Episode 87 Transcription

Welcome to Episode 87 of Behind The Mission, a show that sparks conversation with PsychArmor trusted partners and educational experts.

My name is Duane France, and each week I'll be having conversations with podcasts guests that will equip you with tools and resources to effectively engage with and support military service members, Veterans, and their families. 

You can find the show on your podcast player of choice or by going to www.psycharmor.org/podcast. 

Thanks again for joining us on Behind The Mission. Our work and mission are supported by generous partnerships and sponsors who also believe that education changes lives. This show is brought to you by PsychArmor, 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. 

On today's episode, I'm having a conversation with Dr. Erin Fletcher, the Warrior Care Network Director for the Wounded Warrior Project. Erin has over 15 years of mental health experience working with adults in a variety of treatment settings. In her role, Erin collaborates with the four academic medical centers that comprise the Wounded Warrior Partnerships Warrior Care Network to foster network alignment regarding program implementation and delivery. You can find out more about Erin by checking out her bio on 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: So glad to bring the Wounded Warrior Project back on the show and I'm a huge fan of the work that you're doing in mental health and wellness. But before we get into that, I'd like to give listeners an opportunity to hear about why you've been doing this work with WWP for almost the last 10 years.

ERIN: Oh, absolutely. It's great to be here. I'm glad to engage in this conversation. What brought me into working with Veterans? I've been a practitioner in the mental health field for, oh gosh, probably about 15 years so far. Worked in a variety of treatment settings. almost exclusively with adults, with dual diagnoses, so a mental health condition and a substance use disorder.

And I was fortunate enough during my graduate training to complete a training year at a VA here in Chicago. And that really certainly sparked my interest and passion for working with Veterans. And I, you know, will joke with some of the warriors that I've worked with, that, you know, I wasn't brave enough myself to serve and so this is really my way of giving back, and doing my best to honor the sacrifices that Veterans and active duty service members have made.

DUANE: You know, that's something. I think that, a lot of people who know that the VA is like the largest healthcare system, but something they don't realize is the VA is one of the largest teaching hospitals, teaching systems, many clinicians, especially at the PhD level, get their start at the VA, perhaps not having had exposure to military service before that like yourself. But once they get in the VA, this can really develop into a passion.

ERIN: Oh, absolutely. And that's exactly where it started for me and some of the best training that I was able I think to receive throughout my career. And that really gave me a great foundation in military cultural competence, and really recognizing, the importance of that, as a practitioner, in whatever field. You can say I don't have to have, you know, a broken arm to know that it hurts, but having an understanding of that background or what individuals might have gone through, to be helpful, I think is so important.

And having that sense of competence knowing the acronyms, being able to know the language of the military really helps build that rapport. It really helps build that relationship with those that you work with that is really so important to the healing process. So it was an incredible experience for me for sure. 

DUANE: And I can also imagine being 15 years ago, that was at the height of the beginning of some of the most challenging you had the first, maybe the second wave of combat Veterans coming back. There were surging in Iraq and Afghanistan sort of at that time, that had to be, and, thrown in the deep into the pool, almost working with some, very heavy things.

ERIN: It was, and that kind of surge as they were coming back, you could just feel it in the halls of the hospital and just what have these folks been through? and how can we be here right at this kind of transition point? When they're coming back, we know transition points are scary and can be dangerous. And so we wanna be there and provide that support and provide resources. Yeah, it was an interesting time.

DUANE: And then transitioning to the Wounded Warrior Project. So you know, about the last 10 years you've gotten into the Wounded Warrior Project, coming from that clinical care space, and really the Wounded Warrior Project has emerged as a long-term support organization, especially for post 9/11 Veterans.

