Kacie Kelly oversees and manages policy, operational, and programmatic efforts on veteran health and well-being for the George W. Bush Institute Military Service Initiative, which includes the Warrior Wellness Alliance.  She manages strategic efforts to promote the partnerships, collaboration, and alignment among organizations that are so crucial to fostering the health and well-being of post-9/11 Veterans.

Prior to this role, Kacie served as the National Director for Public-Private Partnerships in the U.S. Department of Veterans Affairs Office for Suicide Prevention where she was responsible for developing a comprehensive and integrated public health approach to prevent suicide among the 14 million Veterans not engaged in VA healthcare. Throughout her 15-year career with VA, she led innovative programs to serve more Veterans and their families through strategic partnerships within government and across public and private sectors.  In addition, she has had leading roles to promote military culture competence in the community, outreach efforts to reduce stigma associated with seeking mental healthcare, and to enhance provider proficiency in evidence-based mental health care.  She earned her Master of Health Sciences (MHS) at Louisiana State University and has a Graduate Certificate in Women in Public Policy and Politics from the University of Massachusetts - Boston. Kacie has also been an active volunteer in the New Orleans community where she served as a Commissioner on the BioDistrict Board of New Orleans and on the Board of Directors for the American Red Cross.

Shauna's latest book: Beyond the Military: A Leader's Handbook for Warrior Reintegration

Duane's latest book: Military in the Rear View Mirror: Mental Health and Wellness in Post-Military Life

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Duane France (00:00):

Welcome to episode eight of the Seeking the Military Suicide Solution podcast brought to you by the military times. I'm Duane France.

Shauna Springer (00:07):

And I'm Doc Shauna Springer.

Kacie Kelly (00:09):

And we'd like to thank you for taking the time to learn more about suicide in the military affiliated population. I'd also like to thank our sponsors, milMedia Group. milMedia Group is a proven web design and digital media agency specializing in supporting organizations focusing on the military population. Find more about them at www.milmediagroup.com.

Duane France (00:36):

Thanks again to everybody for joining us to listen to an honest conversation about service member veteran and military family suicide. Do you want more folks to find the show? Make sure to give us an honest rating and review on your podcast player of choice. We'd also like you to join our Facebook group moderated by fellow combat veteran Dee James. You can find the group and the show notes by searching for Seeking the Military Suicide Solution on Facebook. As we continue this series looking at suicide in the military affiliated population, we want to highlight a number of groups that are working to bring folks together in collaboration. That's what our guest today is talking about. Shauna, what can you tell us about today's guest?

Shauna Springer (01:11):

Yes, Kacie Kelly has spent 17 years working in the field of suicide prevention. While she was at the VA, she spearheaded efforts to disseminate cognitive processing therapy and prolonged exposure therapy throughout the VA system. Efforts which led to the training of 20,000 mental health professionals to become certified providers of CPT cognitive processing therapy in one year alone. She currently leads efforts at the George W. Bush Warrior Wellness Alliance, an ambitious initiative that aims to knit together the efforts of veterans serving mental health organizations with peer support based veteran service organizations and peer support based community organizations.

Duane France (01:55):

Yes, I'm glad that we're able to have Kacie come on the show. As many listeners might know, I'm involved with Kacie in the Bush Institute, through the veteran leadership program, and really think that the stuff that they're doing, the Warrior Wellness Alliance to bridge some gaps is some good stuff. So we'll get into the conversation and come back afterwards to pull out some key points.

Duane France (02:27):

The Warrior Wellness Alliance, really, for the last several years has been taking the lead on a lot of different things including suicide prevention. So from your point of view, what do you see that's working when it comes to preventing suicide in the military community?

Kacie Kelly (02:40):

Well, I think we're really starting to see a shift in how much people are talking about suicide. At one point in my career, my now 17 year career, you know, people who are even afraid to say the word suicide. And I think that we have reached an inflection point where people are so frustrated that the numbers aren't changing and are really recognizing that perhaps that veterans might have an opportunity to change the trajectory of the suicide crisis that we have in this country.

