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South Texas Veterans Health Care System (STVHCS)

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Kerrville MH Series: Serving Hill Country Vets

Dr. Aven Senter, welcomes the crowd in a room prior to the presentation

Dr. Aven Senter, Kerrville Mental Health Program Manager, welcomes the participants of the inaugural mental health series. A quarterly event designed specifically to meet the mental health needs of Hill Country Veterans.

By Steven Goetsch
Monday, November 19, 2018

A group of Veterans, community providers and VA employees gathered in a small classroom on the Kerrville VA campus in October to network at the first-ever Mental Health event series. The series was a concept developed to fit the more intimate nature of the Hill Country community, a departure from the full blown, all day mental health summits of the past.

Dr. Aven Senter, Mental Health Program Manager in Kerrville, said although Kerrville has increased mental health staff, their community partnerships are critical to serving Veterans. “This is a first of hopefully a long series of meetings connecting our partners in the community with our VA providers,” Senter said. “We need to improve our communication between the two because we need you desperately here at the VA.”

Dr. Jared Bakker, the newly appointed Home-Based Primary Care Psychologist, echoed Senter’s sentiments. “If we do anything here today, we need to get your feedback,” Bakker said. “We need to continue customizing and tailoring the series to fit the Hill Country, so it fits our connection, our providers.”

A group of people sitting a listening to a mental health presentation

The inaugural mental health event series focuses on a trending Hill Country mental health issue or topic. The series is a departure from year's past where it brought larger crowds and covered the gamut of mental health programs.

Backgrounds and Veteran experience were as diverse as the patients they see. County service officers, social workers, nurses and transition assistance coaches and Veteran Experience Officers came to network and knowledge share.
One of the biggest knowledge brokers was Tanya Workman, VA Licensed Professional Mental Health Counselor. She was the key note speaker at this inaugural event, and her experience made her an easy choice. Prior to serving Veterans, she spent a career serving in the Army.

That first-hand experience was valuable to her audience as she warned them about military culture and the barriers it creates to treatment. “Veterans learn the culture of sucking it up,” Workman said. “You learn to minimize your symptoms. You don’t want to talk about certain things or issues if it puts you at risk for losing your security clearance.”

She added that another barrier to care is perception. She has met many Veterans who, after their treatment, share that they were surprised because they thought they would not receive good care. Workman told the audience that she stresses three guidelines for treatment; changing expectations, encouraging self-advocacy and facilitating engagement. Workman shared many of the tools she uses with her community peers through analogy. “We want our Veterans to be in the driver’s seat, we are simply to be beside them and holding the emergency brake,” Workman said. “We want them to know they have the biggest say in how they go forward in treatment.”
One of Workman’s favorite ways to empower Vets is introducing them to MyHealtheVet, a patient portal that puts medical records and even providers a mere click away.

Workman wasn’t the only VA employee that offered Veteran tips. Kathy Turner, a social worker who manages the Kerrville Homeless Veterans Program, said linking Veterans to services starts long before getting a MyHealtheVet account. “Many of you have intake forms that will ask, have you ever served in the military,” Turner said. “What I would suggest is that you take the next step and ask, ‘”are you enrolled in the local VA,’” Turner added.

Turner gave the suggestion because she comes across many Veterans that do not believe themselves as eligible or worthy of VA care because they never went to a combat zone or were hurt in a training accident. She said the qualification system can be rather complex, and that is what a benefits advisor is for. She handed out benefits cheat sheets so the community providers could make informed referrals.

A man is standing in front of room of community providers giving a talk as part of a Veteran panel

Ryan Ussery, retired from the U.S. Army, was a member of a Veteran panel who told their personal stories of transition to the group of community providers so they could get a better understanding of Veteran's issues

That was music to Melissa Carder’s ears. She is a social worker at the Kerrville State Hospital. The program topics were right on point for her. “As part of my job at the state hospital, I plan discharges,” Carder said. “I want to make sure they [Veterans] have adequate services whether it is at the VA or a community resource.”

She has seen a slight uptick in her caseload Veteran population. She said it is important to attend sessions like this one because it is a good reminder of the challenges that Veterans are going through.Her feedback included that she hopes to see the complete compensation and pension system laid out smartly so it is more understandable. Carder also loves the repetitive nature of the event series because the conversation between VA and community providers needs to continue.
Following Workman’s briefing, the attendees were introduced to a Veteran’s panel that was asked to speak about their personal military transitions.

Meghan, an Air Force Vet, had a difficult transition which was expedited due to a medical condition. She told the audience of providers that one of the reasons she came out of her transition unscathed is the support of her husband who was still active duty. She also said that isn’t the norm for everyone. “When you get out, you are in a completely different environment. There is no control, and you do not have the same access and support you are used to,” Meghan said.
She also shared her own reluctance to get treatment. “As far as my experience as a Veteran, I get my care here even though I was nervous at first,” Meghan said. “After I got to know the doctors, I actually felt really comfortable.”

Michael, a 27-year Army Veteran also had a difficult transition except many of his issues centered around his family. He loved serving, but elected to retire to spend more time with them. “I’m already at a heightened state, coming from a place that’s being mortared every day, so when your kids do something that scares you, you lose your temper,” Michael said.

“It boils over, and after being married for 23 years, you have your wife tell you, get help, or we’re gone,” Michael said, adding that he was forced to man up. He pictures himself as an Army warrior, and he viewed his loss of control as a sign of weakness.
Michael was tense while speaking to the room. He said himself, like many other Veterans, do not feel comfortable talking to civilians about those issues. He overcame his anxiety because he hopes that he could provide extra tools for the Vets coming up behind him.

The remainder of the event was dedicated to networking and learning more about the true mental health network that exists in the Hill Country. A special committee will determine the topics and time for the next event series.


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