Bringing It All Back Home: Social Work and the Challenge of Returning Veterans

Abstract

The June 2007 DOD Task Force on Mental Health report cited here suggests the current system of care is inadequate and unable to meet the needs of veterans now and into the future. This is so, not only because of a lack of human power, but also because of the underlying theoretical and methodological assumptions on which the system is based. The report states emphatically that the current system is not succeeding in providing successful care for those affected by the current Iraq war or in building resilience among the soldiers and their families as a whole. This report challenges the way that health and mental health care in the United States has been provided, not only to veterans and their families, but also to all of those affected by exposure to violence. In recent years, social workers, and others working in the formal health and mental health sector, have been required to apply a medical model that treats psychosocial issues as though they were diseases, to be managed through dosed therapies designed to reduce symptoms. This medical model is different from the biopsychosocial framework on which social work practice is built and the strengths perspective, which places each person as the subject rather than the object of his or her own life (Robbins, Chatterjee, & Canda, 2006). Therefore, the DOD critiques of the model of care for serving mental health needs of soldiers, veterans, and their families present social work with an important opportunity, if not an obligation. Namely, to bring its methods of inquiry to bear on the problems of reintegrating war veterans into society, as well as understanding and mitigating the effects of exposure to violence on soldiers and civilians alike. The need to build resilience and promote effective reintegration processes for active-duty soldiers, veterans, and their families is not a problem for practitioners alone. It is an issue that requires stringent intellectual inquiry to locate, test, and provide more successful models of intervention, and in so doing, shed light on the contemporary discourse regarding trauma and recovery, violence, and transformation. The task force report (DOD, 2007) provides a detailed account of the scope of the current problem facing the Departments of Defense and Veterans Affairs. According to the report, which uses data from the Post-Deployment Health Reassessment administered to service members from 90 to 120 days after returning from deployment, * 38 percent of soldiers and 31 percent of Marines report psychological symptoms. * 49 percent of returning National Guard members report psychological symptoms. * Hundreds of children have experienced the deployment of one or both parents. * Psychological concerns among family members have yet to be quantified. The report emphasizes the prevalence of co-occurring diagnoses, most frequently posttraumatic stress disorder (PTSD) and traumatic brain injury, sometimes complicated by physical injury and disability. The report states that such a range of injuries require a seamless continuum of biopsychosocial care (DOD, 2007) that is unavailable in the current system. One issue raised by the report is the emerging public health problem presented by a cohort of men and women returning from repeated deployments with untreated mental health and neuropsychological issues. Of greater concern is the loss to the nation of the enormous leadership potential that this returning cohort represents. Viewed through a strengths perspective lens (Scurfield, 2006), these men and women represent essential resources to address current and emerging social, economic, and developmental problems here at home. A BRIEF HISTORY Some history is useful to help us understand how work involving emotional and physical difficulties resulting from the effects of external real-world stressors was ceded to the medical model. The diagnosis of PTSD formally entered the nomenclature in 1980. …