Duane France (03:12):

Not just for veterans and military families, but for our country overall. And one of the things that I think has helped with that is the Bush Institute. We've started really sharing our philosophy in that suicide prevention is not crisis intervention only. It is really about promoting a life worth living and the things that are working are not only evidence-based mental health care, but those other activities and programs that promote community and help veterans find purpose after the military and organizations such as The Mission Continues and Team Red, White, and Blue, and the Wounded Warrior Project, that continue to help veterans find their peers and find purpose and community after they've taken off the uniform.

Duane France (04:09):

Yeah, I agree. The idea that the conversation is starting now. Ultimately that's how this project had emerged. And Military Times got on board because so many people are, are interested. I mean we've been here for the last 15 years or so talking about it, but now the time for action is upon us and, and I agree there is a lot more discussion about it. And I think we're ready to move beyond just awareness.

Kacie Kelly (04:38):

I agree Duane and we're seeing some of that with the policy changes that we're seeing come to fruition. Both within the Department of Veterans Affairs and with some leadership coming out of the White House with the PREVENTS executive order and another executive order that came out before PREVENTS that was really focused on the transition period. That executive order we're actually now seeing, put into practice and that the VA has just kicked off one of the outcomes of that original executive order where they are proactively calling transitioning veterans at, the first call is at the 90 day mark. And that's something that people have been advocating for for many years that is now finally coming to fruition. And I'm really pleased to see that action being taken by the department and by our political leaders.

Kacie Kelly (05:36):

However, I think there's a lot more that we can do. I think that one of the reasons that the Bush Institute started the Warrior Wellness Alliance is because we believe that the VA and our government officials cannot do this alone. We know that the large majority of veterans actually don't go into the VA for a variety of reasons. And that supporting veterans mental health and supporting thriving veteran communities is really everyone in our country's responsibility. You know, less than 1% of our country defend our values and our freedoms and our country really needs to get their head around the fact that this is not a VA issue. This is not a DOD issue. This is an American issue and we should be proud to support military families on a daily basis.

Duane France (06:22):

You know, and I think that's a mind shift that a lot of people, maybe they're starting to have, but really need to have. And this is actually something that came out with my conversation with Barbara Van Dahlen was that for a long time we think suicide prevention is something we do to somebody. Like you said, it's this crisis intervention piece, but really it's something we do with somebody and with each other.

Kacie Kelly (06:45):

Exactly. Again, the Bush Institute started the Warrior Wellness Alliance with an effort to connect more veterans to effective mental health care that exists around the country. It is the only collective of organizations at the scale that seats veteran peer leaders at the same table with clinical subject matter experts. And my charge in leading the Alliance has really been to empower them to work collaboratively and equally as a collective. And even though of the 14 organizations, they all have their own mission, their own primary responsibility to get their own organization's job done, they have come together and recognized that there was so much more power in our collective and that even if mental health and suicide prevention was not their primary mission, they were dealing with it as a secondary or tertiary mission anyway. And so I'm really excited that we're to a place where we're taking this concept and this philosophy into action and we are kicking off pilots of a process that we have worked together to generate that actually functionally connects nonclinical organizations to clinical organizations and provides a mechanism for our peer networks to be able to refer themselves or to refer their buddy when they see them struggling to effective mental health care. In a way that does not put them in a position that makes them feel like they have any liability or that overextends what they feel their capacity is.

Kacie Kelly (08:27):

As far as training. We really have worked to understand their operations. While we are excited about the three pilot regions, what I'm most excited about in kicking them off is that this is just the beginning. The intention is that we will learn, we will refine and then be able to give this new knowledge and this process that has been developed to others and scale it on a national basis.

Duane France (08:50):

And I think that, and as you mentioned, we'd been doing this for so long, I think maybe that identifies what one of the things that isn't working is that each of us doing something individually isn't solving the problem. Right? I mean, we all complain and tear our hair out about these silos and these turf Wars and stuff like that. And like you said, this is why the Warrior Wellness Alliance was created was to bridge that gap. But is that one of the things that isn't working when it comes to suicide prevention?

