Transcript
Nicole Militello (00:04):
You're listening to RadioEd, a University of Denver podcast.
Lorne Fultonberg (00:09):
We're your hosts, Lorne Fultonberg-
Alyssa Hurst (00:11):
Alyssa Hurst-
Nicole Militello (00:12):
And I'm Nicole Militello. With Veteran's Day right around the corner, we wanted to explore not only the mental health struggles and obstacles to care veterans may face, but also highlight the resilience and strength of our veterans. President Biden recently called suicide among service members, veterans, and their families, a public health and national security crisis, with an average of 17 veterans dying by suicide each day. We'll hear more about this crisis later, as I chat with Kathryn Barrs. She's a clinical director of The Sturm Center, which is a behavioral health training clinic for veterans, service members, and their families. But first, we'll hear from veteran Evan Stratton. He was just 17 years old when his parents had to sign his paperwork for him to enlist in the military. That launched a journey that would shape the course of his life. And now he's working to shift the conversation about veteran's mental health, inspiring veterans to reach their full potential. The story he shares starts in 2009, after he joined the Marine Corps and was deployed to Iraq. Just nine months after arriving, his team was injured in an ambush that defined the rest of his military experience.
Evan Stratton (01:16):
I took a bunch of shrapnel wounds to the face, neck, arm, body, upper extremities, everywhere. So I had a traumatic brain injury from that, bunch of shrapnel puncture wounds all throughout my body. My spinal accessory nerve was severed, so I was paralyzed on my left trap shoulder and tricep for almost two years. I mean, it never fully recovered, but I got the vast majority of it back, which is good. Piece of shrapnel, about the size of a bullet, went into my neck, actually pushed into my carotid artery and stopped without punctuating it. Had shrapnel go through my eyelid into my ocular bone and all sorts of fun stuff.
Nicole Militello (01:57):
After that ambush, he set out on a long journey to recover.
Evan Stratton (02:01):
I had over 13 staples in my neck to put my neck back together. Had over 50 stitches in my mouth. My lip had to be reattached. I think all in, I was somewhere like the 250 stitches range. And with my nerve being severed, not really being able to move my arm, I could bend at the elbow, but I couldn't lift my arm up or do those things. I spent a lot of time at doctor's appointments, a lot of occupational therapy, neurology, physical therapy, eventually, once I started to get some more nerve recovery back. And that was usually just I spent about two and a half years doing that, but then, really, that recovery continued as I got older into the more mental health aspects of it. So the brain injury I had suffered was largely ignored.
Evan Stratton (02:49):
So then, when I left the military and went to school, cognitively, I was having these challenges that I didn't used to have. And so that really brought to light a lot of those issues so I could start addressing those. And in that same attack, my gunner and good friend, Brandon Lata, was killed. I was 19 years old when that happened. So I don't think I really had the emotional depth of comprehending that. And so when I left the military in 2011, I was a little bit older. I really had to come to terms with PTSD and those aspects of my injuries that were invisible, but that were greatly affecting my life. So I went through a whole gamut. Had years of therapy and all very well worth it to get to a good place.
Nicole Militello (03:36):
And that inspired him to take on another kind of challenge.
Evan Stratton (03:39):
Yeah. So I got involved with Fight Oar Die, and it's O-A-R [inaudible 00:03:45] puns. So Fight Oar Die is an all-US-veteran ocean rowing team. It was founded in 2017 by four army veterans that decided that they wanted to inspire veterans to live their lives instead of taking them.
Nicole Militello (03:59):
So Stratton joined for the second year and prepared to row across the ocean as part of the Talisker Whisky Atlantic Challenge, the world's premier ocean rowing race that takes challengers on a journey from the Canary islands to the Caribbean.
Evan Stratton (04:11):
So it's a completely unsupported row, which means you have no sails, no motor. You have no support boat following you. All of your supplies, everything has to be on the boat and it's all entirely human-powered. So, as we say, "You ain't rowing, you ain't going." More people have been to outer space or climbed Mount Everest than have ever rowed across an ocean. So it's a very little-known sport. I guess you could call it sport, adventure but is hands down one of the hardest things I've ever done.
Nicole Militello (04:42):
In December of 2019, Stratton and his three other veteran teammates went on their journey across the ocean. It took them 50 days, 11 hours, and 35 minutes to complete the challenge.
