2011 National Hispanic Medical

Association Conference

Becoming Familiar with Hispanic Veterans Healthcare:Hispanic Veterans and the VA

Gabriel Pérez, CEO, Phoenix VA Health Care System

and President, Board of Directors, National Forum for Latino Healthcare Executives

La Familia

Hispanic Veterans increasing

Stress on military families

Clinician awareness

Special considerations

Phoenix Experience

Governor’s Commission 2010

Shift in emphasis to family members

National Task Force Recommendations

Hispanic Veterans

Exhibit higher risk of PTSD Might other postwar adjustment

problems and life stressors be more prevalent among Hispanics?

Did factors in the War Zone contribute to Hispanic Veterans’ higher rates

of PTSD? Puerto Rican Vietnam Veterans

PTSD Elevated prevalence rates Other possible explanations

War Zone stressors Differences in prewar vulnerability factors Ethno-cultural factors (experiencing distress) Powerful stressful events Experiences with racial/ethnic prejudices and

distress La familia relationships

Severity of Combat Related PTSD vs Non-Combat Related PTSD

Combat exposure Psychiatric disorders Social impairment

Rates of PTSD Comparison

Demographics and Diagnosis of OEF/OIF Veterans

Demographics: OEF/OIF Patients

12,480 triaged In Germany 10.1% to Psychiatry

More likely to be: Female under 31 years Black or Hispanic Enlisted or National Guard/Reserves

80% evacuated during first 6 months 17% evacuated during second 6 months

Demographics and Diagnosis of OEF/OIF Veterans

Diagnosis: Adjustment Disorders 37.6% Mood Disorders 22.1% Personality Disorders 15.7% Anxiety Disorders 15.4% No Psychiatric Diagnosis 9.2%

Only 5% returned to OEF/OIF duty

Veteran Suicides

Military Service – Traumatic Experience Devastation Killing Torture Life-threatening situations Unexpected

US Army suicide rates doubled since 1943.

Suicide Rates Keep Rising Increased risk

Lack of social support Traumatizing life events Deprived sense of control PTSD (Iraq – US Marines experience highest DX) General anxiety disorders Depression Failed relationships

Hispanics higher risk Marginalization conditions Lack of bilingual language management Discrimination

Partial Solution for Prevention

Screening at earliest interface

Culturally sensitive

Planned interaction

How to Serve Veterans Understand

Past military service Utilization of available services

Examples 1954 Segregation

Utilization of VA Services Black Veterans – 3.7 times more likely to use VA Hispanic Veterans – 5.3 times more likely Korean Veterans – More than WWII OEF/OIF – Phoenix: 44% market penetration

Department of Veterans Affairs Mission

Provide Primary care, Secondary Care, and Related Medical and Social Support Services to eligible Veterans.

Mitigation of disparities

Minority Veterans go to VA for treatment Why??

The VA – “The Best Health Care System in the World”

One Part: Mental Health Prevention PTSD and Suicide screening Coordinated care Housing Mental Health expansion MICHM Homelessness Hotline: 1-877-4AID-VET (877-424-3838) Tele-health Veterans Court National Suicide Hotline: 1-800-273-TALK (8255)

Your help is needed. How??

Conclusion

Future Veterans

Disparity attention

Access

Target Groups

Constant Needs Assessment

A Few References

J. Clin Psychiatry, 2010 Jul; 71(7): e16.J. Clin Psychiatry, 2010 Apr; 71(4): e08.J. Trauma Stress, 2002 Apr; 21(2): 133-41.J. Nerv Ment Dis, 2007 Aug; 195(8): 655-61Cultur Divers Ethnic Minor Psychol, 2000 Aug; 6(3): 235-51Am J of Psychiatry, 2000 Apr; 157(4): 615-9Gen Hosp Psychiatry, 2006 Jul-Aug; 28(4): 352-6Bol Assoc Med PR, 2009 Jul-Sep; 101(3): 33-41Mil Med, 2002 Jul; 167(7): 525-31Mil Med, 2002 Mar; 167(3): 235-41Med.Care, 2002 Jan; 40(1 Suppl): 117-28

Hispanic Veterans Health Care and the VA

Thank you!

Gabriel Pérez, CEO, Phoenix VA Health Care System

and President, Board of Directors, National Forum for Latino Healthcare Executives