Welcome to episode 146 of Behind The Mission, a show that sparks conversation with PsychArmor's trusted partners in educational experts. My name is Duane France, and each week I'll be having conversations with podcast guests that will equip you with tools and resources to effectively engage with and support military service members, Veterans and their families. Find the show on all the podcast players or by going to www.psycharmor.org/podcast.

 Thanks again for joining us on Behind The Mission. Our work and mission are supported by the generous partnerships and sponsors, who also believe that education changes lives. This episode is brought to you by PsychArmor, the premier education and learning ecosystem, specializing in military cultural content. PsychArmor offers an online e-learning laboratory that's free to individual learners as well as custom training options for organizations. You can find out more about PsychArmor at www.psycharmor.org. 

On today's episode or having a conversation with Dr.Tanya Hess, the training director for the department of veterans affairs, coaching into care family call center. Dr. Hess is a licensed psychologist and is responsible for the training and development. For the staff of the family call center for the coaching into care program, a national telephone based support service for family members and others who want to help reluctant veterans access their VA healthcare benefits, particularly for mental health concerns. You can find out more about Dr. Hess By checking out our bio in our show notes. So let's get into my conversation with her and come back afterwards to talk about some of the key points. 

duane----he-him-_63_11-02-2023_064713 (1): Dr. Hess, so glad to be able to share your work on the show. I'm excited to be able to talk about the Coaching Into Care program. But before we get into that, I would like to provide you an opportunity to share a bit about yourself and why the work you're doing is such a passion for you.

dr--tanya-hess--she-her-_1_11-02-2023_084713 (1): thank you for having me. This is great to be here. I am a psychologist. I've been working with the VA for about 14 years. and I was, working with coaching into care. I got interested in the field of working with veterans. I actually don't come from a military family, other than a few people here and there, but, I did grow up in a Air Force town, where many of my friends were, children of, service members.

And, so after getting my PhD, it seemed like a natural fit to start working in a space that could both use my psychology skills and help service members and their families.

duane----he-him-_63_11-02-2023_064713 (1): I find it interesting, obviously you had some familiarity growing up in a town outside a military base and having friends and family members, but maybe you saw veterans at home or service members at home. I'm curious what it was like for you to start working with veterans. One on one, not coming from that military background,

dr--tanya-hess--she-her-_1_11-02-2023_084713 (1): You know, it's interesting. I have one of the few positions in the VA where I work with the families, much more than I actually work directly with veterans. and that is something that I actually was familiar with. I grew up with very close friends whose, fathers had been in Vietnam. and who had been affected by, a lot of the, remnants of having been in service and, that ability to connect or not connect when one comes back can be really important and I saw it interestingly more firsthand with friends, as they, did or didn't connect with their parents. And so part of what I do is working with the families themselves to, to try and, intervene and help.

duane----he-him-_63_11-02-2023_064713 (1): I was one of those, my father served in Vietnam and as did three of his brothers. I had cousins who's one of my uncles stayed in and they had a military background. But I never experienced the military lifestyle. I experienced the son of a veteran who was struggling with all of those things,disrupted home and substance use and even periods of potential homelessness and all of those things, growing up as the son of a combat veteran, arguably by my life choices and continuing on to the military. that's what you're seeing now is a lot of the family members of people like that. and that was really, like you said, who you grew up with.

dr--tanya-hess--she-her-_1_11-02-2023_084713 (1): Yeah. and it's, one of those interesting things where when there's trauma, it can ripple and you can see it, not only in the person who experienced it, but you can start to see the effects and family members, which, is one of the reasons we like to try and intervene, on the flip side of that, family members can often see it and recognize it first, before the service member and the person most affected, even recognizes or is willing to ask for help.

duane----he-him-_63_11-02-2023_064713 (1): Yeah, and I think that is, the big piece.as a veteran and mental health professional, as we mentioned before we started recording, I'm familiar with Coaching Into Care, and I've often used it as a resource to share with family members who reach out to me with questions about how to support their loved ones. what can you tell us about the Coaching Into Care program?

dr--tanya-hess--she-her-_1_11-02-2023_084713 (1): So, Coaching Into Care is a VA program for family and friends of veterans. Who noticed that the veteran may be struggling, specifically with mental health issues. so it could be depression, isolation, substance use, a number of other things. that the family member or friend sees the struggle and, we wanted them to have a place to reach out.