Kacie Kelly (09:19):

Yeah, I think that while there are variety of things that aren't working that need to be improved, but one of the things specifically that, that we have learned in the Alliance and that I think we will be able to share is this barrier of we just have limited mental health care in this country. We have limited quality mental health care in this country. We also have this mindset of expecting veterans to come into the healthcare system. With the Alliance, we're, we're combating both of those challenges and both of those barriers. In this process, we have sort of created a way for nonclinical organizations to access quality, mental health care when they need to. We all know that there's nothing about this that's easy. And I'm just really thankful that at the table with me through the Alliance, we have so many brilliant experts.

Kacie Kelly (10:20):

And the brain capital in our Alliance I think is really what's going to make us feel successful. So I would say there are three things that we're really addressing through the Alliance that are barriers to suicide prevention and barriers to more people accessing quality care. One is the negative perception issue. The "reaching out for help means I'm weak" by working through our peer networks and sort of sending a message that their strength and power and shared experience and that we really want you to thrive. It's not just about surviving, it's about thriving. We're targeting that negative perception, that stigma issue. The second is the navigation to quality care. You know, once someone is willing to raise their hand and say, okay, I'm struggling, I need some help.

Kacie Kelly (11:14):

I don't know what it is. It's really hard to get access to something that would be a good experience. And so through these pilots, we've created this easy button, if you will, that we'll be testing and refining. And then the third thing that that is much bigger, and the Alliance alone cannot tackle this, is the fact that we have limited quality mental health care in this country. So one of the ways that we are planning to combat that is through technology, through coming together to really shine a bright light as a collective, that this is an issue that more people need to be focused on. And then to be positioning ourselves to get those nonclinical resources into folks hands at a community level so that people who maybe aren't social workers or psychologist or psychiatrist will know what to do and know how to take action and feel competent that when they take action to help their buddy that they will get the care that they need.

Duane France (12:16):

Kacie and I talk about the impact of leaving the military and the challenges of transition to post-military life.

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Duane France (13:41):

Yes. And this is, again, looking at the gaps, and you've mentioned it a couple of different times, but this, you know, the idea that all of the peer organizations are over here on this side of the chasm and all the clinicians are over there on that side of the chasm and never the twain shall meet. Right? It's like, you know, the chocolate and the peanut butter and nobody knows they work together. And that's what the pilot program...well, the Warrior Wellness Alliance overall, but the pilot program is aiming to do in these three target regions is to bridge that gap almost literally.

Kacie Kelly (14:17):

Yeah. Literally. It's exciting. And you know, I think that there will be a lot of things that we will learn and we'll learn them really quickly. But you know, the number that sort of strikes me is, is that while we know that the large majority of veterans come home and transition and go on to contribute as leaders in our communities around the country and, and in corporations, we also estimate that at least 250,000 Post 9/11 on any given day are struggling with some sort of invisible wounds of war. And there's no simple rapid or reliable way for them to confidently refer themselves or to refer appear to effective mental health care and quality mental health care. And I think that while we are focused on referral to effective mental health care, that many of the byproducts are going to be in uniting these organizations around a singular mission that will ultimately lead to not just reduction of disease and reduction of the sort of challenges associated with invisible wounds of war, but will also be an opportunity for these organizations and the Alliance to unite around a shared mission and to continue to thrive in this community that we have developed called the Alliance.

Duane France (15:52):

You know, and I really appreciate that identification, maybe that delineation and, and as you will know, it's not even as easily delineated. You know, a couple of years ago a friend of mine, he was a deputy sheriff in the local veterans court. And he said, how long have you been out? And I said, well, I've been out for three years. And he was like, Oh, you've had a great transition. Well, it's not felt like that from my standpoint, right? Because it's not always blue skies and puppy dogs and rainbows. And so even those non 250 that aren't struggling with an invisible wound of war, maybe necessarily sort of the idea that we're all two paychecks away from poverty, we're all two really big incidents from really needing to connect with somebody.

Kacie Kelly (16:36):

Yeah. Well, Duane, you know, I also like to remind folks that mental health and that transition is not only a veteran issue. While there are certainly things that our our military face that are different than and not even comparable to the rest of our population. Change is hard. Change is hard for everyone. And whenever that is a traumatic event or a career change or geographical relocation it is to be expected that there will be some challenges associated with those transitions. And I think sometimes that we, we forget that some of this is just normal and it's life. It's okay to not be okay is the, the latest phrase I've heard. Because, you know, I think that we forget that when there are challenges, there's also growth, right?