Evan Stratton (04:53):
So you have super-flat days where there's no wind and it feels like you're rowing in concrete. You have days where there's just constant 20- to 30-foot swells. We had days where there was 45-foot swells, which it's like the whole earth is moving, and you just go through everything. What made it so hard and so difficult is that you don't know when it's going to end. You really do have to have these like deeply internal anchors of what's your motivations and drive to do it. One of it is the veteran aspect. So I was a veteran that struggled a lot with my mental health.
Evan Stratton (05:33):
I had a suicide attempt in 2013, and I was in a really low point at one point in my life. And luckily, I had a great support system and got some help. And I put in not just a little bit of work. I was in therapy and other things for the better part of three years. But it got me to such an incredible place to where I was succeeding in my own life. That, for me, is something I really wanted to translate into the rows that, "Hey, not only is this to inspire other veterans to do this, but think about where were... Evan, think back to where you were a few years ago. Think back to like 2013. Where you are now, you're actually rowing across in the actual ocean." So I've actually lived the experience of rowing in my personal ocean and then rowing in the actual ocean.
Nicole Militello (06:22):
Stratton says there is a part of veterans' mental health that is often overlooked.
Evan Stratton (06:26):
I mean, everyone really knows about PTSD and TBI as these invisible injuries that veterans face. But I think the big thing, like I mentioned, that is so often ignored is transition stress and the challenges that come with just with transitioning. It's a traumatic event in of itself to leave the military. You lose your entire social structure because you often don't stay where you're stationed at. You return to wherever you're from. Most often you've been gone for years. So everyone you knew back home and friends and family have been moving along their lives, and they've moved along in their lives without you being a part of it. So you have to integrate back into a social structure that you haven't been a part of for a very long time. You lose all sense of security. You no longer have consistent paychecks. You don't have the access to medical care in the same way that you had it. All your basic needs are provided for in the military, and you lose that. And then, biggest of all, you have to redefine yourself. You lose your sense of self. I was no longer Sergeant Evan Stratton, United States Marine, walking around with that mission and with that purpose. So I lost my purpose as well. And all veterans go through this.
Nicole Militello (07:41):
And just like his row across the ocean, Stratton shares how mental health wellness is a journey.
Evan Stratton (07:46):
It's an ongoing process in that there's no finish line to mental health and wellbeing in the same way, physically, we can always grow and change. Mentally and emotionally, we'll continue to grow and change. And that's what we want at Fight Oar Die is that, "Hey, rowing your personal ocean is the first step. If you're struggling and you're not in a good place, get the big issues figured out and get to a good place, but then what's that step beyond? How do you, then, not only just get to a good place but thrive beyond it?" And I think that's the next frontier for veteran mental health is that we don't want to just get through our issues as veterans and, hey, address issues. We want to be leaders in our community. I mean, who better than a veteran, in the community, who has struggled with their own mental health issues, has all this life experience, that's a well-respected profession and background to be able to stand as a leader in their community, be an advocate and leader and inspiration to others that aren't in the military?
Nicole Militello (08:52):
That was veteran Evan Stratton. Now, let's turn to my conversation with Kathryn Barrs who's a licensed clinical psychologist. She's also the clinical director of The Sturm Center, a behavioral health training clinic for veterans, service members, and their families. She shares some of the main struggles veterans and their families are facing right now.
Kathryn Barrs (09:12):
At this point in time, we actually have 19 million veterans in the United States. Some of the challenges that we're experiencing right now for veteran service members and their families are the same ones that we've always experienced. However, there also are some that are more pertinent right now, such as there are 17 veterans a day who die by suicide. One of the difficult new statistics is that women veterans are also dying by suicide at a higher rate than we've ever experienced in the United States. A 2020 study showed us that veterans are more likely to experience trauma than non-veterans in the United States. And one of the things that's really difficult is that our male veterans are less likely to ask for care than women veterans, most likely due to the stigma associated with asking for help and some of the cultural paradigms, if you will, in the military, such as pull yourself up by your bootstraps.
