Understanding PTSD treatment

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1 Understanding PTSD treatment Do I need professional help? Whether or not you need help can only be determined by you and a mental health professional. However, you can take the self-assessment in the PTSD Coach Canada Application to see if you are scoring in the high, medium or low range of symptoms. You can also ask yourself the following questions. If you answer "yes" to any of them, then you might want to seek help. Have you felt sad or depressed most of the time for longer than two weeks? Have you been feeling anxious or do you have distressing thoughts almost all the time? Have you had trouble working or meeting your daily responsibilities? Have you had problems in your relationships or trouble taking care of your family? Have you increased your use of alcohol, street drugs or prescription medications, or have you been using them to cope with your problems lately? Are you very angry most of the time? Do other people say they worry about you and think you should go talk to someone? Are you having trouble sleeping most of the time? Are you having trouble eating, or have you gained or lost a lot of weight without trying? Do you currently have serious thoughts about suicide, or hurting or killing someone else? If you said "yes" to this last question, please call or the suicide hotline in your area, visit the Suicide Prevention website, or go to the nearest hospital right now. If you said "yes" to any of the other questions, you could benefit from talking with a mental health professional. You don't have to wait for an emergency to speak to someone. Why do people usually seek professional help? The first few weeks after a traumatic event can be hard. It is common to have trouble with life, avoid situations, feel very nervous, and have trouble sleeping. But if you don't get better in the first month, then you should think about talking to a mental health professional. People close to you mean well, but they may not be able to help you the way you need. Maybe you would like to talk with your friends and family, but you feel cut off from them right now. Experiences like combat, witnessing suffering and dying, rape, assault, domestic violence, or loss of a buddy, may feel too private or sensitive. You may feel uneasy or unsafe to talk with someone you know. One of the most helpful ways to feel better and get back on track is to work with a mental health professional. However, many people don't seek counselling even though they might benefit from it. Professionals who specialize in working with PTSD can help you learn to manage

2 your feelings and thoughts. They can also help you feel relaxed about talking to people in your daily life, pursuing your goals and focusing on your future. Keep in mind that seeking help is a sign of strength, not weakness. Talking to a mental health professional can improve your ability to help yourself. Will it really work? Scientific evidence shows that many types of psychotherapy and medication really do work. It may be hard to imagine now, but you can get past your stress. Therapy may also help ease your transition back home. Like many others that have received counselling, there is a very good chance that you will thank yourself later for sitting through a few uncomfortable hours. If you are worried that mental health professionals can't help you or won't understand what you have been through, you may be surprised to find out that this may not be true. Mental health professionals are well trained. Some of them even specialize in working with military personnel and Veterans, rape victims, or other special populations. They cannot help or understand you if you don't give them a chance. If you have a few sessions with a mental health professional and you don't think it's going well, you can talk to the treating professional about what you want changed or you can ask for a different one. Mental health professionals are interested in your recovery and will help you get the help you need. PTSD treatments that work The good news is that there are several types of treatment that work for PTSD. The best evidence supports cognitive-behavioural therapy (CBT) for PTSD. Two types of CBT that have the most research behind them are cognitive processing therapy (CPT) and prolonged exposure (PE). Research also supports the use of eye movement desensitization and reprocessing (EMDR), and finally, medications called selective serotonin re-uptake inhibitors (SSRIs). If you have PTSD, you can look for a mental health professional who is trained in one of these approaches. What about practical things like finding a mental health professional, scheduling appointments, costs and transportation? When considering professional mental health services, many people worry about practical things that may keep them from getting help. Concerns about how to find a mental health

3 professional, the cost of treatment, getting time off from work, and transportation to appointments are very common. Each is addressed briefly below. Finding a mental health professional A good place to start your search for a mental health professional is to ask your doctor. They can make a referral for you. If you are a Veteran, you can also call Veterans Affairs Canada at and ask for recommendations. If you are a Canadian Armed Forces (CAF) member, a CAF health services centre is a good place to start your search. Every CAF medical clinic offers two levels of mental health care; psychosocial and specialized mental health programs. The Psychosocial Program provides first line services that CAF members can directly access on their own at any time. The Canadian Forces Health Information Line is available to all eligible CAF members. It is operated on a 24 hour a day, 7 day a week basis, and is designed to provide CAF members with convenient telephone access to health care advice, general health information, and guidance on where and how to access health care services. Call MED-DENT ( ) Costs Try not to worry about how much therapy will cost, until you have all the details. Think of therapy as an investment in your health and well-being. It can help you live a happier, fuller life. Veterans Affairs Canada may be able to pay the cost of counselling for Veterans with servicerelated disabilities. Services at CAF health services centres are also provided at no cost to serving members of the CAF. Scheduling appointments If you need flexible appointments so you do not miss work, look for a mental health professional that will accommodate your schedule. You want to find a time that works for you and where you won't feel rushed. Most employers will understand and help you take care of your health, whether it's physical or emotional. Often, people can work out a flexible schedule with their boss to free up time for their appointments. Transportation If getting to and from appointments is a challenge, there may be travel options available to you, including simple things like public transportation or asking friends or family members to help. You might be surprised at how many people will take the time to help you get to an appointment. Veterans Affairs Canada may also reimburse health-related travel costs for