Kacie Kelly (17:44):

And I just always try to push back when folks try to put veterans sort of in this like corner that they're so different, because in my experience, I have learned more about leadership and more about strength and courage and vulnerability frankly from the veterans that are in my life. And I actually think that what our veteran community is doing related to advancing proactive public health approaches to helping their veteran communities thrive, whether it's through the enrichment program at TRB, or the shared mission of the Mission Continues or our own team 43 that's really sort of taught us, taught the Bush Institute about the power of competitive sport and recovery and the power of community through competitive sport. I think all of those social determinants, those sort of preventative activities are really what's going to be the secret sauce when we crack the nut on on suicide prevention. I think we, we as a country have completely missed the boat in how we've thought about suicide prevention and mental health care and thinking that it was isolated to a healthcare setting. I think there's so much more that we have to learn and so much more opportunity for us outside of the healthcare system.

Duane France (19:16):

I seem to be saying this almost every interview and I might start to edit it out because the listeners are going to hear it over and over. But if I as a mental health counselor had the solution in my community, had the solution, the problem would be solved, right? It's not just an us problem. What are some actions, steps that people can take? It's great to think about this and beyond, you know, pushups and hashtags, but what are some action steps and actual things that people can do to maybe make a difference in their lives, in their community?

Kacie Kelly (19:48):

So the first thing, when I get this question, I always try to remind people that asking sincerely how someone is doing and waiting to listen has so much power. And that is something that every one of us can do. And I think we take it for granted because we are all so busy doing our life. And I think technology, this is an area and I'm a huge fan of technology. I think this is an area where technology has, has created an additional barrier. So I would just, I think, strongly encourage listeners to not undervalue the power of looking someone in the eye or picking up the phone and sincerely asking how they were doing and letting them know that you were there to grab a cup of coffee or to go for a run or something.

Kacie Kelly (20:42):

I think the other thing that is a pet peeve of mine is when people are interested and wanting to do something about raising awareness about the suicide epidemic in our country. They often time raise the numbers, right, highlight the problems. And I strongly encourage implore every one of you that are willing to take that action. And thank you for taking that action to raise awareness about this problem, to also make sure that you include some resources that are available. Because the last thing we want to do if someone really is starting to feel down or just start thinking about suicide is to continue to reinforce how bad the problem is without actually letting them know that someone is there and that there are resources that are available. So those are, I think those are my two biggest suggestions.

Duane France (21:40):

My...it brings in mind thinking, you know, if you've got a bunch of stray dogs running around just pointing how many stray dogs are out there isn't solving the problem. It's how do we coordinate our efforts to reduce the stray dog population.

Kacie Kelly (21:53):

Yeah, exactly. Duane . And unfortunately I've been on the other side of it where when we were reviewing tragic situations where we have learned that people decided to take their life and you know, as a result of feeling like there was really no hope. Because of people raising the numbers. And I think the final thing I would just offer, we've talked a bunch about the Alliance, but if folks would like to get involved with any of our Alliance organizations please check out www.bushcenter.org/wwa. You can find opportunities to connect with peer networks that are in the Alliance. You can also find opportunities to learn more about effective mental health care organizations around the country. And what we're going to continue to build out the website. So I would encourage you to check back. You can also follow me on Twitter at Kacie A Kelly, I'm sure Duane will send out some contact information and follow up to this. I just really thank you for allowing me the opportunity to join you today and share a little bit about what we are doing with the Warrior Wellness Alliance to try to help be a part of the solution and create a country where more veterans are able to thrive and continue to lead our country the way they so passionately want to.

Duane France (23:30):

I really enjoyed the conversation with Kacie . Again, as I've mentioned in the intro and a number of different times, I've known her I if for a couple of years now actually in our mutual interaction at the Bush Institute and I really do believe what they're doing as far as making that bridge between the organizations that have veterans participating like Rubicon and stuff, and then mental health professionals. I think it's a noble goal. So what did you think about our conversation?

