Military Culture Trainings Seek to Build Trust Between Veterans, Civilian Healthcare Providers

Nov 12, 2015

All this week we’ve been hearing about programs that help veterans who are struggling with PTSD or TBI.  But before these programs can work—veterans who need help actually need to ask for it.  But we know that’s a barrier to getting healthcare.

A recent survey of New Hampshire veterans indicated many felt ashamed of needing help. And they also felt the providers—most of whom have no military experience—don’t understand what it’s like to be a veteran. The state’s Department of Health and Human Services is trying to fix that.  It’s funding classes on military culture for health workers. NHPR's Peter Biello stopped by one of these training sessions in Portsmouth.

"Now if you would, there are all kinds of definitions of a veteran. What is a veteran?" 

Ted Kehr poses this question to a room full of mostly mental health professionals. Kehr is a veteran of the Army and the New Hampshire National Guard, and he looks the part: he’s bald with muscular frame and moves about this seminar room with quick, efficient steps.

Someone answers, "Someone who has served in the military."

"Here’s another one," Ted says. "A veteran is someone who at one point in their life wrote a blank check payable to the United States of America up to and including their life.”

By now it’s clear that Kehr is a passionate advocate for veterans. The Department of Health and Human Services funds this training which is run by Dare Mighty Things, an organization that works with at-risk youth and families. Kehr says this education bridges the gap between civilians and veterans.

"This puts us on the same wavelength, the same playing field, makes the comfort level better for the service member who is seeking services," he says. 

DHHS also funds other programs to help vets in a similar way, including the “Ask the Question” campaign. That’s a push to get doctors, police officers, therapists and others to ask questions about someone’s military service.

At the culture training session, Kehr runs through the branches of the military and their ranks.And he spells out how veterans of different wars prefer different ways of communicating. For example, World War II vets want you to show the value of what you’re telling them. Post 9/11 war vets prefer action words and humor. The ultimate goal here, he says, is to build trust.

"Stigma is the prelude to trust," Kehr says. "Stigma is something that prevents these folks from coming forward or seeking help."

In that survey, nearly a third of veterans reported not getting the help they needed because they were embarrassed or ashamed. Another 16 percent reported not feeling understood by their healthcare providers.

These military culture trainings aim to change that. Ellen Tully is a welfare administrator for the city of Portsmouth. She works with people in financial trouble. Some are veterans.

"I communicated with them before just like I do with anybody who comes to my office, but now I think I can hone in on the military aspect a little bit, as far as background, experiences," Tully says.

Now Tully says she’ll ask questions like: what branch did you serve in? What did you do when you served?

Diana Dumais works at the Seacoast Mental Health Center in Portsmouth. For her, the takeaway is the communication style lesson. For example, if a veteran of a post-911 war misses an appointment, a text message may be the best way to reach out. But if it’s a World War II veteran, she says, "that rules out sending emails for a lot of those people because maybe they’re not of a generation that’s so hooked into technology. Like, I’m sitting here checking my Facebook. A World War II vet might not do that."

Which may sound obvious, but for many healthcare providers, it’s not something they’ve thought about in this way before. It’s that kind of awareness that Patty Driscoll says is really important. She’s the Adult Services director at Seacoast Mental Health Center.

"If the cultural background of the people we’re serving plays a role in what they’re looking for service for and how to communicate and how to understand how they accept help, it’s going to make it easier and it’s going to be more effective."

Dare Mighty Things hopes to hold fifty of these trainings by the end of next year. It’s too soon to say what impact they’ve had, but it has changed what Diana Dumais thought she knew about veterans.

"I always thought of them as, ‘I’m proud of what I’ve done, so I’m going to come right out with this,’ but it’s the asking for help part that’s the problem and the stigma for them," Dumais says.

For Ted Kehr, today’s session was an investment in the future of how the state cares for veterans.

"I think we’ve planted the seeds. I’ve had three or four come up and say, ‘We’re going to call and schedule. We need to do this,'" Kehr says. 

Call—as opposed to email or text—because some veterans need a phone call to start building trust with the person on the other end of the line.