Mental Health Veterans Presentation

Working With U.S. Army
Veterans Who Have Served in
Iraq and Afghanistan

Jeannette M. Horton, MA, CDP, LMHCA
Honorably Discharged Staff Sergeant, U.S. Army
South Korea DMZ, OIF2, OEF7 Veteran

jeanhorton@live.com
http://www.linkedin.com/in/jeanmhorton

Table of Contents
Section One: Help for Mental Health Counselors
Working With OIF/OEF Veterans

Section Two: An “On The Go” Special Population
Consult for OIF/OEF Veterans

Section Three: Referral Information, Community
Resources and Help

Section One: Help for Mental Health
Counselors Working With OIF/OEF
Veterans

PTSD – A Soldier’s Perspective
• Bullshit! I was always this angry before! I always drank
this much before! You don’t know what its like, so get
out of my head and quit telling me that you do know!
• SHH! Don’t say that out loud! My unit will think I’m
crazy and then I won’t get promoted. My people won’t
respect me. Its hard enough being in the military
without some damn label following me around.
• Me? No way! Guys actually saw other guys get killed!
Guys killed people! I didn’t do any of that! I never got
off the base! How can I have PTSD? I’m fine! Don’t say
that I have PTSD when other people had it so much
harder than I did. Focus on them, not on me.
• PTSD is for those crazy Vietnam vets.

PTSD – A Soldier’s Perspective
• Do I have PTSD? Ok, I hear that word a lot, but what
does it really mean? I feel crazy and weird and unhappy
all the time, but what am I supposed to do about it!?
PTSD is those guys who come home and shoot their
wives and kids, right? So how can that be me? I had a
good time over there, and I’m doing okay now! (…am I
doing okay?)
• Yeah, maybe I got that PTSD thing. So what? I still gotta
live my life and do my job. Everyone has nightmares.
Whatever! I don’t have time to deal with all that crap,
I’ve got stuff to do. I don’t want to think about all that
bad stuff, and I don’t want to deal with it. Oh, and I
resent the hell out of you for thinking that dealing with
this stuff is a good idea, too. Why open the can of
worms when its fine sitting in the cupboard where it is?

PTSD Triggers for a Soldier
• The firing ranges on nearby military bases and firing ranges. Booming in
general can trigger hypervigilence.
• Hypervigilence = easily spooked! Coming up behind them unexpectedly?
Waking them up by shaking them? Please don’t do this.
• Seeing convoys of military vehicles on the highway, etc
• 21-gun salute, Taps, etc (either in real life or in movies). Graphic war
games
• Burning fuel/burning garbage smell
• Overpasses, heavy/slow traffic, getting into a fender bender.
• Certain dates, holidays, anniversaries
• “Harissa” is a flavoring/spice combination that is common in Middle
Eastern cooking. Its popping up in restaurants here as a savory flavor
that can really “take you back.” (savory blend of garlic, hot peppers,
thyme, and cloves)
• Seeing the U.S. flag waving people on overpasses and being all “yay
soldier” or hearing this kind of thing on the radio or television (if you
don’t feel proud of your service, this is just annoying and makes you feel
bad. Even if you ARE proud, this can bring back memories).

Special Situations To Understand - Age
• A soldier can enlist when they are 17YO. If they leave for
basic training right away and pick a job with a short training
time (i.e. Infantry, Artillery, etc) they can potentially be
deployed and experiencing high risk situations before their
18th birthday!
• Soldiers that join young and do well will move up in rank.
This means increased responsibility at young ages. A 20YO
can make Sergeant/E-5 and be in charge of people older
and younger than him, have to make intense decisions that
impact people’s lives, and have way more responsibility on
their shoulders than a civilian 20YO would likely
experience.

Special Situations To Understand - Age
• Being older doesn’t mean not experiencing hazardous duties and
deployments. 55YO+ soldiers still only get around the deployment
zone by convoy (all soldiers on a convoy are expected to participate in
convoy defense), still guard front gates (which are big targets for
suicide bombers), and more and more these older soldiers are being
relied upon to train local Iraq and Afghan people to take over security
operations due to their experience (which means greater exposure to
hazards from infiltrators, not to mention grueling difficult work!).
• Older soldiers have also more likely experienced the Gulf War
(chemical weapons were commonly used), Bosnia (many soldiers
witnessed the after effects of genocide), and other conflicts. This
means they have learned different tactics for different conflicts in
different political climates – adjusting to OIF/OEF after deployments
like this is difficult. Every conflict has different rules and a different
environment.