Shauna Springer (23:56):

Well, first off, Kacie is absolutely on the money when she points out that even though many of the pure based veteran's service organizations didn't start with the central mission of preventing veteran suicide, this has become a secondary or tertiary purpose for many of them. Team Rubicon, a disaster relief organization started and led by veterans, is a perfect example of this. Team Rubicon's founders originally conceived of TR as a way to tap the unique skills of veterans to become a highly capable, adaptable disaster relief organization. The suicide of beloved Marine and founding member Clay Hunt prompted deep grief and a time of soul searching among TRS founders. And they emerge from this grief with a realization that Team Rubicon's central mission would be the support of veterans through giving them purpose, which can be lifesaving for some members as a rank and file gray shirt within Team Rubicon, I've been deployed twice as part of disaster response operations in Northern California.

Shauna Springer (24:56):

Being on these operations has given me a window into the comradery between service members that can be so hard to put into words. At the end of the day, we gather around a fire pit huddled together by the glow of the fire. The conversation quickly turns intimate. Fellow gray shirts, sharing their grief in losing fellow veterans to suicide. How they themselves have battled with their own demons and how the mission of Team Rubicon has been lifesaving to them in the context of this mental warfare. It's critical to stand with these organizations. Live saved isn't well captured by research, but I've personally witnessed this outcome repeatedly because of organizations like Team Rubicon.

Duane France (25:34):

Yeah, I am a huge fan of whatever we call them, the new age VSOs or what have you. The way I sort of describe it, and have had this conversation with folks from Team Rubicon and RWB, and things as well as the VFW and the Legion is that you know, the VFW and the Legion sort of give veterans what they need. They do a lot of legislative activity. They do a lot of obviously supporting for benefits and meeting the needs of veterans and their families. The new VSOs can really be seen as giving veterans what they want. Right? I want to go exercise, I want to engage in that. So I go to team RWB. I want to, you know, run through the woods with the chainsaw. So it's Team Rubicon. I want to do community stuff. So it's a, the Mission Continues and at the same time, that also meets both of them meet a deeper need of connecting to other veterans just as what you're talking about, which can definitely keep somebody from going into a suicidal crisis.

Shauna Springer (26:37):

I know you were kidding. And I know that team Rubicon would never let their sawyers, who are the people with the chainsaws go running through the woods with them.

Duane France (26:45):

It is a post-military version of something...I used to say running through the woods with muddy boots and rifles. I was speaking metaphorically, not literally, don't run with chainsaws, kids. Do not try this at home.

Shauna Springer (26:58):

We joke around a lot about putting out a TR calendar where people would be just with the chainsaw and nothing else and selling that and we would never do it, you know, but I was joking around with some of the guys and women about that kind of a funny fundraiser. Which will never happen. Okay. The second thing that I pulled out is this: I absolutely agree with Kacie that life is full of transitions and that veterans are some of our strongest, bravest, most adaptable citizens. And knowing her heart for veterans, I'm sure she would agree that transition from the military is a uniquely vulnerable time. Research informs us that the majority of first suicide attempts occur within the initial phase following discharge. In fact, to my mind when many of our strongest and bravest citizens are hitting a wall, we should get curious about why this is the case.

Shauna Springer (27:50):

My sense is that current transitional programs view the needs of transitioning veterans as being somewhat like job seekers who need to find their next paid job. Yet those who serve in the military are not like coworkers. They're a family, and the needs of transitioning veterans go far beyond the need to find new employment. That turns often tell me that they feel invisible like ghosts trying to navigate through a culture that has values that are completely different from their own values. This is essentially why Jason Roncoroni and I wrote Beyond the Military to unpack the psychological, cultural and relationship dimensions of transition that we are not talking about and to build a program that will allow veterans to confidently navigate the minefield of transition. Columbia University researchers, Meghan Mobbs and George Bonanno have also done some great research on transition. They publish a very thoughtful article that will include as a further resource in the link to the show notes for this episode.

Shauna Springer (28:48):

Here's a quote that I really liked from their article. :During transition, service members may struggle with unresolved or prolonged grief and bereavement over fallen comrades, loss of their previous military identity, nostalgia for the order and purpose to characterize their service experiences, a sense of moral injury, confusion about military and civilian differences and changing masculine roles". In the final analysis, this is whereI land. military transition is a uniquely stressful experience. And armed with the right psychological insights and the right support, our warriors are uniquely capable of not just surviving but thriving beyond the military. What did you think Duane ?

