Caring for Canadian Armed Forces Veterans: A Primer for Canadian Family Physicians. Family Medicine Forum November 2016

Transcription

1 Caring for Canadian Armed Forces Veterans: A Primer for Canadian Family Physicians Family Medicine Forum November

2 Dr. Burton McCann Assistant Professor Department of Family Medicine Dalhousie University VAC Physician Veterans Affairs Canada 2 2

3 Dr. Burton McCann FCFP ---No conflicts to declare Acknowledgements: Dr. Alexandra Heber FRCPC--- Chief of Psychiatry Dr. Stephen MacLean FCFP--- Senior Area Medical Officer Joel Fillion --- Director of Mental Health Trudy Burke ---Director Strategic Planning All of VAC s Health Professional Division Dr. Jim Thompson FCFP of VAC s Research Directorate 3 3

4 Objectives Recognize the Veterans in your practice Understand Veteran illnesses and injuries Develop strategies to effectively manage your Veteran patients 4 4

5 Who is a Veteran 5 5

6 A Veteran Former CAF Member with at least one day of service May be: Regular Force Reserve Force 6 6

7 How Many Veterans in Your Practice? 7 7

8 Canadian Veteran Population Living in general population: ~700,000. Just under 3% of Canadian adults, or roughly 1 in 30. Operational service: Second World War and Korean War: 90,000+, average age 90. Modern day CAF Veterans: ~600,000, average age late 50 s, range More than 70 special duty areas and operations: Peacekeeping operations prior to 1990s. Increased operational tempo since 1990 including Somalia, Balkans, Persian Gulf, Afghanistan, Libya, Iraq. 8 8

9 First Approval of Disability Benefit When Veterans Come to VAC % Is your patient a Veteran? Encourage them to contact VAC % 25% 25% serving Years after Release Source: RDB,

10 Health Care Group Serving Regular Force Serving Reserve Force CAF Health Services Yes Yes if on operations or working full time in a serviced base Provincial and Territorial Publicly Funded Healthcare Systems Referral from CAF Health Services Yes when in home communities, working part time Veterans Affairs Canada Benefits (if eligible) Veterans No Yes Yes Families No Yes Yes Yes Yes 10 10

11 Veteran Illnesses and Injuries 11 11

12 2010 and 2013 Life After Service Surveys 1. Most Veterans are doing well in terms of mental health, employment, income, life satisfaction and ease of adjustment to civilian life. 2. Most enter the civilian workforce. 3. No stereotype: All ages, short and long years of service. 4. Significant number of Regular Force and deployed Reserve Force Veterans have chronic physical or mental health problems and related disability

13 Prevalence of Chronic Health Conditions 40% 30% 20% Veterans Mental Health Veterans Physical Health Canadian General Population 10% 0% Regular Force Veterans Released in

14 Management Considerations 14 14

15 Management Considerations Context Benefits and Services Culture & Values 15 15

16 Military Context is Important High-demand occupation: hard working, very high functioning, active and energetic during their careers. Were told where to be, what to do while in service (training, occupations, deployments, postings, health care). Military to civilian transition is a stressful time. Culture of rank, clear lines of authority while in the military. May have been in harm s way, or witnessed atrocities. Unlimited liability leads to expectation that if they get ill or injured, they will be taken care of. Pride in having served our country

17 Veterans Affairs Canada: Federal Department responsible for care and commemoration of CAF Veterans and other eligible persons including RCMP Administers disability benefits to compensate for health effects of injuries and illness related to service. Funds treatments. Front line staff: Veteran service agents, case managers, nursing officers, medical officers, occupational therapists, clinical case managers, mental health and rehabilitation consultants. Home visits (nurses, occupational therapists, case managers) VAC case management. Rehabilitation program

18 More VAC Assistance for Your Eligible Veteran Patients National network of specialized mental health clinics Operational Stress Injury Clinics. Private civilian health professionals. Multidisciplinary clinics for complex cases (e.g. severe physical and mental health conditions). Payment for assistive devices such as canes, braces, walkers, wheelchairs, stair lifts, etc. Veterans Independence Program (home care). OSISS National network of specialize peer support Help for Veteran families 18 18