4 Veterans with service-related disabilities. Health-related travel costs for CAF members will also be covered by the CAF health services centre making the referral. Why should I ask for help? Remember that we are not alone in this world. People are here to help. Perhaps you believe that you can handle your problems without help from others. But, people who use the sources of help around them tend to cope better than those who don't. Trying to cope on your own usually makes things harder than needed; and it adds loneliness and isolation to your problems. You may think that needing help means that you're not normal. It is common to experience problems and many people report some type of concern about their mental health after stressful experiences. Seeking professional help and talking about your experiences can help you feel better and stronger. And getting the support you need to live your life more fully shows strength, selfrespect, growth and courage. What if I'm embarrassed about seeking help? You don't have to tell anyone that you are working with a mental health professional. You can just say that you have an appointment and that it's personal. Sharing that information is your choice. Try not to be upset with people that worry about you. Their concern can come from a good place and wanting good things for you. They may be on your side even if it doesn't appear that way to you. Put yourself in their shoes. Think of a moment when a friend was having a hard time. Did you judge them for it, or were you glad that you could help? Friends, as well as family, usually want the best for you and are probably looking for ways to help you. You may think that people will judge you for getting help, because at one point you may have overheard someone making fun of someone in your situation. But you will come to find out that this usually isn't true. It's normal to have problems whether you are a civilian or someone who has served your country. Many men and women report some concern about their mental health. Believing that they will be embarrassed and ashamed for asking for help is the biggest reason that people, including service members and Veterans, don't seek help. But, take a minute to ask yourself the following questions: Is it more important for me to worry about what someone else thinks of me? Or, is it more important to get the help I need to move on with my life? Who can help me?

5 As you think about getting care, know that there are many experts to help you. The following is a brief description of the roles and duties of primary care physicians, social workers, psychologists, psychiatrists, and pastoral counsellors or chaplains. What does a primary care physician do? Family physicians and general practitioners (family doctors) are medical doctors who specialize in primary care. They are available in both the Canadian Armed Forces and civilian communities. Family doctors provide lifetime, comprehensive care for individuals and families across all ages. They are a good first contact to help you with your problems, and to help you find the services you need. They diagnose symptoms to sort out physical and mental health causes, and provide treatment considering your family and community life. To help with psychological problems, family doctors prescribe medications and provide basic therapy, and they collaborate with psychologists, psychiatrists and other mental health professionals when more specialized mental health diagnosis and treatment is required. What does a social worker do? Social workers work with people who are struggling with depression, anxiety, PTSD and substance use problems. They also help people with more severe mental health issues, and family and relationship difficulties. Social workers help clients with other challenges including finding employment, housing and government benefits. Their services may include psychotherapy or "talk therapy," mediation, sex therapy, policy and program development, organizational development, and employee assistance programs. Social workers are not medical doctors and cannot prescribe medications. In most provinces, the Bachelor of Social Work is the minimum educational requirement for entry into the profession. Post-graduate education leading to a master's or doctoral degree is also available. In Canada, social work legislation is the responsibility of the provinces and territories. Social workers work in a variety of settings: family services agencies, children's aid agencies, general and psychiatric hospitals, mental health programs, school boards, correctional institutions, welfare administration agencies, as well as federal and provincial departments. An increasing number of social workers work in private practice. You can find a social worker through advice from people you know or referrals from a doctor, a nurse or your insurance company. A social worker can help if you need someone to help you get back on track with getting a job, housing or government benefits, or if you just need someone who will listen and refer you to an expert. What does a psychologist do? Psychologists work with clients who have many concerns, including depression, anxiety, PTSD and substance use problems, as well as other mental health issues. Psychologists work with individuals, couples, families and groups. They help people deal with life problems such as family and relationship problems. Licensed psychologists most often have a Ph.D. or Psy.D. in psychology or a related field. This takes about five years after the university undergraduate

