While more attention is being paid to caring for wounded warriors and their families, some key aspects of that need five or more years down the road must be addressed, according to a panel of experts at a warrior-family symposium in Washington.

The nation must change its thinking about mental health, in particular the stigma that still surrounds seeking mental health services — not just within the military but also in the civilian community, too, a panelist said.

"We have an opportunity in this country to change the discussion about mental health," said clinical psychologist Jerry Sullivan, general manager of Medicare and federal channels for Optum Behavioral Health Solutions.

The symposium was sponsored by the Military Officers Association of America and Wounded Warrior Project.

Groups are focusing on a variety of solutions to ensure veterans get access to the care they need. That includes making those in the civilian community more aware of ways they can help, especially in rural areas. School teachers, religious leaders, neighbors, judges and police officers are among key groups that should be "aware and knowledgeable and ready to make a good catch" to help a veteran, said Shelley MacDermid Wadsworth, director of the Military Family Research Institute at Purdue University.

"Every story you hear about someone who almost committed suicide, but didn't, there's usually an element of somebody who made a good catch — someone who picked up the phone or answered the phone, someone who reached out," Wadsworth said.

Those who are thinking of suicide usually tell someone, said Marjorie Morrison, CEO and founder of the nonprofit PsychArmor Institute, but those people don't always know where to seek help. One of PsychArmor's recent initiatives involves working with the Department of Veterans Affairs and others to provide an outlet for those in the civilian community to get information when they need to know how to help troubled veterans.

Wadsworth also cautioned that "it's easy to slip into the discourse about how veterans and military families returning to civilian communities are broken."

"In fact, they are also enormous assets to their communities," she said. "They come with lots of energy, they come with lots of skills. Even if they are struggling themselves, it often turns into strong motivation to help others."

She noted that traumatic brain injury and post-traumatic stress are hardly unique to the military. "Anything we can do to help [troops and veterans] will help everybody else in that space," she said. "These issues are present in our communities widely and our systems need to be savvy about them so we can reach out to everyone who needs them."

Wadsworth also stressed that children, siblings, parents and spouses of service members are in a "really different spot than service members and veterans themselves, both in terms of infrastructure for care and consequences for them."

Family members are not just "supporting cast," she said. "Deployment happens to everybody. Everyone in the family is affected."

She noted that the long-term effects on military children of the mental health issues of troops and veterans is still unclear, even though more than a million children who have experienced the combat deployment of a parent are entirely dependent on civilian community care.

cut for space: Different groups need to work with each other, including government and private sector organizations. One goal of the Robert R. McCormick Foundation is to help mainstream nonprofit organizations become culturally competent in helping veterans, said Donald A. Cooke, senior vice president of philanthropy at the foundation. More than 45,000 nonprofits have the word military or veteran in their name, he said, "but what about those that have been doing really great work for 30 to 40 years that didn't know veterans were in their programs? How do we get them up to speed?"

At the end of the day, Cooke said, "it's person by person, family by family. That's where the work gets done.... We know a lot of what works. Let's keep doing that. What I can't figure out is what is the organizing structure around the collaboration."

While challenges remain, the nation has come a long way in providing care for veterans over the past decade-plus of combat deployments, said Kayla Williams, an Army combat vet who is now a researcher and author with the Rand Corp. think tank.

Williams' husband was injured in service in October 2003. When she was accompanying him to his military medical appointments in 2004 and early 2005, she said, caregivers had virtually no resources to guide them in supporting wounded warriors.

"We've found a lot of healing by advocating for improvements for everyone who came home after us," Williams said.

"It's not a one-way-up journey," she said, noting that her husband struggled again last year. Even with their knowledge about the system, she said, it took six weeks for him to get engaged in care. And when they moved to Pittsburgh, Veterans Affairs Department officials didn't have information about their previous care.

"We've seen tremendous improvements,

"But I still see a long way to go," she said. "We're getting access problems addressed much better than we were 10 to 12 years ago, but there are still problems with continuity of care, with systems communicating with one another and with ensuring people are getting evidence-based care, and that they're staying engaged with care."

cut for space -- Patricia probably has something about this in her story. Panel members said health care providers need to be educated about the culture and the issues that face some returning veterans. When a veteran is referred to a provider, there needs to be assurances that that provider is the best person for that problem, said Jerry Sullivan, a clinical psychologist who is general manager of Medicare and federal channels for Optum Behavioral Health Solutions.

More attention also must be paid to the stressors that affect caregivers, Sullivan said. "Caregivers often exist in the shadows. The focus is on the veteran, but we have the opportunity to acknowledge the stressors on caregivers and other family members that can lead to their own substance abuse issues, depression, anxiety, feeling overwhelmed, feeling hopeless. We need to extend outreach to caregivers."

The needs of caregivers will stretch far into the future, said Williams, citing Rand research that indicates caregivers are more prone to have their own health and employment problems.

"As caregivers begin to age, what is the long-term plan and how do we support them nationally … to make sure caregivers don't experience high levels of burnout?" she said.

Karen has covered military families, quality of life and consumer issues for Military Times for more than 30 years, and is co-author of a chapter on media coverage of military families in the book "A Battle Plan for Supporting Military Families." She previously worked for newspapers in Guam, Norfolk, Jacksonville, Fla., and Athens, Ga.

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