Dr. Nurit Fischer-Shemer
SOCW 223: Practice-Informed Research in Health Sciences
The purpose of this study is to highlight the similarities in symptoms and disparities in treatment for PTSD in veterans and individuals who were formerly incarcerated (FI). These populations are particularly vulnerable to trauma due to the violent nature of warfare and incarceration. Veterans who have been in combat may have been exposed to war and the constant possibility of killing and dying while serving their country, and the FI may have faced the same while serving time for their alleged crimes. Both populations face barriers and challenges as they try to reintegrate back into mainstream society.
It is vital that all returning community members be treated with respect and offered equal access to necessary treatment. The VA currently has "almost 200 PTSD treatment programs across the country" (U.S. Dept. of Veteran Affairs), while treatment options for the FI population in California, in most cases, consist of one behavioral health provider for each of the state's 110 parole units. There are currently approximately 45,000 people on parole in the state (Hayes and Goss, 2018.
Understanding the barriers that exist, such as the stigma attached to treatment and fear of being vulnerable, is essential if we hope to close the gap between patients and care and provide competent, evidence-based interventions, resources, and treatments for both populations.
PTSD is a debilitating disease that has existed for thousands of years. The discovery of stone tablets written in cuneiform from ancient Mesopotamian provides us with evidence of holistic healers known as Asipus and Asu who identified, diagnosed, and attempted to treat what we now know were symptoms of PTSD (Hamid and Hughes, 2014). Horwitz (2015) argues that, as a phenomenon, PTSD has been misdiagnosed, mistreated, and even criminalized in America's past. During and following the Civil War, soldiers were often misdiagnosed and even sent to insane asylums and prison for expressing symptoms of PTSD (Horwitz, 2015). The writer also points out terms such as "shell shock," "combat fatigue," and "old sergeants' syndrome" were attempts to label and categorize symptoms of PTSD.
While the effects of spending time in prison were not well-documented until the 19th century, the concept of prisons has been discovered in Mesopotamian and Egyptian records from as early as 1,000 BC. Prisons have been used throughout history as a means of controlling captured enemies, slaves, and criminals. Known for the violence and brutality bred there, prisons were, historically, the last stop before a death sentence was carried out. It was not until the end of the Civil War when soldiers were released from prisons like the infamous Andersonville in Georgia that the effects of what we now know are PTSD as a result of imprisonment in the United States were recorded.
Although there is increased awareness of how prison conditions, abuse, and long-term incarceration affects inmates psychologically, little has changed in terms of treatment for these individuals once they are released from custody. Despite the commonality of PTSD symptoms between veterans and the FI, few, if any, intervention programs are readily available to the FI population.
Findings & Conclusions
This study was mixed method, collecting data through surveys and questioners. The researchers identified common self-reported themes, which were then coded. The results revealed that although the participants experienced trauma in different ways and in different scenarios, the resulting symptoms were similar. Also, though various evidence-based treatment modalities were available to veteran participants and only talk therapy was available to the FI, only one participant from each population was currently receiving treatment. The majority of study participants chose not to utilize treatment interventions for reasons ranging from mistrust of providers to the stigma of being labeled "crazy" attached to those seeking treatment for mental health issues.
It is important for all who serve these populations to keep in mind that these are their neighbors returning to their communities regardless of where they are returning from. The overall health of a community depends on the health of all its members, not just the ones who have served their country or have not been in any legal trouble. The more these similarities and discrepancies are examined, the better the likelihood that the gaps will be addressed. Therefore, more, larger, and longer-term studies are required to produce generalizable, more stable, reliable results. Results from small studies such as this run the risk of undermining "the internal and external validity of a study" (Faber and Fonseca, 2014, p. 29). It is also recommended that a more diverse group of participants be recruited that includes individuals from the LGBTQ community.
Mackey, James and Oliva, Richard, "Similarities and Disparities Between Available Interventions for PTSD in Veterans and the Formerly Incarcerated" (2021). MSW Capstone Conference. 5.