often you'll hear, someone struggling, okay, good, have them call us and we'll help. but people aren't always in that position. to ask for help yet. and what we really wanted to do was create another doorway in, make it a little bit easier for the network around the veteran to start to ask for the help.

so we created, it's a call line. It's also just a clinical service. It's, a team of mental health professionals and psych techs who can take those calls and help to get the person directed in the right direction, either educate them around resources. if you don't know where your local VA is, we'll talk to you about.

where the closest BAs are and how the system works. if you're not sure what you're seeing is a problem, we'll talk through what you're seeing, maybe direct you to some resources to read up and watch videos on topics. and if you're pretty certain you know what you're seeing and it's a problem, But you just don't know how to make that next step.

That's when we do what we call coaching, which is pairing someone up with a licensed mental health professional, to talk through the steps, how the communication goes, where the road bumps are, to try and help clear the pathway for conversation hopes of helping clear the pathway to treatment.

duane----he-him-_63_11-02-2023_064713 (1): Yeah, I really like that concept. As you mentioned before, a lot of times the family will see or be experiencing things that either the veteran doesn't recognize themselves or the veteran knows what's going on, but they're just not willing to or not able to whatever to be able to reach out for help. I know sometimes I've had family members reach out to me says, if I give you their number, can you just call them and talk to them and make them get into care? and yeah. And for a number of different reasons, that doesn't work, obviously, our own free will and personal autonomy. I imagine you probably get that a lot as well.

dr--tanya-hess--she-her-_1_11-02-2023_084713 (1): we get that exact same statement all the time, probably every other day. can I just give you their number? Can you just call them? or can you just tell me that one word that I can say and everything will be okay? And oh, I wish I had one magic word I could just say and everything would be okay.

But it's about starting to have conversations. And so to clarify and because of your point, we do not go out and pick up the veteran and take them to the VA. We do not call the veteran and ambush them with, a sales pitch on coming, but we do try to have. the family in a more educated space so that they can have those conversations over time.

which is an important piece that, these are often problems that have developed over time. as much as we may want them to solve quickly, they're often things that take time to solve. and it's about partnering. with the veteran not trying to, tell the person what to do.

Like you or me, if one of us, I always think back to like when you're a kid and your mom says, go clean your room now, even if you were a About to clean your room. You are not doing it now. and we're all like that. we all want to have choice and autonomy and make our own decisions.

so one thing I'll often talk to people about is you don't want to back someone in the corner. You don't want to say you must so that they have to say, I will not, you want to make it. A more of a conversation. it seems to me like you're having a hard time with this. Can we talk about it?

if not now, is there another time that we could talk about it? We talk a lot about choosing your time. in the midst of a argument when someone just came home from a bar, maybe not the best time to have a conversation about, Hey, maybe you need help, but maybe the next morning when they're hung over.

is a time,or a little after they're hungover, but, picking your time, knowing who you're talking to, knowing who the message comes best from. so we'll often get calls from family members who, say, they're not talking to me right now. So we'll say, well, who are they talking to?

Do they want to join the conversation with us? we do family members. We have friends. I've gotten calls from a boss. I've gotten calls from a construction worker who was worried because there was a veteran camped out in the back of the construction lot and didn't want to just kick him out.

Wanted to be able to have a conversation about what his other options were. neighbors where the whole neighborhood had gotten totally upset about what was going on with a veteran and really working with that person to educate the other neighbors on what's going on and create a safer space with the idea that the more of a safe space you can create, the better chance that person has to make a choice to get help or to have some of those roadblocks removed.

duane----he-him-_63_11-02-2023_064713 (1): I think that the really valuable thing I hear about what you're talking about is, removing as many barriers as possible for the veteran to get care because the goal is that the mental health and wellness of the veteran and the family in their environment, of course, right? but you talk about there's external barriers to care.