Special Situations To Understand - Homecoming
• Coming Home usually is fantastic for most troops…for the first month
or two. You come home, there’s lots of ceremonies and awards,
soldiers get leave and reintegrate with their families. This is the
“honeymoon” period. Soldiers get briefed on PTSD, what that means,
are given information on accessing VA services and on what to expect
upon returning home (problems with kids, spouses, figuring out what
parental/spouse roles to play, old arguments coming back up,
infidelity, alcohol/drug use, DV, etc). This happens the first week after
soldiers return home.
• Month 3 or 4 or 5…honeymoon is over. Now what? Lame job on base,
or getting ready for yet another deployment? Maybe you decide to
get out of the military? Then what? Spend time with your
deployment buddies drinking or be at home with the spouse and
kids? Memories memories memories! Running into the families of
people that got hurt or killed. Deployment “families” break up as
units that bled together get broken up and moved to different units,
etc.

Special Situations To Understand - Homecoming
• “I’m supposed to be living it up and I don’t know what that is
supposed to mean anymore. I used to wear a flak vest and carry a
loaded gun and when I spoke people listened because of that. Now
I’m just some guy working some job and nobody gives a damn. I’d
rather be over there than here, because over there makes sense.
Speed limits, lunch breaks, Saturdays, grocery stores, what the hell?”
These things DON’T make sense.

• Overseas soldiers learned how to get complacent with the idea that
they could die at any time. “You can spend all your time worrying
about it or you just learn to not care so you can do your job.” This
means getting numb, getting tough, working hard and doing your
best not to think about it all too much. Trying to NOT live your life this
way when you get home is really hard!

Special Situations – Unfinished Business
• REGRET. Did you kill someone you weren’t supposed to?
Were you not as helpful/on the mark as you were supposed
to be, and someone got hurt because of it? Did you use
tactics to keep yourself safe that you’re not proud of? (i.e.
aiming your .50 cal at innocent civilians so they keep their
vehicles away from your convoy and watching little kids start
to cry). Did you lose out on the rank you were entitled to
because of politics, paperwork issues, etc? Did a fellow
soldier mess with you and you didn’t say anything about it?
Did you get intimate with a fellow soldier and you shouldn’t
have? Were you a good leader to your soldiers, or did you just
say ‘yes’ to whatever stupid task your command gave you
without sticking up for them?

• Returning home can mean a lot of unfinished business that
doesn’t ever really get finished.

Understanding The Deployment Family
• Even if you really don’t like the people you deploy with, you bond with them. (I
hated my shop Lieutenant but I made a baby blanket for his new son anyway.
That’s what you do, that’s the ‘rules’.) Platoon sergeants are like fathers and
mothers. Your buddies are your brothers and sisters. Your commander may be
a dork but he’s a decent guy and he remembers that you’re from Upstate New
York, which means a lot. Somebody getting a divorce? We all know about it!
Someone have a baby, a cheating spouse, their mom died? We all know about
it! Go home on R&R and you married the person you were dating! Wow!

• Where are you going to go for Christmas? Why, to work of course! Every day is
Monday! That means going to the holiday dinner with your team (assuming a
holiday meal is available), because who the heck else are you going to spend it
with? Lots of soldiers throw parties, get stuff shipped from overseas and
celebrate together intentionally. ITS FUN. This can mean some problems at
homecoming too – yeah, its nice being with the spouse and kids, but man, it
can’t compare to making s’mores on the exhaust of a HMMVVV and drinking
Near-Beer while singing silent night with the crew! Memories, guilt over rather
being with them than your family, etc are particularly tough at holiday time for
the soldier who comes home.

Understanding The Deployment Family

This kind of thing is NORMAL. What ISN’T normal? The
soldier that DOESN’T bond with their people, that isolates
(its hard to do but it can be done), that doesn’t get mail,
that doesn’t BS, that gets ignored as a result. These soldiers
have a tougher time coming home than the others – at least
the others had buddies to tough it out with. These loner
soldiers had nobody and had to get even more tough, even
more numb. That makes it harder to reintegrate when they
get home.

For Mental Health Counselors
• Didn’t deploy? Say so. Its hard seeing a non-veteran counselor when you
are a veteran for obvious reasons, but it also can be a good thing – your
perspective is not blurred, there’s no semblance of “military rank” hanging
around the session, you are a clean slate who is eager to learn. Many
people don’t think about this perspective! Remember that you have a kind
of advantage by not personally knowing, and remind your soldier-client of
this too. It can put your client in a position of power as a teacher of their
experience just as you are a teacher/healer, and bringing this idea up to
them can be very empowering.
• Don’t understand? Ask. Want to go somewhere but you aren’t sure? Ask. Be
transparent in your therapy/intervention intentions, regardless of your
orientation. Soldiers have a lot of stigma, suspicions and cultural ideas of
therapy – tell a soldier what your point is, why you’re asking the questions
you’re asking, what your perspective on people is. Be up front and honest
about what you’re doing from the very beginning.
• KNOW YOUR BIASES. Just like any other population, working with veterans
will likely bring up things in you, given all the news, politics, etc.
surrounding it.