Duane France (29:28):

No, I obviously I agree having gone through it myself. And it's interesting, I think that we're having this conversation along with the Warrior Wellness Alliance one. In that, back on the other podcast, I had the director of team RWB, JJ Pinter, on the show and he and I talked about the fact that the military really sees transition as transactional. Right? You know, give me your experience. I will return you a resume. Give me your wardrobe. I will teach you how to dress for success. Give me your interview skills and I will help you hone them. Right? So it's very much a give and take. Whereas in JJ's point, it needs to be much more transformational in that we need to change the mindset. I've written before on how to apply Prochaska and DiClemente stages of change. And we're getting into the mental health mumbo jumbo here.

Duane France (30:20):

But the stages of change model, if I am not ready to change my mind, the Army doesn't care, it puts me out anyway. Right? So if I'm in precontemplation stage, they want me to take action. And so we do have to make that shift. And then what...and Meghan Mobbs is a friend...and what Megan and her colleague have talked about is transition stress, moving beyond the medical model of mental health where it's PTSD and TBI, and even substance abuse where there are diagnoses for these, but moving beyond the medical model for mental health to more of a wellness model and these other things like purpose and meaning, moral injury needs fulfillment family, which you're very familiar with relationships. There's no diagnosis for repeated disrupted relationships. But yet that is a significant part of the challenges in post-military life.

Shauna Springer (31:11):

Absolutely. Couldn't agree more. I have so many patients whose relationships ended even solid relationships or had all kinds of relationship-based chaos during the transition period. Which is part of what makes me feel that it, it really is a uniquely vulnerable time for relationships and for personal wellness. But there are ways that we can navigate this if we understand sort of psychological underpinnings of it. And you wrote about some of that too in Military in the Rear View Mirror. You definitely took on some of those things that people don't talk about enough.

Duane France (31:46):

Yeah. And I've often said that one of my secrets of success is that I didn't come home to an empty house. That was one of my very, very important aspects of the support from my wife and, and we've been married for well over 20 years. And so that is a definitely a great point. And, and being able to yes, transitions and changes in life occur. I've got kids going from high school to college and then they'll go from college to the workforce, but it is unique from the military to post-military life.

Duane France (32:19):

Really really appreciate everybody checking out the conversation that we just had a make sure to check out the show notes for this show veteranmentalhealth.com/stmss08. You can get the links to everything that we talked about on this episode, as well as finding the show notes on military times.com. As a reminder, you can ask us questions or let us know what you thought about the show by going to our Facebook group, moderated by the outstanding Dee James by searching, seeking the military suicide solution on Facebook.

Duane France (32:44):

While you’re at it, check out our sponsors, milMedia Group. They’re a web design and digital media agency with over 25 years of experience in supporting service members, veterans and their families. They specialize in working with startups, small businesses, entrepreneurs, nonprofits and city, state and local governments. As a veteran owned business, they’re uniquely qualified to work with those that want to reach an audience in the military and veteran space. Do you have a dream or a vision they can help you bring it to life and get it in front of your audience? You can contact them at (254) 554-0974 or find them online at www.milmediagroup.com

Shauna Springer (33:19):

Just a reminder that the guests and reflections on this show are for informational purposes only and should not be considered professional advice. While Duane and I are mental health professionals, we are not your mental health professionals. We always recommend that you discuss these things with the licensed clinician.

Duane France (33:37):

You can find out more about the work that Shauna’s doing by checking out her latest book, Beyond the Military, a Leader’s Handbook for Warrior Reintegration, and the work that I’m doing with my latest book, Military in the Rear View Mirror. Both are available on Amazon and we’ll have links to those in the show notes. and always remember, you can connect with the veteran crisis line by calling (800) 273-8255 and pressing one, chat online with them at veterancrisisline.net or texting, 838255. Thanks again for joining us to talk about Seeking the Military Suicide Solution and make sure to follow Military Times on social media to keep up with the latest shows. Join us next time for another great episode and until then, remember, you’re not alone. Ever.