I don't know where to go. I don't know where to send them. you have the ability to engage them in resources, but then for veterans, I won myself as family members that you've supported veterans, we have internal barriers to care. the pride thing, the negative self talk like this is really coaching into care is designed to remove both or to, to at least alleviate some of the external and the internal barriers to care.

dr--tanya-hess--she-her-_1_11-02-2023_084713 (1): Yeah, you see. What we're talking about is stigma and self talk around, access to care. You see it in all populations, not just veteran populations. that everywhere, that asking for help can be hard, acknowledging that there's a problem can be hard, trusting someone else with.

 essentially what we're asking someone to do when we ask them to go into therapy is you take the Band Aid off. So if that Band Aid was drinking or that Band Aid was pulling away from everybody, so that you can start to help someone heal. And that's a really scary proposition.

for anyone. one of the things we want to do is we want to, like you said, reduce the barriers to try and make it easier to let the person know that, they don't have to struggle alone, that asking for help isn't a weakness, often in military culture being really strong is a good thing, keeping things pushed down and take care of the next mission.

and it is, But when you get back, it's not always the best thing for you. Sometimes asking for help, can be the better thing and, can help you get to that next step and start healing. I think another, really important aspect is, supporting those who are supporting the veteran. As you mentioned, there is the ripple effect, right? my father's drinking and substance use did affect me, right? in a very significant way. even as I grew up, as I became older. and so I think that's really another valuable resource I would imagine that you find in coaching and care. It's not just how are we helping you help the veteran you're calling about, but how are you supporting yourself? like, how is the caller receiving care themselves?

one of the things that I like to think about when I'm working with families is. I really see them as a system, as a network, a spiderweb almost, if you will, if you move one part of it, all of it shakes, and that can be for good or for bad. And that's part of what we're looking at.

so yes, when there's a problem, there could be a ripple effect through the family of a problem. but that also means that. When one person starts to reach out for help and shift a little bit, you can start to create space for other family members to shift. And I think that's one thing that's often underestimated is that, in that first call, someone's can you make them go in?

No. But can you make a change that allows a little more space for them to then make a decision to go get help? and that can be a hard, concept to get across at first sometimes, but it really, just pulling back. you know, I had, somebody I was working with who would send a text every morning at 7 a.

m. saying, you need to go to the VA, you're. This is wrong and that's wrong. You gotta get out of the VA. and, the family member stopped responding. if there's something you're really hurting about, and someone else, first thing every morning says, it's a problem, you're messed up on this, it doesn't make you eager to open that text.

on that one, we worked a little bit on how do you pull back a little bit? How do you create more space so that the conversation that you desperately want to have actually has space to happen? and so we did work on that. That wasn't a change in the veteran. That was a change in this person on what can you do a little bit differently to create space?

and we see it the opposite, if someone's just really scared to start the conversation, then there's no conversation. So how can you start to open that door just a little bit and, say just a little bit more, create a space where the person might talk to you about it. let them know that this is something you're interested in talking about if they're ready, when they're ready.

and so a lot of it is that, that change in the people around. Around the person who's suffering to try and make it easier to talk. 

duane----he-him-_63_11-02-2023_064713 (1): And so I think that idea of making the environment around the veteran, helping the environment around the veteran be more welcoming and supportive to that, I think you mentioned, and again, as I mentioned, I get this is, can you just make them? Maybe people are approaching you almost in desperation.

Like they're not calling because it's been a bad day or so, right? This is something that, they've gone through this and as, As much as I try to promote coaching into care, there are still a lot of people who may not be familiar with it. but usually it's people are reaching out to you when they're really feeling like they almost have no place else to turn.

dr--tanya-hess--she-her-_1_11-02-2023_084713 (1): yeah, and they have been working with this for years often. And, that I, and I will talk to them about, pacing themselves. This isn't often a sprint and there are crisis moments where you do need to do something immediately. and we do work closely with the Veterans Crisis Line for those kind of cases.

but, oftentimes it's about Taking it step by step, getting the conversation going, and giving space for people to think and to change and to make decisions. you had mentioned something earlier I wanted to come back to, which is as part of it being affecting the whole family, we do also look at resources for the family members.

a lot of times we'll try and direct them to something, educational materials,we'll direct them to support groups or therapy of their own, just to make sure that the people around, part of the system are all, being attended to because that also can, one, it can set a good, model, that it's okay to ask for help.

