COMMENTARY

Mission Critical: Getting Vets With PTSD Back to Work

Barbara J. Meade, MD, DVM, MPH, PhD; Margaret K. Glenn, EdD; Oliver Wirth, PhD

Disclosures

March 29, 2013

Editorial Collaboration

Medscape &

In This Article

Promising Intervention Strategies

Work-related psychosocial factors can place the veteran's recovery at risk. These factors include stress on the job, dissatisfaction with choice of occupation or job, failure to receive necessary accommodations on the job, and lack of skills or support by coworkers. After these areas of concern have been identified, the team can assist the veteran in implementing a plan for employment using the following intervention strategies

Develop coping skills. For veterans with PTSD, handling stress is a core issue. Sources of stress include their medical conditions, their interpersonal relationships, and the changes occurring in their lives. The individual's coping skills must be assessed and addressed through treatment. Individual, group, and family counseling can assist people with developing these skills. Other interventions found to be promising by the National Council on Disability include cognitive-behavioral therapy, exposure therapy, cognitive restructuring, and eye movement desensitization and reprocessing.[28] It may be necessary for the primary care team to refer the veteran to a mental health provider for these services.

Pursue education and job training. Occupations for veterans can be limited by geographic location and the local labor market. Yet, a major reason that many jobs are not filled is the lack of qualified workers.[29] The Vocational Rehabilitation & Education Program in the US Department of Veterans Affairs and the state-federal vocational rehabilitation system are available to help with training.

Request work accommodations. An accommodation is any change in the environment or in the way work is customarily done that helps a veteran enjoy equal employment opportunities. Examples of accommodations for veterans with PTSD include providing a noise-cancelling headset to address concentration problems, providing written as well as verbal instructions for those with memory deficits, using organizational tools to help with time management, allowing more frequent work breaks to cope with stress, or matching a veteran with a service dog that performs specific tasks to improve functioning. These recommendations may be stronger when they come from a physician. A list of functional impairments with associated job accommodations for veterans with PTSD is available at Job Accommodation Network -- Occupation and Industry Series.

Understand the law. The larger world of legislation and policy is an essential part of the negotiation for a supportive work environment. Title I of the Americans With Disabilities Act and the Uniformed Services Employment and Reemployment Rights Act are protections from employment discrimination. Taking the time to understand these laws will enhance the primary care team's ability to assist this patient population.

Keys to Success

The primary care team plays a major role in facilitating the employment success of veterans with PTSD. The limited time that individual physicians have for each patient's overall care underscores the importance of developing multidisciplinary teams for the care of this medically complex population. In addition to providing traditional healthcare, these providers serve a vital function on an interdisciplinary vocational rehabilitation team that understands the importance of employment in promoting health and well-being. By working together, these teams can ensure that veterans, who have endured hardship and sacrifice in service to our nation, receive the assistance they deserve to reclaim a position in the US workforce.

Disclaimer: The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the National Institute for Occupational Safety and Health, the Centers for Disease Control and Prevention, or the US Department of Health and Human Services.

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