For Mental Health Counselors - MI
• Motivational Interviewing is particularly good, because of its strong
adherence to “rolling with resistance.” Just like any client who
engages in negative/unhelpful behaviors, soldiers don’t want to hear
a lecture. They may even have been lectured more than the average
client as a result of their time in the military. Don’t be “The Man.”
(Some research is being done which indicates MI is not only a useful
‘pretreatment’ to get reluctant clients involved in regular therapy, but
that it can be particularly helpful in helping individual veterans get an
idea of what a ‘normal’ person experiences compared to what they
are currently experiencing as a means of motivation). (1)

(1) Arkowitz, H.; Westra, H.A.; Miller, W.R.; & Rollnick, S. (2008). Motivational
interviewing in the treatment of psychological problems. New York: Guilford
Press.

For Mental Health Counselors - MI
***Elicit-Provide-Elicit (EPE): “Can I tell you a little bit about what
I’ve heard other soldiers’ experiences are like? (Elicit)” “Yeah, I
guess.” “Soldiers tend to think that all this therapy stuff is bullshit
(Provide).” “Duh, doc!” “What do you think, knowing that most of
the people who are doing what you’re doing feel like an idiot
sitting in that chair? (Elicit).” (1)
- Soldiers just get TOLD, they don’t get a choice most of the
time. EPE and asking permission, providing your information
and then asking for feedback lets the soldier feel autonomous
and empowered.

(1) Arkowitz, H.; Westra, H.A.; Miller, W.R.; & Rollnick, S. (2008). Motivational
interviewing in the treatment of psychological problems. New York: Guilford
Press.

Normalization Helps
• “Maybe you didn’t see combat. But you saw photos of dead
civilians, you were privy to conversations about intense things, you
witnessed extreme poverty and horrific conditions, saw abuse of
women and children as a part of everyday culture. THIS HAS AN
IMPACT ON A PERSON AFTER A YEAR. You have to become tough
in the face of all of this as well. You don’t have to have killed
someone point blank for you to not feel good in your head.”

• “Feeling like crap after a deployment is actually pretty normal. Its
your brain trying to wrap itself around the craziness you
experienced. You are not crazy, you are doing the best you can
with what you’ve got. If you DIDN’T feel a little funny now that
you’re home, that might actually be crazy!”

The Idea of Tool Maintenance
• Soldiers are VERY familiar with the idea of taking care of their tools
(weapons, vehicles, etc). Leadership takes a very active role in making
sure that PMCS (Preventative Maintenance Checks and Services)
occurs regularly. Broken/damaged/poorly maintained tools will not
hold up to the rigors of a deployment.
• Are soldiers not ‘tools’? How can they operate effectively and serve
the mission if there is damage somewhere? Experiencing symptoms
of PTSD is a sign that not everything is going well, much the same as a
dirty rifle at jams all the time. Seeking mental health services can be
looked at as a mental PMCS to help a soldier become the best
functioning ‘tool’ they can be. (1)
• This is not my idea, but came from a colleague - this is a neat way to
broach the subject of mental health care to individual soldiers while
also serving to break down some of the stigma about mental health
that pervades the military.
(1) P. D. Fitzgerald (personal communication, June 2011)

Things To Help Your Client Move Forward
• The idea of Atonement. Maybe you did some things you aren’t
proud of over there, but you can’t go back. What can you do today
to “pay it forward”? Can you volunteer, pray, make a commitment
to be a better parent and set goals within that commitment, etc? It
can be helpful for a soldier that did bad things or has regrets to do
something ACTIVE in the present as a way of making amends.
(NOT necessarily military oriented. Sometimes breaking a sweat in
a food bank can be really healing)

• Join military organizations like the VFW, etc to regain that sense of
camaraderie and deployment family. This can provide respect from
other veterans who have been there (this is a special kind of
respect. Even if I’m an OIF vet and he’s a Korean War vet, we
understand one another)

Myths – Please Help Stop The Spread of These!
• You are a veteran, and so you must be
– A hero
– Willing to work extremely hard and be self sacrificing all the time
(“Well, weren’t you in the army? Doesn’t that mean you never say
no?”)
– Evil, or at least more likely to respond with violence (You don’t
hear baby killer much, but people can be wary of you when they
find out where you’ve served)
– A natural leader (Soldiers always know what to do)
– Struggling with PTSD (“Oh, you were in Afghanistan? You aren’t
gonna go ballistic when I make this popcorn are you?”)
– Lying (“You’re too young”)
– Ultra patriotic (“Ah man, you must really love your country!”)

