Comparative Analysis of the U.S. and Armenian Veteran Mental Health Services

Authors

  • Elina ASRIYAN Yerevan State University, Yerevan, Armenia
  • Davit GEVORGYAN Department of Social and Clinical Psychology, Yerevan State University, Yerevan, Armenia https://orcid.org/0000-0001-8434-8458
  • Lilit MESROBYAN Department of Social and Clinical Psychology, Yerevan State University, Yerevan, Armenia https://orcid.org/0000-0003-1344-7314
  • Mher NAGHDALYAN Department of Social and Clinical Psychology, Yerevan State University, Yerevan, Armenia https://orcid.org/0000-0003-1645-6160

DOI:

https://doi.org/10.24234/wisdom.v23i3.848

Keywords:

veterans, PTSD treatment, psychotherapy, mental health, U.S. and Armenian experience

Abstract

This article aims to present the analysis of systematic approaches to the treatment of PTSD and war-related mental health issues adopted in Armenia and to illuminate possible differences and similarities between the latter and the best practices implemented in the USA.

The analysis of the aforementioned mental health systems has been carried out based on three main axes: general treatment management, diagnosis and treatment planning, treatment and subsequent follow-up.

As a result, we have concluded that despite the absence of a regulatory framework of the Armenian mental health system and the lack of a well-thought-out organization of patient admission, therapy and follow-up procedure, the model in place has more similarities than differences with the U.S. system. In particular, the therapeutic modalities, the format of psychotherapy, and the clinical supervision of specialists implemented in the psychological centres across Armenia are in line with U.S. standards. Nevertheless, as the psychological assistance delivered to veterans is not regulated on a national level and as there is currently a significant lack of institutional and professional resources, the improvement of the efficiency and the quality of mental health services in Armenia remains an important challenge.

Downloads

Download data is not yet available.

References

Bisson, J. I. (2015). Post-traumatic stress dis-order. BMJ (Clinical Research ed.), 351, h6161. https://doi.org/10.1136/bmj.h6161 DOI: https://doi.org/10.1136/bmj.h6161

Bovin, M. J., Miller, C. J., Koenig, C. J., Lip-schitz, J. M., Zamora, K. A., Wright, P. B., Pyne, J. M., & Burgess, J. F., Jr. (2019). Veterans’ experiences initiating VA-based mental health care. Psychological Services, 16(4), 612-620. doi: 10.1037/ser0000233 DOI: https://doi.org/10.1037/ser0000233

Crocq, M. A., & Crocq, L. (2000). From shell shock and war neurosis to posttraumatic stress disorder: A history of psychotraumatology. Dialogues in Clinical Neuroscience, 2(1), 47-55. doi:10.31887/DCNS.2000.2.1/macrocq DOI: https://doi.org/10.31887/DCNS.2000.2.1/macrocq

Edwards-Stewart, A., Smolenski, D. J., Bush, N. E., Cyr, B-A., Beech, E. H., Skopp, N. A., & Belsher, B. E. (2021). Posttraumatic stress disorder treatment dropout among military and veteran populations: A systematic review and meta-analysis. Journal of Traumatic Stress, 34(4), 808-818. https://doi.org/10.1002/jts.22653 DOI: https://doi.org/10.1002/jts.22653

Evaluation of the department of veterans affairs mental health services (2018). National Academies of Sciences, Engineering, and Medicine, et al. National Academies Press (US). doi:10.17226/24915 DOI: https://doi.org/10.17226/24915

Greenstone, C. L., Peppiatt, J., Cunningham K., Hosenfeld, Ch., Lucatorto, M., Rubin, M., & Weede, A. (2019). Standardizing care coordination within the department of veterans affairs. Journal of General Internal Medicine, 34(1), 4-6. doi:10.1007/s11606-019-04997-6 DOI: https://doi.org/10.1007/s11606-019-04997-6

Haravuori, H., Kiviruusu O., Suomalainen L., & Marttunen, M. (2016). An evaluation of ICD-11 posttraumatic stress disorder criteria in two samples of adolescents and young adults exposed to mass shootings: Factor analysis and comparisons to ICD-10 and DSM-IV. BMC Psychiatry 16, 140. https://doi.org/10.1186/s12888-016-0849-y DOI: https://doi.org/10.1186/s12888-016-0849-y

Harik, J. (2018). Shared decision-making for PTSD. PTSD Research Quarterly, 29(1), 1-9. Retrieved from https://www.ptsd.va.gov/publications/rq_docs/V29N1.pdf