ERIN: Absolutely. And coming into Wounded Warrior Project I think one of the greatest assets that Wounded Warrior Project has, is the comprehensive approach, that we as an organization take to the health and wellness of the Veterans that we serve. And as prior to Wound Warrior Project, a die hard practicing clinician that was using, evidence based care in typical individual or group sessions, using those gold standards of treatment, prolonged exposure, cognitive processing therapy, those models coming into Wounded Warrior Project and seeing how having a whole program dedicated to social connectedness is so helpful. How Wounded Warrior Project addresses the physical health and wellness of the individual, how they're addressing the financial wellness and even how Wounded Warrior Project addresses mental health.

Wounded Warrior Project does not directly provide clinical services. We partner with a number of great organizations that we can talk about. But we also deliver mental health-based programs that are therapeutic in nature. Not direct therapy but therapeutic. And before I was able to see that, it's just, it's not something that we were, that I was necessarily taught in school and it was not something that I, I had practiced. But seeing that comprehensive nature and how you can approach things, in different ways has just been incredible.

DUANE: No, I absolutely agree. As we mentioned before, we started talking my clinical background.  I saw the same thing. I have a colleague actually, who used to say that, his job was to wipe the mud off the pig, but then the pig would just go back into the pig style and get dirty again. Right.

So what more can we do? And I think really, especially at that time, and even now, as we've seen, as we're talking about this, we know that September is suicide prevention month and that's a topic that's very important to many of us who and support service members, Veterans, and their families. As a clinician, yourself and working at the Wounded Warrior Project this is a topic that you're dedicated to addressing.

ERIN: Oh, absolutely. Any person that dies by suicide one, is too many. And we certainly wanna raise a voice around suicide prevention in September and really every day. And I think that's, again, a really unique aspect of Wounded Warrior Project that we, in whatever team you work on at Wound Warrior Project, if it's the physical health and wellness team, if it's our financial wellness team or our mental health and wellness team, everything we do relates back to suicide prevention.

We're looking to increase resiliency. We're looking to improve your overall psychological wellbeing. We want you to feel connected to your community. We want to reduce that sense of isolation. We want there to be a conversation about the invisible wounds of war, the same way, and at the same frequency and comfort that we talk about the physical injuries. And I think that's something that Wounded Warrior Project is especially committed to is bringing the invisible wounds right on par with the physical wounds.

DUANE: Oh, I absolutely agree. I often describe, people say, you know, how do we solve, service member, Veteran, military, family suicide. It's not the problem to be solved. It's a lagging indicator of other unsolved problems that are below the surface. Yes, some of those life stressors like justice involvement and financial stress and employment and things like that, which Wounded Warrior Project does, but also like you said, the psychological stressors, are those things that could lead to someone having a suicidal crisis?

ERIN: Absolutely. And I think really looking at how, this isn't just, and so it probably sounds like I'm gonna talk outta both sides of my face right now that certainly there's a large mental health component to somebody struggling with, suicidal thoughts, but the solution and that responsibility, isn't only answered with a mental health solution.

And I think that's when we can, we can frame it that way that's a really empowering message, is that even without your full on degree in the mental health field, that being willing to ask the question to somebody. Well, first to know the signs and symptoms of somebody that's struggling, with thoughts of suicide, to know what to look for, and then to be willing to ask the question to that person very directly.

Are you thinking about killing yourself? And then knowing where to send that person? You don't have to be that individual's therapist. You don't have to feel like I can't have that conversation because I didn't go to school for that, And that's really, something that we're, that Wounded Warrior Project is training people on is knowing the signs and symptoms, how to ask the question and where to get that individual, who's struggling connected to the professionals that can provide the care that's needed, but there's a lot that can be done in between kind of point A the struggle and point C seeking treatment. And that's really something that Wound Warrior Project is committed to.

DUANE: Now I think that's a really great point. And I would say even maybe 10 years, 15 years ago, you may not have heard clinicians say that to say that, that it's not a mental health struggle. I think that, and again, this is something that I've often said is I, as a clinician, I don't have all the answers because if we, as an industry had it, the problem would be solved by now.

In the same way as the community programs, let's say we can't just make sure a Veteran has a good job and a good house. it has to be an integrated solution.