Myths – Please Help Stop The Spread of These!
• You are a veteran, and so you must be
– Proud of your service (“Thank you, young man! You must be so proud!”)
– More knowledgeable about politics than the average person, or that your
personal opinion is somehow more special (“I’ll bet you voted for McCain!
What do you think about Libya? Gays in the military sure is a crock, isn’t
it?”)
– Constantly aware of what is going on ‘over there right now’ even if you
have been home for years and refuse to watch the news (“I heard a bad
bomb went off somewhere in Iraq last week. Did you hear about it?”)
– Willing to answer inappropriate questions in public (“Did you kill anyone?
Did you see anyone get killed? Can my four year old son ask you questions
while we wait in this line at Safeway?”)
– Grateful for all the random strangers that approach you to say thank you,
hug you, buy you things (Yes, its kind! Its also really awkward!)
– Were DEFINITELY exposed to combat/seeing bad stuff/etc. (Most soldiers
see some stuff, but not many see really hardcore stuff.)

Please Don’t Ask
• At least, don’t ask us unless you know us really well, we’re
somewhere quiet, and you actually are ready to hear the response
(this means no asking questions because the story sounds
fascinating! I hear more stories from buddies who get asked these
questions because the other person thought it would be
entertaining)
– Did you ever kill anyone?
– Did you ever see anyone get killed?
– Were you ever shot at?
– Do you miss it?
– Were you scared?
– Why do you think the U.S. went to those countries?
– Were you ever ‘messed with’? (i.e. sexually assaulted)

(NOTE: This is not to say that counselors can’t ask these questions! This
information is intended to enforce the idea of delicacy when approaching
these topics and to help spread the word that asking veterans these questions
in the wrong circumstances is not okay.)

Section Two: An “On The Go” Special
Population Consult for OIF/OEF Veterans

Why Does This Matter?
• Serving in the military means joining a culture that is
just as multifaceted as Hispanic, Asian, Native
American, etc.
• This culture is highly publicized in news, movies,
popular television series and more importantly –
locally! But most of it is twisted, stereotyped,
opinionated, and dead wrong! The result is that cultural
ignorance is alive and well!
• Its frustrating. Its pervasive. It impacts the kind of
mental health treatment veterans receive. Most
importantly, it can impact a veterans’ decision to seek
treatment!

Army Rank for Dummies
• Enlisted soldiers = everyone who isn’t an officer.
Ranked from E1 (Private) through E9 (Sergeant
Major).
• E1 – E4 will happen automatically if you don’t get in
trouble. Anything higher means getting special
training and earning rank through a points system.
• NCO = NonCommissioned Officer. These are the
upper enlisted (Sergeants).
• NCOs “Work For A Living.” There is a natural disdain
from enlisted soldiers in general towards officers.

Army Rank for Dummies
• Officers – the ones in charge of pretty much
everything. Ranked from O1 through O10.
• 01 – 03 will happen automatically if you don’t get in
trouble. You need to have a college degree in order
to become an officer and attend special training.
Anything higher means getting more special
training and earning rank through a political system.
• Officers hold command posts.

Don’t Forget The Other Branches!
• Its not only the Army serving in the middle east these
days. The Air Force, Marines and Navy all have a very
active presence there and quite frequently serve right
alongside Army soldiers. They generally have their own
branch commands represented where they are
stationed, but they also serve and report to the
commands of the other branches with whom they are
serving.
• I had the great opportunity to have two navy personnel
and an airman working under me in Afghanistan. They
had their own things going with their own commands,
but they reported to my shift, obeyed my orders, and
went through me for permission for various things. It
continues to be a learning experience for all involved.

Rank in the Other Branches
• Navy Rates (this is not a typo – the Navy uses the
term ‘Rate’)
http://www.navy.mil/navydata/ranks/rankrate.html
• Marine Corps Rank Structure
http://www.usmchangout.com/usmc/facts/usmcra
nks.htm
• Air Force Rank Structure
http://www.militaryfactory.com/ranks/air_force_ra
nks.asp

Some Basic Understanding
• OIF – Operation Iraqi Freedom
• OEF – Operation Enduring Freedom
– These conflicts are broken down into numbers according
to when the conflict began. Most soldiers will refer to
their deployments this way (i.e. “I was in OIF2 and
OIF6”).
• If you went to Iraq between March 2003 and March 2004, you
are a veteran of OIF1. If you went to Iraq between March 2006
and March 2007, you are a veteran of OIF4.
• There are very distinct periods of time within these conflicts
(more to follow). Understanding this will give you a better idea
of what your client specifically experienced.

