Cultural Competency and our Veteran Community
By Teresa Black, Program Coordinator II
I have seen military life from almost every angle possible. I have been the brand new, homesick airman just trying to get through basic training, and the veteran just off active duty and trying to adjust to civilian life. I am currently a reserve member balancing civilian life and service commitments, and the seasoned leader mentoring the future of the force. I have served alongside members of all six branches of the military. I have deployed twice, and held down the home front as my husband took his turn serving overseas. As a mom, I have spent sleepless hours worrying about my oldest son as he spent three tours in the Middle East. As a civilian, I aided my fellow veterans in finding safe and affordable shelter, and now I give back as their therapist.
Having worn so many different hats, I can offer a slightly different perspective from the narrative we most often see in the media, in popular culture, and in the training we get for the work we do. When we hear our client is a veteran, it may immediately evoke thoughts of Post-Traumatic Stress Disorder, homelessness, and the “22 a day” veteran suicide rate. While those are certainly important, widely publicized issues within the veteran community, it does not serve our clients well to paint them all with this broad brush. The vast majority of military members never see direct combat, have a relatively easy time transitioning back into civilian life, and have a good support system. This is not to say that their service did not include other events that can have a long-term impact on them, well into their civilian years.
I have personally struggled to change people’s perceptions that all veterans are left broken and struggling with mental illness. Mental health concerns have become a stigma of military service that negatively affects many of us. In fact, recent research by Pew Social Trends shows that more than 70 percent of veterans feel that civilians do not understand the challenges veterans actually face. The same research showed that fewer and fewer American have personal ties to the military, which only widens the understanding gap. This perception is backed up by other research. Vogt et al, (2014) found that civilians greatly overestimate the percentage of veterans who may experience PTSD. While the perception was that 50 percent experience PTSD, in reality, the number generally falls between 10 and 20 percent. The most frequently documented civilian perception of those who suffer PTSD, according to the study, is that they are violent or crazy. According to the National Veterans Foundation, only 20% of veterans returning from Iraq and Afghanistan suffered major depression or PTSD, and of those, almost 20% of those people also have a traumatic brain injury. While that number is high as compared with the general population, it still signals that 80% of those returning from war are reporting no post-combat related mental health problems.
So how can we strive to provide culturally competent care to veterans and active service members? The first step is to approach your client without preconceived notions about how their service is probably impacting them. Let the client guide you through their problems or concerns, and work to avoid making assumptions based on stereotypes. Typically, if an issue they have is related to their military service, they will let you know.
The second step is to learn more about the other more common experiences from military life that may color their current reality. For instance, did you know that almost 70% of veterans report at least one health problem related to joint pain upon discharge from active duty? And while we are not in the business of treating their physical health, we know too well what impact chronic pain can have on mental health over time. Other issues to keep an eye out for include sexual trauma and harassment for both men and women. While 55% of women seeking treatment at VA Health Facilities report being sexually harassed, 38% of men experience this as well.
Many veterans also report re-employment issues follow their service, including: not having the necessary credentials to perform the same job in the civilian sector that they excelled at in the military; having to start out at the bottom after serving in leadership roles; having to adjust to civilian leadership styles and structure; frustrations with arbitrary advancement and promotion systems; and going from one of the most stable industries to being subject to at-will employment policies and market forces.
The final step is to be ready with other resources for veterans who identify service-related issues to you.
One excellent resource is available to you, free of charge, through the Uniformed Services University. They offer a four-module online learning course — Military Culture: Core Competencies for Healthcare Professionals. You can find it at https://deploymentpsych.org/military-culture-course-modules
There is also a relatively inexpensive course where you can earn CEs through the American Psychological Association. The cost is $50 for non-APA members, and $35 for APA members. It can be found at https://apa.content.online/catalog/product.xhtml?eid=31642
You can direct your clients to the following resources for help with a variety of issues they may be experiencing after leaving military service: