Transitioning and Grief Royal Ottawa Operational Stress Injury (OSI) Clinic
Overview Introduction to Ottawa OSI Clinic The Importance of Transitioning Overview of Transitions Encountered Transitions and the Family Understanding Loss Understanding Grief Dealing with Grief & Loss Resources & Discussion
The OSI Clinic The Royal Ottawa OSI Clinic is one of 10 clinics across Canada. The Clinic is fully funded through Veterans Affairs Canada with services delivered through the Royal Ottawa Mental Health Centre. Staff consists of: psychiatry, psychology, social work, nurse, research & program evaluation coordinator, a program assistant, a manager of patient services and an operations director
The OSI Clinic We offer services to Veterans of the Canadian Forces (CF), eligible members of the CF, and the Royal Canadian Mounted Police (RCMP) who have (or suspect they may have) an OSI. Services are also offered to family members.
Operational Stress Injury Any persistent psychological difficulty resulting from operational duties performed while serving in the Canadian Forces or the RCMP. The term OSI was created to fight stigma. Umbrella Term: PTSD Depression other Anxiety Disorders Substance Use Disorders and others
The Importance of Transitioning and Grief
The Importance of Transitioning Transitions are an important and normal part of life. Transitions can be challenging. Leaving the service to become a civilian creates transitions in many areas of life that can become losses.
The Importance of Transitioning Adding an OSI and or physical health problems can add more losses. Losses need to be acknowledged. Grieving loss is a normal process.
Transitions Commonly Encountered in Service
The Nature of Release Type of Release (medical, voluntary ) Expected or Unexpected Voluntary or Imposed Ready or Not Ready Supported or Not Supported These factors can affect how prepared and supported the individual feels in facing upcoming transitions to civilian life (family, work, social, cultural )
Transitioning from Service to Civilian Life Behaviours that were necessary, normative, and adaptive during service may no longer be helpful.
Service Culture Organizational culture Organization = family Structure & routine Dealing with emotions and stress
Transitions Mission Orientation Mission Before Everything Focus on specific task More Flexibility & Choice Individual needs considered Multiple tasks and priorities
Transitions Safety Trust in buddy s training stick together, rely on them Trained to be aware of surroundings May feel isolated and wonder who s got my back Increased concern about safety
Transitions Decision Making Clear chain of command Following/giving decisive orders No questioning Collaborative, no clear chain More flexibility and discussion Input given from multiple sources
Transitions Structure & Routine Everything operates on a schedule, carefully timed Structure = safety & predictability Heightened readiness Multiple inputs on schedule, frequent changes Structure = helpful convenience (not safety mechanism) More relaxed, flexible
Transitions Family Roles & Routine Family adjusts to job requirements Changes are primarily related to service Set roles in family Need to balance family needs and work/career Changes may be family-determined Roles may need to be re-negotiated
Transitions and the Family
Transitions & the Spouse Makes independent decisions Routine and role of a Single person or Parent Must discuss and make compromises Must adjust to being part of a couple, co-parent
Transitions & Children Experiences Difficult Emotions Feels lack of control Feels uncertain with change in parent s mood, physical ability, & role Change of Behavior and Stress New routines, roles, and expectations Feelings of confusion May feel they are to blame
Sesame Workshop Homecomings: Family Routines http://www.sesameworkshop.org/initiatives/e motion/tlc/
Transitions & Family & OSI"s Member develops OSI Caregiver Burden Less Communication Avoidance, numbing & anger Reactive to partner (walking on eggshells) Verbal - physical outbursts
Film Clip from Children of Soldiers by Claire Corriveau National Film Board of Canada Production Available at www.nfb.ca
Understanding Loss
Understanding Loss A loss is when something or someone we are attached to is no longer available to us. Transitions often result in a loss. Losses are a difficult and normal part of life.
Resiliency Resiliency is described as behavioural elasticity This refers to an individual s ability to cope in a way that matches the situation
Types of Losses Death Psychological or Moral Injury Physical Injury Relationships Roles & Responsibilities Identity Financial & Employment
Death Family member Close friend or service buddy Directly or indirectly
Psychological or Moral Injury Witness disturbing actions or scenes Loss of values & changed beliefs Witness morally questionable behaviours Question human nature
Physical Injury Loss of limb(s) Chronic Pain Brain injury Limited or loss of sight / hearing
Relationships Conflict or detachment Separation or estrangement from children or family Disconnected from service friends Socializing may be a challenge
Roles & Responsibilities Role as a professional Feeling unproductive or useless More or less involvement at home (chores or parenting) Shift of role (new work setting, at home)
Identity Who am I out of uniform? Sense of belonging (service family ) Body image / fitness level Living with an OSI
Financial and Employment Job security, income or financial stability Finances may limit activities Change of daily routine No longer provider
Understanding Grief Grief is the natural reaction to a loss. Grief is a process. There is no right or wrong way to grieve. Grief can involve a wide range of responses (emotional, cognitive, behavioural).
Four Tasks of Grieving J. William Worden, Ph.D. Accept the Reality of the Loss Experience the Pain of Grief Adjust to a New Reality Withdraw Emotional Energy & Reinvest
Grief and OSIs Is it grief, OSI or both? Acute vs. chronic Similar manifestations
Similar Manifestations 1) Emotional and Psychological Effects Anger, Sadness, Betrayal Anxiety, Depression 2) Physical and Cognitive Reactions Somatization, sleep disturbance Memory lapse, lack of concentration
Similar Manifestations 3) Spiritual and Existential Questioning Uncertainty & unpredictability Why me? ; What now? 4) Family and Social Expectations Isolation, avoiding gatherings Fear of being judged, lack of intimacy
Dealing with Transitions, Grief and Loss Look after your health (sleep, diet, exercise) Some options for support: Family, friends, peer support Consider a support group Religious or spiritual leader Therapy may be helpful
Dealing with Transitions, Grief and Loss Try to accept your emotional reaction remember that reactions to losses can vary and there is no right or wrong way to feel. Try to express how you feel in a helpful way: Talking, writing, finding a creative outlet. Be patient with yourself! Transitions can be challenging and grieving can take time.
Dealing with Transitions, Grief and Loss If you have an OSI, or if you feel your emotions are too intense or difficult to cope with, consider seeking treatment with a qualified professional. Speak to your family physician Ask your Case Manager
Some Suggested Resources: www.rohcg.on.ca www.vac-acc.gc.ca/clients/sub.cfm?source=mental-health www.istss.org www.ptsd.va.gov www.ementalhealth.ca www.traumacenter.org THANK YOU! www.sesameworkshop.org/initiatives/emotion/tlc http://www.nfb.ca/film/children_of_soldiers/