Lingo
• Hajji/raghead – derogatory term for Muslim people
• Man jammies – the long loose tunic and loose fitting pants that are
common dress in the Middle East
• Burqua – the head to toe enveloping fabric that some Muslim women
are forced to wear (note: color denotes tribal affiliation)
• Hijab/Jilbab – the headscarf or full body cloak most Muslim women are
required to wear
• A’zan – a publicly broadcast call to prayer that happens five times a day
on loudspeakers from multiple mosques at once (it has a very distinct
sound and can be a trigger for soldiers and PTSD symptoms.)
• DFAC – chow hall
• Connex – the big metal containers you see on tractor trailers. Soldiers
ship these overseas on boats and it’s the main way that stuff gets from
the U.S. to the deployed soldiers. It gets trucked from the port in Kuwait
to Iraq and Afghanistan, and A LOT OF STUFF GETS STOLEN BY LOCALS
ON THE WAY.
• Chocolate Chips – the uniforms the soldiers wore in Desert Storm (the
black dots on the camouflage look like chocolate chips)

Lingo
• DCUs – Desert Combat Uniform, looks like the old school green
camouflage but its all desert colors
• ACUs – what soldiers wear now. The bluish/greenish/tannish colored
uniform that has camouflage-like smudging on it, but the camouflage is
made up of tiny pixels
• Combat Patch vs. Unit Patch – The unit patch is something you wear on
your left sleeve, and its just the insignia of the current unit you belong
to. The Combat Patch is also a unit patch, but it belongs to the unit you
deployed with and goes on your right sleeve. (i.e. You’re in the 201st
Brigade, so you wear their patch on the left sleeve. But you went over
with the 1st Infantry Division, and so you wear that patch on your right
sleeve as a way of telling other people that you’ve deployed and who
you went with. This is a big point of honor among troops and the root of
lots of frustration between commands and the lower ranking soldiers
about which Combat Patch they choose to wear, and discussions about
where loyalty lies and who is the tougher soldier).
• Stripe Wearer – A soldier who is promoted to Sergeant but doesn’t
deserve it, or behaves inappropriately once promoted. Lazy.
Incompetent.

Lingo
• IED – Improvised Explosive Device (roadside bomb)
• SIED – Suicide Bomber (walk up in a vest)
• SVIED/VBIED – Suicide Bomber (drives up and blows the car)
• FOB – Forward Operating Base (usually smaller, more primitive)
• Camp – More like headquarters, better amenities
• Flagpole – Wherever command is located (“Man, Camp Victory
is way too close to the Flagpole for me!”)
• Dog and Pony Show – doing pointless activities to impress VIPs
• FOBit – A soldier that never gets off the FOB or Camp. Are
usually considered soft, lazy, and are reviled by the guys who
“actually go outside the wire and do something” (note: Medics
are always highly respected, even if they are a FOBit)
• Outside the Wire – anything outside of a secure area

Lingo
• Queen for a Year – a female soldier who is not very attractive, but
due to the lack of other females gets a lot of attention anyways with
the understanding that this will end once she returns stateside
• Rear D –Most units leave a small group of soldiers back at the main
base in the U.S. as a ‘rear detachment’ to help with paperwork issues,
ship specialty things to the deployed soldiers, and work as liaisons
between overseas and stateside commands
• CENTCOM – the big brass in charge of operations in the Middle East
• GIF – Good Idea Fairy (usually means lower ranking soldiers are doing
a stupid task that someone with more rank decided was a Good Idea)
• MOS – Military Occupational Specialty. This is the soldier’s job. Its
usually a mix of numbers and letters (i.e. 95B is an MP, a 33W is a
Military Intelligence computer specialist, etc. 11B is infantry, anything
in the 13’s is artillery related)
• Butter Bar – A new 2nd Lieutenant. Generally regarded as
inexperienced, headstrong, “bright eyed, bushy tailed and stupid.”

OIF – Things That Impact The Soldier
• Soldiers fly to Kuwait first and for a week or two get briefings, training, and
plan for upcoming convoys. Any gear that was shipped via boat is now
accessible. Everyone lives in transient tents. Sand storms are a reality. Bases
are safe.
• Iraq has roads! Real, paved highways. This means that most soldiers convoy,
and convoy frequently to get around the country. Convoying from Kuwait to
all points north in Iraq means driving through some traditional ‘hot spots.’
• Iraq is flat except for the very northern part of the country. This means easy
access for snipers, etc as convoys move on these highways regularly. The
very northern part of the country is Kurdish country, and to this day U.S.
forces are still well liked up there in the less populated areas, although
Mosul remains a significant hotspot.
• Supply is fairly regular due to good highway routes and airports that were in
good repair when we got there that have only gotten better since.
• Most soldiers aren’t living in tents anymore in country. Trailer parks are the
norm, as are old buildings and palaces that have been converted to living
and working quarters.

OIF – Shifts In Conflict: 2003
• March: The conflict begins. Fighting is more like what
people imagine it to be – tanks, airstrikes, one army vs.
another army.
– The U.S. is greeted as heroes. Joy in the streets. Saddam
Hussein was hated by all but the few elite (although he was
pretty liberal – women could drive, own property, seek
divorces).
– What little there is of the Iraqi Army collapses with little
resistance. Naysayers who think the West is evil don’t have
much power and are mainly ignored.
– The U.S. Army is not very prepared! NO uparmored hmmvv’s,
flak vests without armored plates in them, supply issues
rampant, and orders on what to do from here are very
unclear.

