Treatment Planning Addictive Behaviors Treatment

Treatment Planning

Addictive Behaviors

Treatment Planning and Depression

Treatment Planning

Suicide rates among current and former military personnel are astounding in comparison to non-military populations. In fact, suicides of military personnel make up 20% of all suicides in the United States (Wells et al., 2010). The deployment of a soldier places unique stress on the individual and their family. This can be particularly complicated in an individual who is at risk for mental health issues such as depression or anxiety (Wells et al., 2010). Male soldiers who have experienced combat are at an increased risk of developing major depressive disorders (Wells et al., 2010) In order to effectively prevent suicide in these individuals, several steps will need to be taken including screening, assessment, treatment planning, and treatment engagement.

The screening and assessment process will need to clarify diagnoses, ruling out Posttraumatic Stress Disorder (PTSD) which is present in many military personnel who have been exposed to combat areas. In order to clarify diagnosis, the clinician must complete a thorough history as well as a clinical interview to determine if there are underlying mental health issues that place the individual at greater risk for the development of PTSD, depression, or suicidal tendencies during deployment. Screening tools such as the Post-Deployment Health Assessment, Mississippi Scale for Combat-Related PTSD as well as depression scales such as the Beck Depression Inventory and Hamilton Depression Rating Scale can be useful in ratings of depression and overall mental health and are easy to score and interpret. A thorough suicide risk assessment will also be administered as this individual has endorsed suicidal ideation.

An initial crisis intervention plan should be implemented in order to ensure that the individual has the resources necessary to intervene and prevent suicide behaviors. At the heart of this plan is the individual's ability to identify high risk thoughts or situations that may trigger depressive episodes or suicidal behaviors. Interventions included in this plan should identify friends and/or family that can lend support when crises occur. It will also include community resources such as information regarding the toll free suicide prevention hotline [HIDDEN] TALK) which was established by veteran affairs to provide trained counselors 24/7 to veterans experiencing emotional crisis. The individual will also be provided with information regarding local emergency mental health providers in case of severe situations.

During the assessment process the clinician should consider issues such as chronic illness, decreased activities of daily living, significant loss, and underlying mental health issues (Owens et al., 2009). Military personnel also experience unique risk factors for depression such as the ending of active duty, older age, enlistment status, length of deployment and exposure to combat. The Major goal of the assessment process is to determine which if any depressive disorders are present as well as to differentiate between PTSD and depression in this individual due to the high comorbidity rates (American Psychiatric Association [DSM-IV-TR], 2000).

In the treatment planning process, one must identify which courses of treatment make the most sense given the situation of the individual. Many forms of interventions have been recognized as being beneficial with this population including cognitive-behavioral therapy (CBT), Eye Movement Desensitization and Reprocessing (EMDR), relaxation therapy, support groups, biofeedback, psychotropic medications, and behavioral interventions (Silver, Brooks, & Obenchain, 1995). Each of these interventions has been shown to produce positive, incremental change in the individual who has PTSD symptoms such as nightmares, intrusive thoughts, anxiety, depression, and relationship problems (American Psychiatric Association [DSM-IV-TR], 2000). In particular, cognitive-behavioral therapy has received substantial research to support its effectiveness as an intervention strategy. Yet those interventions that combined psychotherapy and medications have been proven to be the most effective in the military culture. However, the recommendation to consider medication management may be met with resistant by the individual and should be explored in a manner that allows the individual to feel empowered (Silver, Brooks, & Obenchain, 1995). Interventions that occur early on in the symptomatic process can also result in fewer individuals developing PTSD.

In order to successfully treat the post-combat individual, a clinician utilizing CBT needs to be able to assist the individual in identifying the role that their coping strategies played in keeping them safe and stable during deployment and in combat situations (Owens et al., 2009). Despite the positive role that these strategies played in survival, these maladaptive coping strategies often make community reintegration difficult. Successful integration will require that family, friends, and community members are not only engaged in the treatment process but are also respected for the crucial contributions that they make to the integration process.