Hoge, C. W., Lesikar, S. E., Guevara, R., Lan-ge, J., Brundage, J. F., Engel, C. C., Messer, S. C., & Orman, D. T. (2002). Mental disorders among US military personnel in the 1990s: Association with high levels of health care utilization and early military attrition. The American Journal of Psychiatry, 159(9), 1576-1583. https://doi.org/10.1176/appi.ajp.159.9.1576 DOI: https://doi.org/10.1176/appi.ajp.159.9.1576

Hoge, C. W., Toboni, H.E., Messer, S.C., Bell, N., Amoroso, P., Orman, D. T. (2005). The occupational burden of mental disorders in the U.S. military: Psychiatric hospitalizations, involuntary separations, and disability. The American Journal of Psychiatry, 162(3), 585-591. https://doi.org/10.1176/appi.ajp.162.3.585 DOI: https://doi.org/10.1176/appi.ajp.162.3.585

Hoppen, T. H., & Morina, N. (2019). The prevalence of PTSD and major depression in the global population of adult war survivors: A meta-analytically informed estimate in absolute numbers. European Journal of Psychotraumatology, 10(1). DOI: https://doi.org/10.1080/20008198.2019.1578637

How is PTSD assessed? (n.d.). Retrieved July 4, 2022, from https://www.ptsd.va.gov/understand/isitptsd/measured_how.asp, https://www.ptsd.va.gov/gethelp/tx_programs.asp#two

Lancaster, C. L., Teeters, J. B., Gros, D. F., & Back, S. E. (2016). Posttraumatic Stress Disorder: Overview of Evidence-Based Assessment and Treatment. Journal of Clinical Medicine, 5(11), 105. https://doi.org/10.3390/jcm5110105 DOI: https://doi.org/10.3390/jcm5110105

Megnin-Viggars, O., Mavranezouli, I, Green-berg, N, Hajioff, S., & Leach, J. (2019). Post-traumatic stress disorder: what does NICE guidance mean for primary care? The British Journal of General Practice: The Journal of the Royal College of General Practitioners, 69(684), 328-329. doi:10.3399/bjgp19X704189 DOI: https://doi.org/10.3399/bjgp19X704189

Mohamed, S., Neale, M., & Rosenheck, R. A. (2009, July 1). VA intensive mental health case management in urban and rural areas: Veteran characteristics and service delivery. Retrieved June 15, 2022, from https://doi.org/10.1176/ps.2009.60.7.914 DOI: https://doi.org/10.1176/ps.2009.60.7.914

Mott, J. M., Stanley, M. A., Street, R. L., Grady, R. H., & Teng, E. J. (2014). Increasing engagement in evidence-based PTSD treatment through shared decision-making: A pilot study. Military Medicine, 179, 143-149. doi:10.7205/milmed-d-13-00363 DOI: https://doi.org/10.7205/MILMED-D-13-00363

National consensus statement on mental health recovery (n.d.). Retrieved June 15, 2022, from https://dmh.mo.gov/media/pdf/national-consensus-statement-mental-health-recovery

Nidich, S. Mills, P. J., Rainforth, M., Hepp-ner, P., Schneider, R. H., Rosenthal, N. E., … Rutledge, T. (2018). Non-trauma-focused meditation versus exposure therapy in veterans with post-traumatic stress disorder: A randomised controlled trial. The Lancet. Psy-chiatry, 5(12), 975-986. doi:10.1016/S2215-0366(18)30384-5 DOI: https://doi.org/10.1016/S2215-0366(18)30384-5

Paintain, E., & Cassidy, S. (2018). First-line therapy for post-traumatic stress disorder: A systematic review of cognitive behavioral therapy and psycho-dynamic approaches. Counselling and Psychotherapy Research, 18(3), 237-250. doi:10.1002/capr.12174 DOI: https://doi.org/10.1002/capr.12174

PTSD treatment programs (2007, January 1). Retrieved July 2, 2022, from https://www.ptsd.va.gov/gethelp/tx_programs.asp

Reisman, M. (2016). PTSD treatment for veterans: What’s working, what’s new, and what’s next. P & T: A Peer-Reviewed Journal for Formulary Management, 41(10), 623-634.

