Faces of Public Health: Elizabeth Clark on Social Workers and Military Mental Health

Aug 14, 2012, 11:23 AM

Faces of Public Health is a recurring editorial series on NewPublicHealth featuring individuals working on the front lines of public health and helping keep people healthy and safe.

Returning veterans and their families continue to face mental health problems linked to injuries, time away from loved ones and the stress of being at war. Military suicides are at an all-time high; recent reports show a heartbreaking one suicide a day since the beginning of 2012.

The Department of Defense and mental health professional organizations are actively promoting and creating initiatives to help service personnel, veterans and their family. A new program just announced by the National Association of Social Workers (NASW) will add hundreds of thousands of trained personnel for the military-affiliated individuals keenly in need. The NASW military program will create free continuing education opportunities for all social workers, regardless of practice area or focus, on the critical issues related to the care, culture and lifestyle of military personnel, veterans and military families. According to the NASW, the initiative adds more than 650,000 social workers to the ranks of mental health professionals trained to meet the needs of service men and women, veterans and military families.

Social workers are hardly new to the military. According to the NASW, social workers have been serving veterans since 1926, when the first social work program was established in the Veterans Bureau (now the Department of Veterans Affairs). Currently, the VA is the largest employer of master’s-degreed social workers in the nation with over 9,000 social workers. Social workers also serve in and work for the Air Force, Army and Navy in clinical, administrative and research posts.

NewPublicHealth recently spoke with Elizabeth Clark, PhD, ACSW, MPH, executive director of the association, about the mental health needs of military personnel, veterans and families and the critical help social workers can provide.

NewPublicHealth: Why are social workers such an important component to the mental health professional needs of the military?

Elizabeth Clark: There are more social workers than psychiatrists and psychologists and nurse practitioners clinically trained to work in mental health, combined. We have a tremendous workforce and they’re all over the country, in communities across the United States.

NPH: Are mental health issues of service personnel returning from Iraq and Afghanistan different from issues returning military members faced previously?

Elizabeth Clark: In several ways, yes. Traumatic Brain Injury (TBI) is the signature injury of these wars and it can be hard to understand someone who looks very, very normal, but has many significant issues that they’re going to live with. We’ve also watched people survive their injuries from these wars who would not have survived previously because of field treatment and evacuation improvements. So they’re living with injuries that are so serious, and that, of course, creates new emotional issues as well, for them and for their families. I met a young husband recently who survived, but had been blinded, lost both legs and an arm. Now, think about that. This is a young man who went to war in great shape and came back and now has a wife trying to take care of him and her kids and he’s without an arm, two legs and he’s blinded. Those challenges are huge, just huge.

Are we prepared as a society to really help individuals like that? To help them get the limbs that they need, help them get through the incredible maze of health care that’s out there, help them get a job? What happens with that young man and his family going forward? Because we had so many medical advances and we had such capability, people have lived and we’re grateful for that. We really are grateful. But I do think we have a lot of work to do in so many areas including helping veterans find jobs. You go away, and you do your patriotic duty, you come back and there are no jobs. What happens then? So many veterans are so demoralized and that’s a key reason I think we’re looking at the high suicide rate in young veterans today.

NPH: How equipped are we to handle the military suicide rate, which has been as high as one a day this year?

Elizabeth Clark: Years ago, after World War II particularly, we never talked about Posttraumatic Stress Disorder and depression. We talked about shell shock and those people were treated differently, but always respected. We didn’t know much about Posttraumatic Stress Disorder and now we’re seeing it everywhere we turn. We’re seeing more domestic violence, we’re seeing more substance abuse, we’re seeing just tremendous mental health issues that families are facing, and families are breaking up.

Many social workers were trained years ago and many of us do not have the current training that is needed to deal with these issues. So our goal is to be certain we train social workers so that they are qualified. They already have great skills; they’re great clinicians, they work in substance abuse, they work in domestic violence, but it’s the combination and the complexity of this and also looking at things such as the military culture and learning how to deal with that. How do we deal with families where someone has been deployed three or four times, not just once? Social workers will benefit from continuing education and that is what brought us to our initiative. We do believe that there are social workers out there who are great problem solvers and very resilient themselves, but the vets are also very resilient and courageous and problem solvers and heroic and we want to match those up the best way we can.

NPH:  What are the critical parts of the new initiative?

Elizabeth Clark: We have DOD/VA educators, clinicians, practitioners and uniformed social workers who are coming together to create standards for social work practice with service members, veterans and their loved ones. By setting these standards, it will help social workers understand that they need to get continuing education to be able to meet these standards. The second piece is a free online, five-course training module that all social workers can take online that will cover military culture, advocacy, direct process, cultural competency and standards review.

And then finally we’re launching a professional credential for social workers, and this is geared towards social workers who are working primarily with service members, veterans, or their loved ones. It will indicate an advanced level of learning and knowledge.

NPH: Social workers contribute to an important project called Give an Hour. Can you tell me about that?

Elizabeth Clark: Give an Hour is a nonprofit organization that brings together a network of mental health providers. It’s primarily psychiatrists, psychologists, social workers and pastoral counselors, and there are also some other counselors and marriage and family therapists that come together and they provide one free hour of mental health services each week to a service member, a veteran or a loved one. The program has provided millions of dollars in free mental health therapy and served thousands and thousands of individuals and families. And social workers represent about a third of the providers in the network. We’re really proud of that and we promote this and help our members to join the network at every turn.

This commentary originally appeared on the RWJF New Public Health blog.