6 studies to complete. They must also complete supervised professional experience. In Canada, psychology legislation is the responsibility of the provinces and territories. Although psychologists are often called doctors, they are not medical doctors and cannot prescribe medications. Their role is to provide assessment and psychotherapy. There are psychologists working in institutions, in the community and in health care throughout the CAF and at Veterans Affairs Canada. You can find a psychologist through advice from people you know or referrals from a case manager, doctor, nurse or your insurance company. What does a psychiatrist do? Psychiatrists are medically trained to diagnose, treat and provide ongoing care for mental health conditions to patients of all ages. A referral from a medical professional is often required to access services from a psychiatrist. Psychiatrists work in a range of settings including psychiatric or general hospitals, private offices, research units, community health centres, social agencies and government. Psychiatrists use a mix of treatment options, including medications and psychotherapy, depending on the psychiatric conditions. Often part of the treatment or rehabilitation plan will include referral to or collaboration with a range of other services. What does a pastoral counsellor or chaplain do? A pastoral counsellor or chaplain is a member of the clergy who provides spiritual support and guidance, conducts religious services in the field, and offers support in emergency situations. Chaplains help people regardless of their faith or religious beliefs. Chaplains are not always trained to provide mental health counselling, but they can refer you to a general practitioner or a specialist, like a psychologist or a social worker, who can help you address your emotional difficulties more thoroughly. If you are looking for spiritual guidance as part of your road to receiving professional care, then perhaps a pastoral counsellor or chaplain is a great start for you. Where can I find professional care near me? Most communities, especially cities and large towns, have many different sources of help. If you feel desperate and need help immediately, you should call or go to the emergency ward of your local hospital; Your telephone book will have the phone number of a community service referral agency and the number of a crisis hotline that you can call; Your family doctor can help you find the professional help you need; Contact a community organization specializing in support can provide information or help direct you to a mental health clinic in your area; or

7 Contact the Canadian Mental Health Association (CMHA). Founded in 1918, it is one of the oldest voluntary health organizations in Canada. As the nation-wide leader and champion for mental health, the CMHA facilitates access to the resources people require to maintain and improve mental health. The CMHA has more than 10,000 volunteers and employees across Canada in over 120 communities. For mental health information, resources and tools and for a list of mental health services in your area, please find a CMHA community location nearest you. Other support Operational Stress Injury Social Support (OSISS) Want to talk to someone who is experienced and trained in offering peer support to those with an operational stress injury? If you are a Canadian Armed Forces member, a Canadian Veteran or a family member, OSISS peer and family support coordinators may be able to help you. For the OSISS coordinators in your area, visit the OSISS website or call Veterans Affairs Canada Assistance Service and the Canadian Armed Forces Member Assistance Program (CFMAP) Employee Assistance Services of Health Canada is the service provider for the Canadian Forces Member Assistance Program (CFMAP) and the Veterans Affairs Canada Assistance Service. This line is staffed 24 hours a day, 365 days a year, by fully-trained bilingual counsellors. It provides free, confidential, voluntary, short-term, solution-focussed counselling services to assist current and former members of the CAF and their family members with support to resolve many common psychosocial stresses. Within Canada and the United States you can call them toll-free at If you are calling from another country, you must dial the International Access Code first Services and benefits from VAC We recognize that when you serve with the CAF the work you do is unique. That's why Veterans Affairs Canada has a variety of services and benefits available to support you. Whether you are still serving and have been injured, are medically releasing or are retiring and would like help in your transition to civilian life, Veterans Affairs Canada is here to help. Services for Canadian Armed Forces members CAF Health Services is the main providers of mental health services for CAF members. The Psychosocial Program is available at all CAF medical clinics. Social workers, mental health nurses and addiction counsellors normally staff the Psychosocial Program. The Mental Health Program, which consists of specialized mental health services, is available at the larger CAF bases, with

8 elements of the program available at smaller bases. After regular office hours, members are advised to contact their local hospital emergency department. The Canadian Armed Forces Health Information Line is available to all CAF members. It is operated on a 24 hour a day, 7 day a week basis, and is designed to provide you with convenient telephone access to health care advice, general health information, and guidance on where and how to access health care services. Call MED-DENT ( )

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