• April: Street fighting is limited. LOTS of road checkpoints that locals
are forced to wait at for hours before being allowed to drive on.
Frustration starts to mount, and then the abuse photos from Abu
Ghraib prison are released. Promised infrastructure repairs don’t
happen. Areas of the country that were used to having regular
electricity still don’t have it. Access to clean water remains an issue.
– The mood of the country shifts. Soldiers are greeted with distrust
or outright hostility. Naysayers that say the West is evil start to be
taken more seriously and get organized. IED attacks increase
significantly. Bases start getting mortared regularly. The army is
still not prepared! Uparmored hmmvv’s are RARE, people still
don’t have properly outfitted flak vests, while soldiers are on the
roads and dealing with the uprising in the country more than ever.
Soldiers on the bases are starting to be killed in mortar attacks. No
place is ‘safe.’

• Orders on what to do remain unclear. Soldiers at all ranks are
frustrated and nervous. Things start to get out of hand as the
“cowboy mentality” kicks in (“The top leadership doesn’t get it and
isn’t going to, Iraqis hate us, the U.S. doesn’t support us, we have no
clue why we’re here anymore, supply sucks, and now we’re starting
to get killed in high numbers by nasty means. Its time to look out for
our own selves and do whatever we gotta do to not get killed
because nobody else is looking out for us”). NATO forces start pulling
out.

OIF – Shifts In Conflict: 2005 - 2007
• Anti-American sentiment is high. Resistance forces are organized.
Religious leaders openly speak out against the presence of U.S.
forces. Iraq has had its first election and voting process since the
invasion, and Iraqi foreign policy towards the U.S. was a major
point for electoral candidates. “Vote for me and I’ll kick the infidels
out.”
– Supply is better. Bases are well established, mortar attacks become
more rare although the IED problem is still rampant. The “cowboy”
mentality continues and only serves to make national feeling towards
the U.S. more negative as collateral damage increases. Street patrols are
invading houses and not making amends when they get things wrong.
People at home in America are starting to pay less attention.
Infrastructure is slowly improving but not as quickly as the Iraqi people
would like. Thousands of soldiers are on the ground, and orders from
above are starting to get a little more concrete “avoid collateral damage
wherever possible, be friendly with the locals” but this seems like too
little, too late for most people. Part of the mission shifts to seriously
training the Iraqi Army (IA) and Iraqi Police (IP) in anticipation of having
Iraqi forces take over operations so the U.S. can gradually step back.

• Anti-American sentiment is still high, although many Iraqi people seem to think
that our presence is now inevitable. Elected officials who promised to get
Americans out of Iraq don’t follow through on promises, talk of civil war is going
on, Iraqi parliament issues/corruption/inability to restore infrastructure any better
than the U.S. leads to Iraqi’s being skeptical of both the U.S., IA and IP forces
(corruption is RAMPANT), and religious leaders gain even more power as a result.
Resistance forces are still organized, many are operating with the backing of major
religious leaders. Religious leaders openly speak out against the presence of U.S.
forces and Iraqi government.
• Mortar attacks still rare although the IED problem is still rampant. The “cowboy”
mentality starts to diminish as Iraqi’s don’t just hate the U.S. but are skeptical of
everyone in power. Collateral damage remains an issue, but COIN (Counter-
Insurgency Operations) are starting to really take off. Concentrated efforts to make
infrastructure improvements and financial donations to areas that have been
traditionally hostile towards the U.S. really get under way. Rules of Engagement are
enforced more tightly than ever, resulting in less ability for the “cowboy” mentality.
This frustrates soldiers, who are still nervous and unsure of what they’re supposed
to be doing in Iraq, and are now more limited in the ways they can protect
themselves.

• The mission shifts more and more to seriously training the Iraqi Army
(IA) and Iraqi Police (IP) in anticipation of having Iraqi forces take over
operations so the U.S. can gradually step back. This is a solid mission,
but its hard to do – the Iraqi culture is very different than U.S. culture,
and training people who are suspicious of America anyways is not
easy. Tension rises between IP, IA and U.S. forces who are responsible
for training, who are also under immense pressure from above to
“get the IA and IP ready, operational, and non-corrupt ASAP so this
can become their problem.” More NATO troops pull out.