ERIN: Absolutely. And engaging in the conversation. This really suicide particularly in the Veteran community, this is an all-hands-on-deck model at this point. There is no one solution like you said, if there was, gosh, I hope we'd be giving it away. I hope. I hope that it would be that it would be out there.

But right now it's not. And I think that it can be very empowering to know that, Joe's citizen can do something to help. And I think that when people read about suicide, which, you know, I mentioned is certainly a tragedy within the Veteran community, but this is a human problem. And it can be a human solution and that there is something that we can do, that, that sense of helplessness and powerlessness is really, I get it very uncomfortable. And nobody likes to feel that way. But with some training, you can have an impact, a positive impact, and hopefully, stand between somebody who's struggling. 

DUANE: And I think the other piece, the other message, and you'd mentioned it earlier though, is that, we know that those conditions that are underlying, the reason why someone gets into a crisis, we know how to treat those. We know that if someone is struggling with post-traumatic stress disorder, that there are like you said gold standard treatments, or if someone has TBI or someone even has moral injury or lack of purpose that there are clinically and evidence-based solutions to be able to treat those conditions.

ERIN: Absolutely. And that's the hopeful part of this message. And so if we can increase the conversation around suicide and suicide prevention, knowing that there are those gold standards that are out there and there's organizations like Wounded Warrior Project who want to help and that want to be that resource.

We can take it from there, if somebody's struggling, and you ask the question, there are resources out there and there's treatment that works. We just gotta get you connected, but we don't know, if somebody's struggling, unless you ask, gotta ask the question.

DUANE: Yeah, I've always described it as a continuum of support. You and I, and even maybe even farther, clinicians who are working in an inpatient setting in immediate crisis, we're not the ones that are necessarily need to be there. Like I can keep myself from going to a cardiologist by practicing good heart health, right. I don't need the cardiologist to, listen to my heartbeat all the time. We need the cardiologist. We need the clinicians to be able to be available, to treat the more severe conditions if we refer to it that way. But then others can learn some of that, and we talk about mental health first aid, but some of those nonclinical tee therapeutic things you were talking about can exist as part of a continuum. And then if it gets to be too much for someone who just needs somebody to talk to, now I can get them to a clinician.

ERIN: That continuum piece is so important. And again, certainly something that Wounded Warrior Project offers this continuum of if we're gonna speak specifically about mental health support ranging from being able to help get folks connected to those more intensive inpatient treatment programs, that real crisis intervention, and then looking to kind of step down from that or perhaps we have a lot of Veterans that start on the other end of that continuum, the less intensive they're just looking to dip their toe in a little bit. You know, we have our Wounded Warrior Project Talk Program that is our, weekly telephonic, emotional support calls. Again, small T therapeutic, not, individual therapy, but it's a way to increase some accountability. It's a way to explore some goal setting, to get some support. And maybe it's in those conversations, that the Veteran has with their Wounded Warrior Project talk specialist, where they realize, you know, I am struggling a little bit more, maybe I do need a referral to an outpatient clinical therapist and we can help there.

And then perhaps, they start in therapy with their individual provider and they realize one hour, a week of therapy isn't enough. That's where Wounded Warrior Projects Warrior Care Network comes into play. This is two weeks of intensive outpatient mental health treatment using again, these gold standards of care to address the invisible wounds to address post-traumatic stress disorder, traumatic brain injury, military sexual trauma, substance use disorders.

So there's a variety of entrance points. I think it’s important to remember, there's really no wrong door to get into. And there's options and we know that it works.

DUANE: And I think the thing that I've always valued about the warrior care network is it can be dialed up or turned down, as quickly as it needs to be. Right. You know, if someone, if all I need is to be reconnect with my fellow veterans and have some highpoint adventures then Project Odyssey.

And if Project Odyssey is the only thing I need, then that's great. I get a couple of weeks in the mountains and then throughout the year. And then that's fine. But also the individuals there who are working with Project Odyssey, can tell or trained, like you mentioned to say, hey, there's something more here.