Kathryn Barrs (10:18):
So we know that male veterans actually wait for much longer before seeking care than their women counterparts. Various theories around that include a higher rate of exposure to interpersonal traumas, such as sexual assault, military sexual trauma. Also, women veterans are now being put in combat positions and combat roles, which was not the case before. Some of the recent information about women during COVID, and specifically women veterans during COVID, is that often they're taking on even more than their male counterparts in terms of taking care of childcare, roles in the house, taking care of the home, and also working. So there are ideas that maybe those various roles are increasing the level of suicide for women veterans.
Nicole Militello (11:16):
I'm curious if you have any context for the 17 veterans a day number. How has that shifted over the years?
Kathryn Barrs (11:23):
That is such an interesting question. And honestly, I wish so many more people would ask that question. It is a very complicated question. The stats, when I first started working with veterans and service members, was 22 veterans a day die by suicide. That's often still the one that you will hear quoted. However, that's not consistent with the current literature and the current research that we have in the field. So now, there's a combination of views here. One is that the numbers have decreased in combination with we're measuring those numbers differently over time. So they're going to look differently, which is what happens with research in general. I will say, though, there have been some campaigns over the past five or 10 years through the Department of Veterans Affairs. They've come up with some really innovative treatment options and approaches that have actually made a very significant impact on veteran suicide. One of the statistics that's really important to say today is that even though veteran suicide is an extremely important issue, we should always continue to work towards decreasing this always. But it's important to point out that since COVID hit, veteran suicide has actually not increased for veterans enrolled in VA care, which is really interesting and really indicates that a lot of the programs that the VA has in place are really significantly helping those veterans who are enrolled.
Nicole Militello (13:11):
That's great to hear, because my next question was about the COVID-19 pandemic and what kind of impact that it has had on veterans. And I know you talked about women veterans being more affected during COVID, especially with the burden of childcare. Are there any other impacts that you want to highlight for people?
Kathryn Barrs (13:26):
Absolutely. Yes. And I mean, the Coronavirus Pandemic, along with the political unrest that our country has experienced in the past several years, has played a very big role in civilian mental health and veteran mental health. So that is not unique to veterans and service members, but there are unique ways in which it has impacted veteran service members and their families. So we don't have all those stats yet. Those are stats we're collecting, but some of the preliminary stats tell us this: Black indigenous people of color veterans have higher rates of unemployment than their white counterparts. They have also had more difficulty accessing basic resources like food, shelter, childcare, and transportation since COVID-19 hit. Another one of the things is that we know that because veterans and service members have experienced higher rates of trauma than their civilian counterparts, what's going on in the world right now can really trigger some of that trauma and bring up some of those prior symptoms that they may have been experiencing or were currently experiencing.
Nicole Militello (14:47):
One thing that I wanted to ask you about too is... And this came up in my conversation with Evan that we heard earlier is, he was talking a lot about how there's just so much of a focus on veteran suicide and traumatic brain injuries, which should obviously be something that we're talking about, but also he wanted to emphasize the transition back to society. And I was wondering if you can just talk a little bit about like what conversations are you hearing surrounding the transition aspect for veterans?
Kathryn Barrs (15:12):
Oh, absolutely. And it's not just veterans that struggle with transition. It's also active duty service members, because if you think about Guard and Reserve, they're active duty for part-time in their job, and then they also usually have civilian jobs. So they are constant going back and forth between civilian jobs in the civilian world and the military world and military jobs. So their transition is constant. So this is a very, very significant issue. Some of the things that I've heard veterans and service members, who I've worked with over the years, talk about are just really struggling with coming back from an extremely structured environment, like the military, to a pretty unstructured place, like the civilian life. I think if we're civilians and we haven't been in the military, we might think that it's pretty structured here in life. It's not compared to the military. And so that can often be really difficult for the transition for people coming back.
Kathryn Barrs (16:22):
Another thing that can be really hard is that, in the civilian life, rank and authority is not as clear. We work at the University of Denver where there is a hierarchy, but it's more horizontal in the way that people engage with each other. That is very difficult for a lot of veterans and service members to make sense of. So that's a challenge that I often hear them talk about too. Another is, think about being in the military. You are there and with very strong values and an overarching mission. When you come back to civilian life, a lot of people often feel like they don't have that mission anymore. They feel like they're flailing around out there trying to find a mission, trying to find a sense of connection and meaning. So those are some of the things that they're often faced with.