19 What VAC Does Not Provide VAC pays for but does not deliver health care services. VAC Medical Officers are not treating physicians. VAC contracts but does not operate health care facilities. VAC does not provide disability benefits for non-servicerelated health problems. Most Veterans are not participating in VAC programs. Ask your patient to contact VAC to find out if they are eligible

20 20 20

21 Where to find us, across Canada 21

22 Cultural Considerations in Veteran Medical Management Values Integrity Courage Loyalty Stoicism Commitment Self sacrifice Peacefulness Restraint Obedience These values provide the standard of conduct for members These values regulate the lives of members on a day-to-day basis 22

23 Military Culture Not just a job but a way of life Culture extends to personal life and family Universality of Service Can be called to work at any time, any place No over-time pay Military must know your location at all times Even on vacation! 23

24 CAF Veterans Once a member, always a member After releasing from the military, they retain values, attitudes and behaviors that are military, and distinct from civilian values and attitudes 24

25 Difficulties in Help-Seeking Unfortunately culture of strong cameraderie can sometimes lead to an isolationist sentiment and belief system Us versus Them stance They form a distinct society, which feels psychologically distant from the civilian world 25

26 Military Culture Mental Health/Medical Culture Collectivistic External locus of control Who I am Emotional suppression Pain: Increased tolerance Strength focused Self Sacrifice Grounded in tradition Individualistic Internal locus of control What I do Emotional expression Pain: Early identification and reduction Illness/injury focused Self Care Focus on change Adapted from Lunasco, One Shot- One Kill: A Culturally Sensitive Program for the Warrior Culture

27 How do they present? With stoicism Underreporting of symptoms Defensiveness, challenging Joking Avoidance May have a grief reaction on release/retirement Transition difficult, especially for those who joined when young May not have well-developed ability to reflect on inner experience, or verbalize symptoms 27

28 Educate Yourself So you can understand your patients world To build positive rapport with your patients 28

29 Suggestions for Rapport-Building Cultivate safe, non-judgemental, encouraging relationship then, be patient! Take a strengths-based approach (will resonate positively with your patient s values) Acknowledge virtues of their profession, eg protection of the public Commend them on their willingness to serve others, at great personal risk, and for a purpose larger than themselves Thank you for your service Show what you know ( eg. rank structure, culture, history of military). Show you are willing to learn 29

30 Suggestions for Rapport-Building Initiate interview with questions about their service history (Important part of identity) How long did you serve? What was your trade/job/specialty? Family-members who served? In which military environment (element)? Where were you posted? Have you deployed? Where? When? 30

31 POSTTRAUMATIC STRESS DISORDER: A Primer for Primary Care Physicians Authors: Dr Catherine Classen, PhD C Psych LCol (ret d) Alexandra Heber, MD FRCPC CCPE How to recognize, diagnose and treat PTSD Designed for frontline clinicians Available in English and French Online course fully accredited for Mainpro and MOC credits Free of charge. Just need to register Sponsored by the Mood Disorders Society of Canada Access course at: 31

32 Veterans Health Files in Canadian Family Physician Fictitious case studies tailored for busy Canadian Family Physicians and General Practitioners: Battlefield Brain Traumatic brain injury. Overgrown Lawn Home supports. Horror Comes Home Posttraumatic Stress Disorder. A Sailor s Pain Chronic pain and disability. Battlefield Blues Depression. Shaken World Musculoskeletal disorders and mental health problems. Forms for Father Importance of those forms

33 Military and Veteran Health Research Forum Seventh Annual Research Forum will be hosted by the Canadian Institute for Military and Veteran Health Research in Vancouver, November 21-23,

34 What you can do Summary: Accept CAF members needing FPs on release. Ask if current patients have past military service. Consider Veteran identifier. Be aware most are well adjusted and functioning well. Most will have the same health conditions as all Canadians. Some have serious and complex health problems and most of those are VAC clients already. VAC can provide lots of support and services with shared patients/clients

35 35

36 36

37 Questions 37 37