And you can dial up fairly quickly because it is part of a network. It's not a bunch of disjointed individuals who don't know what comes next. 

ERIN: Right. And I think that's really one of the key aspects here. And certainly, as you mentioned, if it's whatever door you come in at Wounded Warrior Project. If it's that adventure based workshop through Project Odyssey where you've engaged in really some self awareness and realizing, oh, I do think I need something a little bit higher.

We can get you into, warrior care network, that two week model of intensive treatment. And even that is very tailored, to that individual. There's we certainly know what treatments kind of work to address post-traumatic stress disorder and traumatic brain injury, but it's still not a cookie-cutter approach.

We still want that to be individualized to the unique needs, of each Veteran that goes through Veteran or service member that goes through this. And we really wanna be able to, again, address that whole person. This isn't gonna be eight hours a day of talking about the absolute worst thing that ever happened to you in your military career.

It'll be part of that. It's gonna be, it's gonna be a fair amount of that. And. there's going to be mindfulness and meditation training. There's going to be again, a physical health and wellness component. You're going through this treatment in a cohort. So you're surrounded. You have that camaraderie. You're surrounded by people with similar experiences, which we know is, crucial to the healing process. There's equine therapy, there's art therapy. There's ways to get at learning coping skills to address, these mental health challenges. Again in a holistic comprehensive individualized way.

DUANE: And I think one thing that you mentioned, and just to maybe foot stomp, that point is in a safe way, right? In a safe environment. I used to tell my clients is there's nothing that's gonna happen in this room that's worse than what you think is going on in your head. This is a safe place for us to be able to unpack this, to come to terms with it. And we know all the brain science to put things back together so that your life can be better after all this. And I think that fear of the worst thing that is gonna continue to happen to me is one thing that keeps a lot of Veterans from reaching out, especially for clinical help. 

ERIN: Absolutely, because our minds do a great job, particularly, individuals that have experienced, some trauma that, oh man, if I were to let this all out, I don't know that I could be put back together again. I'm barely hanging on right now. And so if I were to like peel all that tape away, that's trying to hold myself together. It's very scary and very overwhelming. And you think, oh god, I really, I don't know if I should take the chance to not be able to be put back together. But the beauty of this, particularly warrior care or any other treatment, that's providing those gold standards of care, it can be done safely. There's evidence to support it. And you're not doing it alone. This is not something that folks should do alone. The support is there, and they've earned it.

DUANE: No absolutely. I 100% agree. Again I have been fan for many years, of the warrior care network and what Wounded Warrior Project is doing. If people wanted to find out more about the warrior care network, maybe some of the programs, the work that's being done at Emory and rush, the road home program and so if people wanted to find out more about the warrior care network, how can they do that?

ERIN: I would absolutely encourage individuals to check out our website at www.woundedwarriorproject.org. That will lead to an overview of all of our programs and services and will, you know, give kind of a, an overview of our four partners. As you mentioned, we've got the road home program at. We've got home base at Massachusetts General Hospital in Boston. We have operation mend at UCLA in Los Angeles and then Emory in Atlanta. And that help truly is one phone call away. And we take it from there and I should. I think folks knowbut I'll say it anyways, that all of Wounded Warrior Projectsprograms and services come at no cost to Veterans or their families to include two weeks of intensive outpatient menta and brain healthcare. We are really looking to provide this resource. We know it works, and we wanna help.

DUANE: Absolutely. And we want to get your message out there as much as we can. Dr. Fletcher, thank you so much for coming on the show.

ERIN: This was wonderful. Thank you so much for having me.

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 is free individual learners, as well as custom trading options for organizations. 

The first point that I'd like to make is that suicide is preventable. There's any one thing to know about suicide that is the first and most important. It's not inevitable. And it's not something that requires a specialized degree as Erin said. It's something that anyone can do. It's an emergency intervention and it can be difficult. Just as it takes effort to overcome resistance, to run into a burning building or help people do to just been in an accident. It also takes effort to overcome resistance, to reach out and talk to someone about suicide if you think they're not doing well. 