Kathryn Barrs (17:19):
Another thing I hear a lot of them talk about is the fact that there's a lot of changing roles within the home. If one family member is deployed and the other is at home, the roles completely change that service members and veterans can miss major life milestones with their children. They can miss birthdays, they can miss holidays, and so forth. And so coming back to civilian life, they often have to completely resettle in with their family, roles have to be readjusted, and it is a struggle.
Nicole Militello (17:57):
You mentioned this a little bit earlier, but I want to make sure we talk about it more, the recent withdrawal of troops from Afghanistan and the impact that has had on veterans. And we're just curious, what are some of the outcomes that you've heard, whether it's positive or negative, of that withdrawal?
Kathryn Barrs (18:09):
Yeah, I mean, this is so complicated. The fall of Afghanistan has been extremely stressful for many veteran service members and their families. And I always want to emphasize and their families because they are deeply impacted too. And so I have heard a variety of responses from my veteran friends, my veteran family members, my veteran colleagues, and the veteran clients that I work with. Some people were relieved that we withdrew and that no American service members would be hurt any longer in country, in Afghanistan. I would say though, that I have heard a strong mixture of feelings of disappointment, fear. A lot of veterans and service members are extremely angry. They live by the motto that you don't ever leave a brother or sister behind. And so when we withdrew and there were refugees, translators, our consultants still stuck there, that was really painful for a lot of people.
Kathryn Barrs (19:29):
I think a lot of veterans and service members are feeling helpless. They would do anything to put that uniform on and go over there and help. Their work in Afghanistan created a lot of improvements in quality of life for a lot of people while they were there. And to see that shift has been really painful. We've had a lot of veterans and service members come in to express increase in symptoms in PTSD, increase substance use, a lot of them talking about sleep problems, changes in appetite, but also a lot of discussion about moral injury. Moral injury is what occurs when somebody engages in a behavior or an action that's inconsistent with their values. So we have clients at our clinic now talking about "I went into this country. I went into Afghanistan. I had to kill people. That is not consistent with my values. I did it for the mission and for my love for the country and for freedom. However, now, after the fall, was what I did worth it?"
Kathryn Barrs (20:44):
And so that in itself, that's causing a lot of existential angst and pain for some veterans who are questioning was what I did worth it. It is so important. I cannot emphasize enough that it's important for us to be telling our veterans and service members that no matter what is happening in Afghanistan in this moment, their service there, and anywhere, was meaningful and impactful. And that's really important for us to say as a community. It doesn't matter if we agree or disagree with the conflict. We still need to be supporting our veterans and service members during this time.
Nicole Militello (21:29):
One thing that we heard from Evan earlier about his row across the Atlantic Ocean and just the mission behind it about how it was to shift the conversation around mental health and veterans. And a lot of the work that you're doing at DU with The Sturm center also aligns directly with that goal. And I was just wondering if you can share with us, why is shifting the conversation so important?
Kathryn Barrs (21:50):
Oh, it's critically important. We have a history in the United States of categorizing our veterans in this bimodal way. So it's hero on one side or damaged goods on the other side. And although hero is preferable, it still creates a lot of tensions and angst for people who don't consider themselves a hero. And damaged goods is clearly unhelpful. So what Evan spoke about and what Fight Oar Die is doing is really working to change the narrative and show that veterans and service members are extremely resilient human beings. Fight Oar Die talks a lot about post-traumatic growth. They refer to rowing your own ocean, meaning doing your own work, getting to know yourself, and then giving back to the community, showing your resilience. We need to be focusing on that as mental health providers, as a community as a whole, and Fight Oar Die is doing that.
Nicole Militello (22:58):
Can you talk a little bit about some of the main barriers that veterans might face in accessing mental health care?
Kathryn Barrs (23:04):
Absolutely. We talk a lot at the University of Denver about what are some of the barriers that veterans and service members and their families experience when accessing care. Some of those barriers to access include long wait times from a lot of organizations. And honestly, that has skyrocketed, wait times have since Afghanistan hit. So long wait times. Although there are so many well-meaning civilian or community providers, they're not always trained in how to provide culturally-competent care to veterans and service members. So some of the veteran dropout rates show that veterans are more likely to drop out when they don't feel that their providers are culturally competent or understand their system.
