Making a Referral

If you are concerned that a Service member or Veteran might have PTSD, consider performing a screening using the PC-PTSD-5. Not all individuals who screen positive will initially accept a referral. There are a number of potential barriers to accepting a referral:

• Some Service members or Veterans may not want to be involved in mental health treatment because of stigma, shame, guilt, fear of lost income, a reluctance to let others down by being gone from their duties, or a fear that others will not trust them if they have mental health issues.
• Some Service members or Veterans may initially not be symptomatic, and may fail to see any need for treatment, only later to develop PTSD symptoms or other long-term problems.
• Some Service members or Veterans are reluctant to discuss something that they sense might bring up uncomfortable feelings.
• Those with PTSD often have co-occurring conditions, such as depression, alcohol abuse or substance use, which can make it more challenging to accept a referral or follow through with a scheduled appointment.

Connecting Service members and Veterans to Mental Health Care Services

The following list of contacts will help you connect Service members and Veterans to mental health care services:

Here are some tips to help Service members and Veterans get the support they need. Many of these concepts are no doubt already part of your practice. Others may be new to you:

• Create a safe, non-judgmental space for Service members or Veterans to share honestly what has happened as well as the meanings they are ascribing to their actions.
• Listen carefully, find the places of theological and spiritual distress, and explore the spiritual meaning that the Service member or Veteran has created for this moral dilemma and his or her actions.
• Provide suggestions about spiritual rituals or practices that might aid in the healing process.
• Explore whether there are communities or groups where the Service member or Veteran can connect with others who have had similar experiences.
• Honor the Service member or Veteran's grief and loss.
• Explore how the combat and other military situations were life-altering and assist in moving toward resilience and growth as described in this toolkit.
• Brainstorm other possible options for the person to receive support, such as peer support or support groups.
• Consider involving the person's spouse or partner in the discussion.
• Encourage the person to go to at least one appointment with a mental health provider, and ask if you can follow up with them to make sure they get connected with services, and to ensure that the referral was a good fit for them.
• If possible, give the person a list of recommended providers who use evidence-based treatment for PTSD, so that they can choose the person they want to contact. Offer to call the provider together, if that will help.
• You may have to suggest seeking help more than once, especially since avoidance is a symptom of PTSD. In your role as a clergy member you may have opportunities to point out how having PTSD symptoms may be interfering in the quality of the Service member or Veteran's life and explore how seeking help can make a difference.

Helping Service members and Veterans Understand the Benefits of Treatment

Oftentimes, Service members or Veterans resist treatment because they do not have a good idea of what evidence-based mental health treatment entails. You may play an important role in educating them about what they can expect to encounter in evidence-based treatment for traumatic stress. Emphasize that these services can help them to better cope, problem-solve, and feel better. The National Center for PTSD's website has a number of resources that Service members and Veterans considering PTSD treatment can explore:

Motivating Service members or Veterans to Seek Help

Sometimes Service members or Veterans may resist seeking help. Based on principles of Motivational Interviewing³⁷, here are some reminders of the things that we know help people make healthy decisions about their lives:

• Individuals are more likely to change if they determine that the benefits of changing outweigh the consequences of staying the same. Clergy can help Service members or Veterans make their own decisions about change by engaging them in a dialog in which they examine their perspectives on the costs vs. benefits of their current behavior. Here, the helper should simply facilitate this examination in a non-judgmental way.
• Individuals are more likely to change if they say that they need to change versus being told that they need to change. As a helper and healer, it can be hard to sit back and watch Service members or Veterans make the "wrong" decision³⁷. If Service members or Veterans are not ready to make a change and we try to tell them what changes to make, they may find fault in our proposal or focus only on the benefits of not changing.
• People can build confidence in changing if their behaviors move them closer to their stated values or goals. Service members or Veterans might identify values or goals and yet continue to do things that are not consistent with them. At these times, it can be helpful for clergy to explore the discrepancy between the Service members' or Veterans' stated values or goals and their behaviors³⁷. Having a non-judgmental conversation and employing a curious, rather than confrontational, tone can help Service members or Veterans to reconcile this gap.

If a Service member or Veteran insists he or she does not want to engage in treatment, but would like to keep meeting, mention that you may bring up referral again in the future. It is always their choice as to what steps are taken. If the Service member or Veteran would not like to keep meeting, encourage him or her to call as needed, reinforcing that you would like to follow up with a phone call or visit, just to check in. Case management check-in calls have been positively correlated with number of mental health visits and amount of reduction in PTSD symptoms³⁸.