And you don't have to be the hero for everyone. Uncertainty about what to do may keep us from responding to an emergency for someone we don't know. But if that were a family member or close friend in that burning building or erect car, much easier to overcome any resistance. And I'm not just saying that suicide is preventable because of  I am mental health counselor. I know it to be true from lived experience. I've personally stepped in and intervened when someone was in a suicidal crisis and help them get the care that they needed. And many of these times happened before I was a therapist or was trained in any clinical interventions. Many times it was as simple as, and as difficult as what Erin described, knowing the signs, having the willingness and the ability to ask directly, if somebody is thinking about killing themselves and then knowing the resources to share or be able to help them find someplace safe. As I often said to attendees of the suicide prevention workshops, I've hosted as service members and Veterans courage is what we do. We would run into a firefight to save a battle buddy, we take a bullet for them, but do we have enough courage to ask if the thinking about taking the own life? That's a key component. once we overcome the resistance to talking about it, then the real work of prevention can begin. 

The other point that I'd like to make is related to this. Not everyone is in crisis all the time. So when we say that suicide is preventable, we don't just mean that it's preventable when someone is in an active suicidal crisis. It is preventable then. Yes. And it's also preventable before it gets to the point of crisis, going back to the burning building. You can prevent a loved one from dying in a fire by running into the burning building and saving them. But you can also prevent a loved one from dying in a fire by helping them learn, not to fall asleep with candles burning, or to make sure that they live in a house that doesn't have faulty wiring. 

When it comes to suicide prevention people can get support at the lowest level necessary as early as possible. And as we discussed in the conversation, That's something that wounded warrior project does well. If you were someone, you know is experiencing some sort of distress related to something going on in your life, find a local support group club or organization to connect to. Maybe that's all that's needed, getting out and connecting with like-minded people that share the same interests. If you still find yourself in distress, then reach out for some peer support. Some one-on-one engagement, like the wounded warrior project talk program. If that brings up more stuff for you, then maybe you can connect with the local therapist. It's nothing wrong with it, if you had a broken leg, you wouldn't hesitate to go to a doctor. 

If you and your therapist find that more is needed, perhaps you add different things into the mix. A combination of therapy, support groups, and peer support. And then if things are still not going the way that you want them to then maybe an intensive program, like the warrior care network, two week programs that Erin described in the conversation. 

Every single one of those steps is suicide prevention in that it is preventing a suicidal crisis from happening. Accessing the lowest level of mental health and wellness care at the earliest possible time is what makes it so much easier to prevent. If we wait until someone is in a moment of crisis, then they need the highest level of care immediately. And that's something that we'd like to avoid if possible. So hopefully you found this conversation beneficial, both Erin and I know how challenging the subject can be, but also how important, especially for those of us who served and those who support.

If you appreciated my conversation with Dr. Fletcher, let us know. Place a review in your podcast player of choice, or send us an email at info@psycharmor.org. We would appreciate knowing that you're listening, what you think and what you would like to hear about in future episodes. 

For this week PsychArmor’s resource of the week, I'd like to share the link to the PsychArmor, Brain Health and Wellness Learning Series on suicide prevention. Suicide is a global public health problem. Every 12 minutes, someone in the United States dies by suicide. For Veterans, this crisis is an epidemic. Wounded Warrior Project is committed to addressing this issue by spreading and providing access to life saving tools that anyone can use to help someone in their time of need. This series removes the stigma often attached to suicide and cast the light on the unique risks, and cultural factors that contribute to suicide in the Veteran population. You'll gain access to important statistics, tools, and resources proven to prevent suicide. In addition to role-play scenarios to demonstrate effective responses to someone in need. You never know when you'll be called to intervene at a critical moment. And we thank you for being an important part of the solution. You can find a link to the resource in our show notes.