Officials Urge More Care for Caregivers

By Elaine Wilson
American Forces Press Service

Jan. 14, 2010 - The military needs to step up efforts to head off compassion fatigue among its caregivers, a National Guard official said here yesterday.

"I do think not enough of it is being paid attention to by the active or reserve component," said Public Health Service Capt. Joan Hunter, director of psychological health for the National Guard Bureau.

Hunter spoke at the 2010 Suicide Prevention Conference here sponsored by the Defense and Veterans Affairs departments. She defined compassion fatigue as the emotional residue or strain of exposure of working with patients recovering from traumatic events. Warning signs, she explained, include a decrease in performance, inattention to self-care, irritability and anger, absenteeism, and conflicts with workers and peers.

"It starts out in a very insidious way, but can escalate very quickly," she noted.

Hunter said she's already seen evidence of it within the Guard's new psychological health program. Through the program, officials have placed a provider, called a state director of psychological health, in every state and territory. Directors work with community health providers to build relationships and networks that will offer psychological health services for Guard members and their families, according to the National Guard's Psychological Health Program Web site.

"In the first year that we've become operational, I've already seen compassion fatigue among the licensed providers that are providing these services to our soldiers and airmen in the National Guard," she said.

Hunter cautioned leaders not to overload these providers, who already are saddled with an extensive workload.

"I think very quickly, if we're not careful in this program, we're going to move on the scale from compassion fatigue to burnout," she said.

Hunter also noted the importance of caring for the 5,000-plus Guard volunteers, many of whom are geographically dispersed.

"As citizen-soldiers and citizen-airmen, we are very tied to our communities and many of us are remote," she said. In the Army National Guard alone, 6,400 members are the only soldiers within their ZIP code, she noted.

Compassion fatigue has touched chaplains, military family program coordinators, state family program directors and sexual assault and response recovery coordinators, Hunter said.

Caregivers often set themselves up for overload by taking on too much, J. Elizabeth Perkins, director of psychological health for the Michigan National Guard, said at the conference yesterday.

"We think we can do it all," she said, "that we can take on just one more thing. The reality of that is there's always one more, and we'll never be able to accomplish what we need to without taking the time and giving ourselves the permission to say, 'No, I need to take some time so I can then help others.'"

To illustrate, Perkins recalled a conversation she had with a state chaplain. "He was reminding his staff about the importance of self-care. I turned to him and I said, 'Well sir, that's wonderful, but when was the last time you took a vacation?' It had been three years."

Caregivers are adept at offering other people recommendations to help them cope, "but we don't then do that for ourselves."

It's vital to build personal resiliency, she said. Maintaining a healthy diet, exercise, adequate sleep, social support and setting boundaries can help, she added.

Perkins noted that the Defense Department-funded Millennium Cohort Study initially has indicated that daily physical activity reduces the risk of developing symptoms of post-traumatic stress disorder. Perkins also cautioned caregivers to be aware of multiple stressors, such as work and personal problems, which can lead to a stress overload.

"We also need to be asking ourselves, 'What else is going on in your life?' And this is not just as helping professionals, but also for those servicemembers with whom we are working," she said.

People at risk of cumulative stress may be confronting mental or physical concerns, for instance, along with marital and family issues. These significant stressors not only raise the risk of illness, but possibly suicide, she said.

Perkins described several effective methods for stress relief including meditation, journaling, deep breathing, the importance of doing nothing and guided imagery. Along with personal de-stressing methods, Hunter said, the Guard is taking big-picture steps to help.

Leaders plan to take the "goals and intent" of the Army's Comprehensive Soldier Fitness program and translate it into a program that works for the Guard. The Army program is a psychological fitness initiative designed to build resilience in soldiers. They also plan to leverage senior enlisted personnel in the hopes of increasing face-to-face contact with junior enlisted members. The Guard doesn't have enough licensed providers to meet the demands of Guard members, she noted.

"I think our counselors and our mental health providers are the best asset we have in the Department of Defense and in [Veterans Affairs]," Hunter said. "And I think it's our responsibility and our duty to protect them and to provide them with the tools they need to get the job done."