Look, I'm doing it too. and I'll sometimes have people say, I let them know I was talking to you. I told them I had somebody I'm talking to and they were interested. They wanted to know what would I want to talk about? And, and that was what they used to get the conversation going. 

duane----he-him-_63_11-02-2023_064713 (1): and again, I have really, and not just as I've referred people to the program, but I have actually had people that I've referred to the program, when I was working in direct clinical work, that their veteran then came to see, like it, it actually worked, right? that they coached the veteran into care, in that the veteran actually, engaged in the treatment, which is obviously, what we hope for. and so the coaching into care program, you do have, there is a course on psych armor, but recently you've been, revamping the course. And that course is due to be released. what can listeners expect to learn from the course that, that you're partnering with developing with psych armor?

dr--tanya-hess--she-her-_1_11-02-2023_084713 (1): We really talked through, what coaching into care is, but also the bigger issue that, oftentimes people don't come in for help. we find that about half of the people who are referred to mental health, when they do go into the VA, they don't follow up with mental health care. and we talk a lot about why that might happen, and it's a.

Variety of reasons. but looking at why that might happen and how to interrupt that cycle a little bit. and then what to expect when you do come into coaching and to care. so when someone calls, it may be one phone call. They may just call and they need that little bit of information to get over the next.

but, as we mentioned, it might be a longer, it might be a series of calls. We might pair somebody up with a coach, talk about what to try. and I loved hearing that it worked with your referrals. cause that's what we go for is we're not a forever program. We're not going to be the therapist who do the work with the veteran.

Or even the therapist for the caller. we will often refer them out, but we are going to really look at how that communication goes, where things get stopped, make sure people have the education they need, and even role play. We'll even let someone, say, what is it you really want them to know?

How do you imagine saying it to them? You want to try it here. Do you want to just say it to me so that you can hear how it sounds? And someone might say it and they're like, Oh, they were not going to like that at all. okay, what else, how else can you say it? and really a space to try things and to think about, what is going to be most important to the veteran.

I'll talk to people about that sometimes. if I see that you need therapy for depression, but you don't see it, me coming at you day after day saying you need treatment, you're depressed. Isn't going to get either of us anywhere. But, if I can start to talk to you about the things you really are worried about, and connect you with resources, which the VA has for a plethora of things, then maybe I can get you starting to Think about it.

and that's part of the model with families is, if you just keep, coming out at the same direction, you're unlikely to get things to change. But if you can start to create a little space by looking at all of the things and looking at what's most important for the person. that you're talking about the veteran, that you might start that process.

duane----he-him-_63_11-02-2023_064713 (1): 

I absolutely agree. I think it is a great program and also as you alluded to in, in the beginning, it is one of the, maybe relatively few programs in the VA that's not for the veteran. Like it is specifically designed for those that are supporting the veteran. so someone is listening and maybe working with family members, maybe they get the same question that, that I get is, can you just.

Call them and make them get into treatment. how can folks find out about coaching into care? Maybe, access the service.

dr--tanya-hess--she-her-_1_11-02-2023_084713 (1): Absolutely. in addition, you had mentioned psych armor. We have all of our information up there and I do encourage people to look, look at that and watch those. we have our own website, and, we have a Facebook coaching into care, where we put all information. Basically all someone would need to do is to call our 1 800 number.

8 8 8 8 2 3 7 4 5 8. and we're open 8:00 AM to 8:00 PM Monday through Friday. That's Eastern time. and we have, responders ready to take the call. they will talk to the person about what's going on, if it's a crisis or if it's, needs to be directed somewhere else. We'll make sure they get to the right place.

and if, it's. about getting a veteran into a little bit more, mental health care, a little more supported, then we'll start that process of having conversations with the caller about that.

duane----he-him-_63_11-02-2023_064713 (1): That's great. so we'll make sure that all of the links to those are in the show notes. Tanya, thank you so much for coming on the show today.

dr--tanya-hess--she-her-_1_11-02-2023_084713 (1): Oh, I'm so happy to be here. It was a pleasure. Thank you.

 Once again, we would like to thank this week's sponsor, PsychArmor. PsychArmor is the premier education and learning ecosystem specializing in military culture content. PsychArmor offers an online e-learning laboratory. That's free to individual learners as well as custom training options for organizations. And you can find more about PsychArmor at www.psycharmor.org.