Kathryn Barrs (23:59):
Another barrier is just some of the stigma or some of shame around asking for help, especially if people are still active duty. There's a lot of fear about losing your career or how that might impact you and your family's stability. Access for spouses or partners and loved ones and children is very limited. Although many of those families have TRICARE, there's not enough TRICARE providers to meet this need. There's not enough VA providers. There's not enough community providers, which is part of why the graduate school of professional psychology created the Military Psychology Specialty so that we can be training a new generation of psychologists who are culturally competent to go out wherever they work and help improve that gap.
Nicole Militello (24:57):
And what are some of the next steps that you think we need to see to adequately address some of these issues that you just mentioned?
Kathryn Barrs (25:03):
Well, as I was just saying, we need far more providers who are trained to provide culturally-competent and evidence-based care. There are very significant things about military culture that can impact veterans' lives significantly. So providers or civilians, community members, really need to have a basic understanding at least of some aspects of military culture. Military culture is much more of a collectivist society, or it's more of a collectivist way of being than the individualism that we mostly experience in the Western world. So it's important to understand that some of those values can be really different. Also, some of the values could include pull yourself up by your bootstraps, keep going with the mission no matter what, keep moving forward, which can be really helpful during a combat zone, but not so helpful sometimes in civilian life when you're back.
Kathryn Barrs (26:08):
I've also had a lot of veterans tell me that they went to a community mental health provider who was so kind and well intentioned, but was completely in shock when they provided details about military sexual trauma or about some of the traumatic events that they experienced. I've also heard of some of them say that their therapists looked distressed or, since they had not heard that content before, had a really hard time digesting it and maybe weren't as able to respond in a trauma-informed manner. So that's why cultural competency is really so important, not just to understand the environments that they've worked in, but they've also lived in those environments, but also to understand how to be the most supportive that you can to them.
Kathryn Barrs (26:58):
We also need to understand, as a society, that traditional psychotherapy is not always the way to go for people. We need to place more importance on methods of healing, such as yoga, art therapy, rowing across the ocean like Fight Oar Die's doing, acupuncture, things like that. And systems are starting to respond to that, but I think we need to firmly put that in place in our culture that there are alternative ways to healing for people.
Kathryn Barrs (27:33):
Also, the United States has not traditionally done a great job with accepting our warriors back into culture. In tribal communities, in historic communities, when a warrior or a combat veteran comes back from battle or war, the community has traditionally accepted that responsibility for the veteran, provided cleansing rituals, surrounded the veteran with love and support. I don't think we have learned to do that as well in Western culture. And we really need to focus on how our community can help veterans in this situation. I also would say that it's so important for us, as a community, no matter our political views, our party alignments, whether or not we agree with the conflict, the war, or the mission, that we still support, our veterans, our service members, and their families. We learned after Vietnam that not supporting them could have a tragic effect. And it did. So no matter our political leanings or our views on war or any conflicts, we need, as a community, to unite and support these individuals through the time of readjustment.
Nicole Militello (28:59):
Yeah. Can you actually talk a little bit more about just the resilience piece that you were talking about, that you mentioned earlier on how it's so important that we focus on it? What do you want people to know about that resiliency aspect of veterans?
Kathryn Barrs (29:11):
Veterans have so many strengths. They are trained, in their military service, with stellar problem-solving skills, how to be a team, how to focus on group cohesion, how to deal with stress, how to deal with dangerous situations in a grounded manner, and whether or not we as civilians agree with their values, they have strong values and engage in behaviors to live consistently with those values. I think civilians have a lot to learn from our resilient veteran counterparts. Many of them are our leaders in this country, and we should really be putting them in many, many more leadership roles because they're the ones that have those skills.
Nicole Militello (29:58):
If you're a veteran in crisis or concerned about one, you can call the Veterans Crisis Line at 1-800-273-8255. Visit our show notes at du.edu/radioed for more resources and information about The Sturm Center. And that's a wrap for season two of Radio Ed. Thank you all so much for listening. Alyssa Hurst is our executive producer. Tamara Chapman is our managing editor, and James Swearingen arranged our theme. I'm Nicole Militello, and this is Radio Ed.