OIF – Shifts In Conflict: 2009 - Now
• Iraqis are still suspicious, but are grateful for the IA/IP as the U.S. takes a
less prominent presence. (more IP patrols instead of Army patrols, or
blended patrols of both forces). Things get more calm as Obama takes the
presidency and starts to talk loudly about his plans to draw down American
forces in Iraq.
• COIN (Counter-Insurgency Operations) is going strong as the army figures
out the best way to make that happen. Iraqi communities are pleased by
the significant financial contributions to their needs (although the
corruption is still a major problem, the local people are more frustrated by
their own leadership and their inability to follow through on their promises
to use this money for the common good than they are by the presence of
U.S. forces, although there is a lot of talk that the U.S. is in collaboration
with local political leaders and the money is just bribes, etc)
• U.S. forces start to take a large step back, numbers start to draw down.
Soldiers are happy because they’re not in harm’s way for Iraq as much,
although there is ongoing frustration with the IA/IP inability to be effective
right away.

OEF – Things That Impact The Soldier
• Soldiers fly to Kuwait first and for a week or two get briefings,
training, and then catch flights to Afghanistan from here.
Afghanistan has a few major airports that soldiers fly to – once
they get there, its either a long convoy or a helicopter ride to their
actual camp.
• Afghanistan has ONE HIGHWAY. Its called “Highway One” or “Ring
Road” and it goes around the exterior loop of the country
connecting Herat, Kandahar, Kabul and Mazar-e Sharif. Most of it is
NOT paved. Roads are mostly dirt, can involve driving along cliffs
and narrow mountain passes, and in general are terrible.
Afghanistan gets snow, which complicates these issues.
• Afghanistan is MOUNTAINS. Kandahar and southern regions of the
country are flatter, but this country is home to some of the tallest
mountains in the world. Most soldiers get around by helicopter, as
convoys are dangerous – mountains make great places for enemy
forces to hide.

OEF – Things That Impact The Soldier
• Supply is hit or miss. There are many camps that are small and
highly isolated. Supply is worse in the winter as the country shuts
down (you can’t land a helicopter in a snowfield). The good news
is winter means less combat as the enemy holes up in Pakistan and
regroups in preparation for the spring attacks.
• The south has traditionally been the “worst” part of the country
for combat operations. East is second worst. The far west and far
northern parts of the country are very isolated and while the U.S.
hasn’t always been popular, there hasn’t been as many problems
there.
• Afghanistan is TRIBAL. Pashto are the leading tribe, but there are
at least a dozen other major tribes. Afghan people will die for their
tribe. Civil war between factions has been the norm since the
beginning of time – U.S. presence has not done anything to stop
this behavior. Elections are just escalated points of these civil wars.

OEF – Shifts in Conflict: 2001 - 2003
• The U.S. goes to war with Afghanistan. Americans are
very happy about this. Most Afghan citizens are happy
with this too – the Taliban was increasingly cruel to
Afghan citizens and we are welcomed. Taking out the
main Taliban forces and restoring some basic order in
the big cities happens quickly, and control starts to be
restored in outlying areas as well.
• Supply is bad as the country has very little
infrastructure. Airports and what roads there are, are in
bad shape. Getting ammunition, vehicles, etc takes a
long time. Things get shipped by boat to Kuwait, but
are then DRIVEN to Afghanistan by locals.

• OIF gets going and the mood in America shifts. OEF gets more and
more forgotten but still is generally supported. Local Afghans are
still supportive of U.S. presence, but collateral damage is hurting
our reputation and the sheer difficulty of getting around the
country makes it hard to follow up on promises to provide better
infrastructure. Taliban starts to regroup and regains control in
outlying areas, as the country is vast and U.S. forces can’t be
everywhere at once. Taliban also use the failure of U.S. forces to
build infrastructure and collateral damage as part of a particularly
vicious anti-U.S. propaganda campaign (still alive and well to this
date)
• The mood starts to shift among the soldiers. “If I’m not stuck here,
I’ll be stuck in Iraq.” The mission remains clear but difficult – the
Taliban look like everyone else and have an advantage that the
U.S. doesn’t have – they know the land, the lingo, the culture, and
have been rooted in this country for years.

• OEF isn’t even getting big news coverage anymore, unless a
big IED goes off. Elections in the country have been held and
civil wars increase, with lots of civilian deaths as the result.
Local opinion of the U.S. starts to get bad “the Taliban is still
here, the tribes are killing each other and killing us, and the
U.S. hasn’t done anything to make this better. All they’ve
done is kill innocent people and make our lives harder.”
• Soldiers are well aware that the people at home aren’t paying
attention anymore. The mission shifts in two directions – fight
the Taliban by playing their own game (strategically placed
humanitarian aid campaigns, anti-Taliban propaganda, etc.
Remember COIN?) and train the Afghan Army (ANA) and
Afghan Police (ANP) to take over security

• ANA and ANP training gets tougher as Taliban fighters
infiltrate the ranks (i.e. an “ANP” gets on base wearing
a suicide vest and kills a bunch of people). U.S. soldiers
are wary – the ANA and ANP are particularly hard to
train, and not being able to trust them when their back
is turned only adds to the problems.
• COIN is going strong, but so is Taliban operations and
propaganda. U.S. forces are spread thin in the push to
support Iraq, and soldiers are experiencing multiple
long deployments (18 months). Soldiers are tired, the
mission seems unwinnable, and they get frustrated
“why the hell are we still here? We bombed them after
the 9/11 attacks, what other point was there?”

