00:00
So I briefly mentioned that there are
several different health concerns,
veteran centric health concerns, but specifically
when we think about mental health disorders,
so PTSD is one of those,
anxiety, insomnia.
00:21
What are some other things?
Sometimes bipolar disorder, schizophrenia,
borderline personality disorder,
and thinking about all of these are kind
of related to the posttraumatic stress,
sometimes it's traumatic brain injury
that also alters mental health status.
00:39
And then behavioral
adjustment disorders.
00:41
You heard me talk about deployment
and then reintegration,
and thinking about where some of those
adjustment disorders could happen.
00:49
One of them is the veteran may have
left their entire family behind. Right?
And so then I'm adjusting to being away
from my family if they're not with me.
01:00
Thinking about sometimes while a veteran or
military service personnel are deployed,
there's a death in the family
and you weren't there.
01:09
So just thinking about the mental or psychological
impact of that and adjusting to that.
01:14
So, I saw my family living before I
left and I was away for all this time
and then all of a sudden they're
dead and so I didn't have closure.
01:24
Thinking about the psychological impact of
that and then reintegration into society,
that's an adjustment as well.
01:31
So you've gone from being in this
completely structured environment,
now you're back into the
world trying to integrate.
01:38
For some people,
that happens easily.
01:40
For some, they don't, but we need
to take that into consideration.
01:44
Those military-related diseases
that we need to think about.
01:48
Again, all this ties back
into that military culture.
01:52
And so it is important that the
structural competency could fit in here
because I'm thinking about how I need to be focused on
all the different unique things that impact a veteran
and so I do need to be aware this is
where cultural intelligence comes in.
02:10
I need to be motivated to learn
so I need to ask that veteran
"Which branch they served in?
How long they served?
What was their job
while they were there?"
Anything that they want
to share with you,
but that won't happen again unless you build
a rapport and a trusting relationship
and simply asking those
questions and being interested,
motivated, that enthusiastic about it which is that
first piece of that cultural intelligence framework.
02:36
And then when I have that
conversation with that veteran
and I will acknowledge this
will be a lot of work,
but after I have the conversation well I go look
some of that stuff up that I'm not so familiar with,
so some of the exposures that may have
happened depending on the exposures
and the war that people served in they are
unique diseases and exposures that happen.
02:58
And it helps me to improve my
individualized care of the veteran
because I can think about "Okay,
they were here in this area
then I need to be doing some screenings on
longs because of the environmental exposures."
If a person shows up with a certain type of rash, is
that a result of service in that particular area?
So lots of different things that it
takes that extra time and effort
and just being committed to
that cultural intelligence.
03:26
So the next time that person comes I'm going to
employ the third cultural intelligence piece
and that would be the strategy.
03:34
So I know Mr. or Ms. X is coming in on
a certain day, now I've learned more.
03:40
So now I want to talk about,
I want to ask some more specific questions
that I may not have asked the last time.
03:47
And then in that moment the A, the
action piece which is behavior.
03:51
So while I'm engaged in that conversation
but let's just say I asked something
and I didn't realize it
might be triggering.
03:58
Well, I need to be able to
be flexible, apologize,
have a conversation ask that veteran or the
military service personnel, actively serving person.
04:10
I need to ask "Oohh I'm
sorry I triggered you."
Like, "What is a better
way I could ask you that?
Would you like to talk
more about it today?
Can we talk about
it another time?"
And it's so important to
explain why you're asking.
04:23
So if I ask you that because I want to see if I need to
do certain diagnostic screenings or test on this person,
I need to say that so people
don't think that people,
meaning the veteran or the military person, doesn't
think that I'm just prying or something like that
and you don't know it's going to trigger
them but you need to acknowledge that.
04:43
So next time you need to be
careful and just ask them.
04:46
How can we engage in
that conversation?
If they said don't even want to talk
about it, you have to respect it.
04:52
The next thing is Substance
Abuse Disorders.
04:56
So, when we think about mental
health and mental illness,
people do try to find ways to
fix or cope with something
and sometimes that happens in the form of a
substance use disorder, not substance abuse
because abuse implies something
negative, but substance use disorders.
05:13
So not using that to label in
stereotype, "How can I help a person?
How can I offer some
alternatives to that?
How can I help rehabilitate the person so
that I can provide those safe alternatives?
You also want to acknowledge that suicide
rate so high in a lot of veterans
so you have to be real careful in your approach
and sometimes there is a psychosis that happens,
you have to be prepared that certain things
will trigger and irritate certain veterans.
05:48
Just lots of different things so it's
so important to do your homework
and apply that CQ framework, and
I mentioned the homelessness
thinking about why oftentimes it circles back to that
mental health diagnosis that the person may have.
06:05
And so if you know someone's home
is there or resources and services,
what your job as the
advocate we talked about,
what your job is is to try to
find housing for that veteran.
06:17
Some will refuse and I know
this, I've seen it firsthand.
06:21
So if they refuse how can I
still continue to engage in
and make sure that they're getting
the medicines that they need,
get in to those
healthcare appointments,
and accept that I can't judge if people just
haphazardly show up to these appointments.
06:36
When they show up, I need to be willing
and able to help them along the way
serving as an advocate in a healthcare provider
focusing on what is optimal health for this person
and it's not going to be the same for everybody
because we want to assign what that should look like.
06:53
What does wellness
mean to that person?
Not to me, but where does this person want to
get to in terms of what they see as wellness?
We have to also understand that a lot of
veterans experience lots of different pain.
07:08
And that pain is significant and
oftentimes people get hooked on opioids,
pain medicines, whatever it is.
So, why is that?
Because that pain is real,
so how can I help with that
instead of seeing them as a drug seeker or
looking at it from a negative perspective?
What can I do to help this person achieve
a level of pain that's tolerable?
For me as a fixer, I would
want it to be a zero or a one.
07:36
But to that person, not just
veterans but any person,
but to that person if they
want to get down to a 5
I need to accept that and not
try to force things on people.
07:47
One point I do want to make in terms
of going back to the suicide,
depressed veterans are more likely to
commit suicide than those with PTSD
so sometimes we may misconstrue
that but it's important
that even though that little tidbit when we
think about culturally responsible healthcare,
not just for veterans but for everybody
but in particular in this case
I need to make sure that I'm able to identify
when a person or a veteran is depressed
and how can I intervene to
try to prevent the suicide
and also providing those resources
for suicide prevention.
08:25
And I know that the VA in particular
is very committed to that
offering those resources and those
numbers for those high lines.