Serving the underserved

With two wars and high unemployment, it’s not surprising that two of the county’s most underserved populations are veterans and unemployed people. Finding ways to meet their needs was the focus of a session at APA’s 2010 Education Leadership Conference.

David Riggs, PhD, director of the Center for Deployment Psychology at the Uniformed Services University of Health Sciences, began with the numbers: “When you start multiplying the number of people affected, it’s not just the 2 million who serve in uniform and 10 million veterans,” he said. Four million parents have had a child deployed, 2 million children have had a parent deployed and a million spouses are coping with deployment.

While huge numbers of service people return home with depression, post-traumatic stress disorder and traumatic brain injuries, said Riggs, “they’re not marching toward us.” That’s because, he said, in addition to geographic barriers, they also confront stigma about seeking mental health care.

The center, established four years ago with APA’s assistance, helps ensure mental health providers are prepared to serve these service members and their families. A two-week course prepares clinicians for deployment — where they may be “doing therapy in a tent with a piece of cardboard between them and the guy next to them,” Riggs explained. A one-week course orients civilian providers to military culture, special clinical issues and the like. In addition, mobile training teams provide seminars in partnership with such groups as the Red Cross and Wounded Warrior Project, while a new one-day program brings university personnel up to speed on military issues.

M. David Rudd, PhD, dean of the College of Social and Behavioral Science at the University of Utah, explored some of the factors that make veterans of Iraq and Afghanistan especially vulnerable. One such factor is repeated deployments, which not only increase soldiers’ chances of physical and psychic injuries but also habituate them to weapons, trauma and death — something Rudd says makes suicide a more acceptable idea. Other factors include the lack of safe places in today’s wars, the “warrior identity” that equates seeking help with admitting defeat and medical advances that allow soldiers to survive injuries that would once have killed them.

The military’s approach to chronic conditions is another problem, said Rudd. The longer veterans with PTSD go without treatment, he pointed out, the harder and less likely recovery becomes.

“Why don’t we pay people to get treatment at the beginning of an illness?” he asked. Congress has rejected the idea, despite findings from Department of Defense-funded research that early intervention with PTSD works. “We have to think creatively and innovatively about how we manage disability with veterans,” said Rudd. “The current system is flawed.”

Psychologists should also be prepared to address the needs of the 10 percent of Americans who are unemployed and about 17 percent who are underemployed, said Nadya Fouad, PhD, who chairs the educational psychology department at the University of Wisconsin in Milwaukee. But many aren’t, she said.

“There’s a common perception that work and personal issues are separate,” she said. “They’re not.” That’s a problem because unemployment is associated with both mental and physical health problems.

The unemployed need general psychological help for depression, anxiety and hopelessness, but they also need more specialized job-hunting help, said Fouad. Psychologists should understand the demographic issues, such as age, that affect employment, for example.

They also need an attitudinal shift. “In different times, if a Wall Street broker came in and said he would like to reinvent himself, that would be fun work,” she said. Instead of focusing on issues of identity and the role of work, psychologists working with the unemployed must concentrate on how the client can find work now. They need to help clients make realistic plans, foster resilience and build coping skills, she said.

They must also recognize the employment situation’s not likely to change soon, she said. “We’re going to be living with this,” she concluded.

Rebecca A. Clay is a writer in Washington, D.C.