Shea, M. T., Krupnick, J. L., Belsher, B. E., & Schnurr, P. P. (2020). Non-trauma-focused psychotherapies for the treatment of PTSD: A descriptive review. Current Treatment Options in Psychiatry, 7, 242-257. https://doi.org/10.1007/s40501-020-00214-y DOI: https://doi.org/10.1007/s40501-020-00214-y

Simiola, V., Neilson, E. C., Thompson, R., & Cook, J. M. (2015). Preferences for trauma treatment: A systematic review of the empirical literature. Psychological Trauma: Theory, Research, Practice, and Policy, 7(6), 516-524. https://doi.org/10.1037/tra0000038 DOI: https://doi.org/10.1037/tra0000038

Spoont, M.R., Murdoch, M., Hodges, J., & Nugent, S. (2010). Treatment Receipt by Veterans after a PTSD Diagnosis in PTSD, Mental Health, or General Medical Clinics. Psychiatric Services, 61(1), 58-63. https://doi.org/10.1176/ps.2010.61.1.58 DOI: https://doi.org/10.1176/ps.2010.61.1.58

Stavrou, S., Cape, J., & Barker, Ch. (2009). Decisions about referrals for psychological therapies: A matched-patient qualitative study. The British Journal of General Practice: The Journal of the Royal College of General Practitioners, 59(566), e289-e298. https://doi.org/10.3399/bjgp09X454089 DOI: https://doi.org/10.3399/bjgp09X454089

Steenkamp, M. M., Litz, B. T., Hoge, Ch. W., & Marmar, Ch. R. (2015). Psychotherapy for military-related PTSD: A review of randomized clinical trials. JAMA, 314(5), 489-500. doi:10.1001/jama.2015.8370 DOI: https://doi.org/10.1001/jama.2015.8370

Sullivan, G., Arlinghaus, K., Edlund, C., Kauth, M., Kemp, J., & Kelly, K. (n.d.). Guide to VA mental health services for veterans and families. Retrieved June 21, 2022, from https://www.mentalhealth.va.gov/docs/MHG_English.pdf

Trauma-informed care in behavioral health services (2014). Treatment Improvement Protocol (TIP) Series, No. 57. Center for Substance Abuse Treatment (US). Retrieved June 20, 2022, from https://www.ncbi.nlm.nih.gov/books/NBK207191/box/part1_ch3.box16/

Treatment for posttraumatic stress disorder in military and veteran populations: Initial assessment (n.d.). 6. Screening and Diagnosis. Washington (DC): National Academies Press (US). Retrieved June 20, 2022, from https://www.ncbi.nlm.nih.gov/books/NBK201093/

Using the PTSD checklist for DSM-5 (PCL-5) (n.d.). National Center for PTSD. Retrieved July 2, 2022, from https://www.ptsd.va.gov/professional/assessment/documents/using-PCL5.pdf

VA/DoD clinical practice guideline for management of posttraumatic stress disorder and acute stress disorder. (2017). Department of Veterans Af-fairs, Version 3.0, from https://focus.psychiatryonline.org/doi/10.1176/appi.focus.16408

VHA directive 1027, October 23, 2019 Super-vision of psychologists, social workers, professional mental health counselors, and marriage and family therapists preparing for licensure, from https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=8558

VHA Handbook 1160.01(1) (2008). Uniform mental health services in VA medical centers and clinics. Retrieved June 15, 2022, from https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=1762

Wampold, B. E., Imel, Z. E., Laska, K. M., Benish, S., Miller, S. D., Flückiger, Ch., … Budge, S. (2010). Determining what works in the treatment of PTSD. Clinical Psychology Review, 30(8), 923-933. doi:10.1016/j.cpr.2010.06.005 DOI: https://doi.org/10.1016/j.cpr.2010.06.005

Watkins L.E., Sprang, K. R., & Rothbaum, B. O. (2018). Treating PTSD: A review of evidence-based psychotherapy intervention. Frontiers in Behavioral Neuroscience, 12, 258. doi: 10.3389/fnbeh.2018.00258 DOI: https://doi.org/10.3389/fnbeh.2018.00258

Watts, B. V., Schnurr, P. P., Zayed, M., Young-Xu, Y., Stender, P., & Llew-ellyn-Thomas, H. (2015). A randomized controlled clinical trial of a patient decision aid for posttraumatic stress disorder. Psychiatric Services, 66, 149-154. doi:10.1176/appi.ps.201400062 DOI: https://doi.org/10.1176/appi.ps.201400062

Yager, J. (2018). Non-trauma-focused therapies for posttraumatic stress disorder. Focus (American Psychiatric Publishing), 16(4), 7s. doi:10.1176/appi.focus.164S12. DOI: https://doi.org/10.1176/appi.focus.164S12

Downloads

Published

2022-09-25

How to Cite

ASRIYAN , E., GEVORGYAN, D., MESROBYAN, L., & NAGHDALYAN, M. (2022). Comparative Analysis of the U.S. and Armenian Veteran Mental Health Services. WISDOM, 23(3), 6–19. https://doi.org/10.24234/wisdom.v23i3.848

Issue

Section

Articles

Most read articles by the same author(s)