OEF – Shifts in Conflict: 2009 - Now
• President Obama sends more troops to Afghanistan
to help as things start to deteriorate. COIN is going
strong, but so is Taliban operations and
propaganda.
• ANA and ANP take to the streets, but corruption is
as bad as (if not worse than) Iraq. Reports of
ANA/ANP attacks on the local populace increase.
Afghans are fed up “the ANA and ANP are as bad as
the Taliban ever were, and the U.S. is still here.
Screw everybody.”

Section Three: Referral Information,
Community Resources and Help

Resources
• *MY FAVORITE* Veterans of Foreign Wars – help with
VA paperwork, access to VA services, appealing VA
decisions and fighting for veterans issues. I highly
recommend that you utilize these guys when trying to
do case management with your veteran clients! They
know who to talk to and understand the VA system.
• There are veterans’ service offices that are specifically
dedicated to helping veterans with obtaining benefits.
Local VFW halls also generally offer access to these
offices and are knowledgeable.
http://www.vfw.org/Assistance/National-Veterans-Service/

Resources
• IAVA – Iraq and Afghanistan Veterans of America. They
lobby heavily in Washington D.C. and intervene for
individual soldiers who need help. They are fabulous
and a great starting point for access to resources.
http://iava.org/
• Coffee Strong – local group in Lakewood, WA that provides
support, referrals, etc in a coffee shop that is veteran
owned and veteran run. It also is a really good website that
offers some insight into the OIF/OEF veteran culture.
http://www.coffeestrong.org/
• Up to date information on what is going on in Congress
regarding Veteran’s benefits, etc. Also a great spot for jobs
that have veteran preference in hiring and a good site for
general information. You can sign up for email updates as
well. www.military.com

Resources
• http://www.vetsresource.com/
• http://www.veteransresources.org/
• NAMI supports veterans too!
http://www.nami.org/Template.cfm?Section=Veterans
_Resources&Template=/ContentManagement/Content
Display.cfm&ContentID=53242&lstid=877
• Substance Abuse/Veteran Info
http://www.samhsa.gov/militaryfamilies/
• The American Legion, another service organization.
http://www.legion.org/
• Disabled American Veterans http://www.dav.org/

Resources
• VA Forms
http://www.va.gov/vaforms/search_action.asp
• Main VA Information Page
http://www.va.gov/landing2_vetsrv.htm
• General military assistance and information
http://www.military.com/benefits/resources/military-
forms/military-forms-and-veterans-forms
• National Center for PTSD
http://www.ptsd.va.gov/public/where-to-get-help.asp
• Veterans Only Employment http://www.vetjobs.com/
• Federal Employment, Veteran Preference
http://www.usajobs.opm.gov/

Resources
• Give an Hour is a nonprofit organization that has
established a national network of more than 5,300 licensed
mental health professionals who provide free mental
health services to U.S. troops, their families and
communities affected by the current military conflicts in
Afghanistan and Iraq. Each one gives an hour each week to
provide free mental health services to military personnel
and their families. In addition, these volunteers work to
educate the public and the military community to reduce
the stigma so often associated with mental health issues.
http://www.giveanhour.org/skins/gah/home.aspx

Resources
• WACVA – Women’s Army Corps Veterans Association.
You must be a female veteran to join, but they don’t
turn away male veterans who need help. They are
nowhere near as active as the VFW and IAVA, but they
are a resource and a great way to connect with other
veterans (I have attended their yearly conventions
before and that is an amazing experience. Their
newsletter is great too). http://www.armywomen.org/
• American Lake VA Homepage (Tacoma, WA)
http://www.pugetsound.va.gov/

Resources
• Confidential PTSD screening tools and referral
information http://www.militarymentalhealth.org
• Washington State VA Website
http://www.dva.wa.gov/benefits.html
• Nationwide VA Facility Locator
http://www2.va.gov/directory/guide/home.asp?isflash
=1
• National Coalition for Homeless Veterans, Washington
State http://www.nchv.org/hvrp_article.cfm?id=52
• Yakima County Veteran Assistance
http://www.yakimacounty.us/commsvcs/veterans/defa
ult.htm

Resources
• Spokane County Veterans Services
http://www.spokanecounty.org/
• King County Veterans Services
http://www.kingcounty.gov/socialservices/veterans.asp
x
• Pierce County Veterans Services
http://www.co.pierce.wa.us/pc/abtus/ourorg/veterans
/default.htm
• Transportation for Veterans to and from medical
appointments (nationwide service)
http://www.dav.org/volunteers/Ride.aspx

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