Therapists with experience primarily treating patients with PTSD related to combat or MST will need to be sensitive to the unique experiences of the National Guard and Reserve service members. For example, this component of soldiers served on COVID-19–related missions that provided food service support to nursing homes residents who were locked down from family members. As a result, they developed bonds with residents who later died. This may have been the first time that these soldiers witnessed death. If such a soldier is assessed and does not have PTSD but is nonetheless distressed, then the soldier may need alternate therapies, such as grief counseling. This need may be more pronounced for those soldiers who lost loved ones to COVID-19 while they served on these missions.
New Jersey Army National Guard soldiers provided food service support at the Woodland Behavioral and Nursing Center in Andover, New Jersey. These soldiers witnessed the unfortunate conditions in this facility, which included stacked bodies in a makeshift morgue during the height of the pandemic; however, they did not have the ability to make changes. The facility is under investigation for abuse and neglect of its residents.13
New Jersey National Guard soldiers supporting that facility and similar ones may have experienced moral injury, defined as “…perpetrating, failing to prevent, or bearing witness to acts that transgress deeply held moral beliefs and expectations.”14 Importantly, when these soldiers present for therapy and express moral injury, their therapists need to be open to spiritual discourse. However, vet centers do not have chaplains on staff, so therapists must refer patients to chaplaincy services.
Among therapists with existing cultural competency for treating members of the military, some nuances exist for National Guard and Reserve service members. National Guard and Reserve component personnel already may feel that their problems are less important than those experienced by active-duty service members. Now that these soldiers have the eligibility to receive therapy, therapists may have to make extra efforts to both reassure this population that they are welcomed and to validate their need for services.
Special outreach efforts to those who served on historical National Guard and active-duty Reserve missions are a way to show good faith in serving these soldiers because they may have untreated PTSD or other undiagnosed mental health disorders related to earlier deployments, such as hurricane recovery missions. A study of disaster survivors found that the prevalence rate of severe and very severe psychological impact after a natural disaster was about 34%.15 Another epidemiologic study found that the prevalence rate of PTSD was 10% to 20% among disaster rescue workers.16 Specific data about the psychological problems of National Guard and Reserve components serving in disaster recovery are unavailable but is an area for future research.
Therapists who have treated active-duty service members and veterans who worked in mortuary services in a combat zone are used to hearing graphic details of horrifying scenes, but homefront experiences are different. Soldiers on homefront mortuary-based missions frequently reported being unable to forget the faces or the smell of dead bodies as they were stacked up and overwhelming the systems. Experienced vet center therapists should be prepared for the challenges in treating this new cohort of patients.
Conclusions
Now that National Guard and Reserve component soldiers who have responded to national and local emergencies are eligible for therapy, we need to be prepared to provide these services. In addition to addressing systemic staffing concerns, therapists need to be aware of the unique challenges faced by those who have served on homefront missions. These homefront missions have the potential to hit home for therapists.