or mental disability, or intentionally inflicting self-injury is a court martial offense.

Q4.  I read that if I have PTSD, I will get a diagnosis of a personality disorder and separated without benefits.  What's the truth about that?

A4.  This is not true.  These are two different conditions.  The onset of a personality disorder can be traced back at least to adolescence or early adulthood whereas PTSD develops in response to exposure to a traumatic event and may occur during any point in an individual's life.  PTSD is a primary clinical condition and may qualify for a Medical Evaluation Board and medical retirement with full benefits.  A personality disorder is a longstanding pattern of behavior that is significantly different than the expectation of that person's individual culture.  When a Personality Disorder produces inappropriate behavior by the Soldier, then it may be appropriate to evaluate and then separate him/her under a Chapter 5-13 IAW AR 635-200.

Q5.  If I talk to a counselor, can the counselor tell my Commander or leaders what I say?

A5.  In accordance with privacy laws, medical professionals keep everything as discreet as possible.  There are some instances related to a Soldier's fitness for duty or for safety reasons (i.e. the Soldier is suicidal or homicidal) that a command needs to be advised about a Soldier's medical care.  At the beginning of all mental health appointments, the counselor will advise the Soldier about the limits to their confidentiality and is available to answer any specific questions the Soldier might have about when the counselor might need to speak with Command.

Q6.  I've heard that seeking treatment can affect my security clearance.  Is that true?

A6.  Whenever you are being investigated for a security clearance you are required to report any type of mental health counseling you are currently receiving or may have received in the past.  Many people with Secret and even Top Secret clearances have sought counseling in the past so seeking treatment alone is not enough to affect your security clearance.  What can affect your security clearance is a condition so severe that it impacts your judgment and/or your ability to make decisions in regards to our national security.