As you heard me say in the conversation, I'm a staunch advocate for the coaching into care program. I recognize there's a lot of veterans who don't reach out for help, whether it's because of internal stigma, external stigma, or barriers to doing so. And those veterans likely have those around them who care for them and want to support them And those closest to veterans are not always clinicians like Dr. 

Hess. It can be frustrating to see someone that you care about continue to struggle while feeling like there's nothing that can be done. And that's where the services of coaching into care. Come in. In the interest of adding a few more practical tips, Dr. Hess's excellent overview. I'd like to briefly share what I often shared with family members who reached out to me. These are tips that I found in the coaching into care website, and they might be helpful for you. 

When having conversations with veterans About seeking treatment. 

One of the first things to remember is to be respectful and calm during conversations, no one enjoys ultimatums demands or overly emotional conversations being calm while someone else's not is a good way to help them calm down, getting as agitated as they are, is a good way to escalate things. Second be patient. 

It usually takes more than one conversation before most people accept the idea of seeking care. When I was working as a clinician, I had a client who was given a copy of my brochure. He left it in the front seat of his truck. His wife picked it up a couple of days later and said, what's this nothing the veteran said and threw the brochure in the glove box. A week later the morning after an argument. He opens his lunchbox to find my brochure in it with my name and phone number circled in red ink. 

He finally reached out because he said, I think my wife's trying to tell me something. Third don't argue or attempt to talk a veteran out of their feelings, thoughts and or emotions. We can't deny what someone is feeling or thinking. We may not see things that way, but we have to acknowledge that they do. Telling them that the wrong, or even worse, stupid or harmful. will only cause them to shut down more. fourth, allow the veteran in your life to decide whether or not they want to talk about what the experience or what they're currently dealing with. 

I've seen this happen both ways, someone who supports a veteran wants to hear about what they went through, but the veteran doesn't want to talk about it or a veteran wants to talk about it, but the person they're seeking support from doesn't seem to care either way. 

Simply listening is the key Be respectful of what the veteran wants and needs. 

Five, Don't take the veterans social withdrawal or isolation personally. Be willing to invite them to events and situations and accept They may not want to participate. Let them know that they're welcome to change their mind. The military is an inherently dangerous and stressful job and things like that, change people. And just because they were all about going to concerts or going out dancing before doesn't mean that they're still into that. 

Again, this is about the veteran, not about us being persistent and open we'll help the veteran understand that they're always welcome. 

Six avoid giving advice, unless the veterans specifically asked for it, telling someone what they should do instead of what they can do is a good way to turn them off from hearing what you have to say. 

I don't give medical advice or legal advice because I'm not a doctor or a lawyer. Even as a clinician, I do my best to avoid giving advice or telling people what they should do. And finally minimize distractions during conversations with the veteran by turning off phones, radio, TV, et cetera. Be willing to limit conversations at 10 to 20 minutes at a time if necessary, think in small steps. How often do we actually sit down and have a face-to-face conversation with no distractions, no video games, no cell phones, no TV. We spend a lot of time sitting next to someone talking like on the couch or in the car. 

Maybe we have conversations at a meal or getting coffee or something, but even then our ability to have a real and honest conversation has limited. So when we're talking about these serious subjects, It's necessary to take the time to have a meaningful conversation. 

So there, you have it. Some of the tips that I received from the coaching into care website that I shared with family members of veterans, that reached out to me. 

So I encourage you to check out the coaching and care website and reach out if you need them or know someone who does, because you will get support with suggestions like these and many more. So I hope you appreciated this conversation with Tanya. If you did, we'd appreciate hearing from you. 

So if you do have some feedback, let us know, drop a review in your podcast, player of choice, or send us an email us at info@psycharmor.org. We're always glad to hear from listeners, both feedback on the show and suggestions for future guests. For this week PsychArmor resource of the week, I'd like to share the PsychArmor course coaching a loved one into care. At times it can be difficult to talk to a veteran about seeking help. 

This course, equips caregivers with tools to identify potential struggles and better understand problems with traditional approaches like ultimatums and forceful decisions. You can find the link to the resource in our show notes.