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25 YEARS OF PHOENIX AUSTRALIA AND PROGRESS IN TRAUMA-RELATED MENTAL HEALTH.
“We thank everybody who has been on this journey with us and we look forward to continuing that journey in the years ahead to provide better outcomes for people affected by trauma – no matter what the cause” – Professor David Forbes, Director of Phoenix Australia
When the National Centre for War-Related PTSD – now Phoenix Australia – began in 1995, the understanding of PTSD was in its relative infancy. Thankfully, the past 25 years have seen a significant increase in knowledge and recognition of PTSD and trauma. That journey continues.
Mirroring the advances made in the understanding, treatment and prevention of PTSD is the growth of Phoenix Australia. On a national and international platform, the organisation has taken a leading role in building evidence and translating knowledge and collaborating with other mental health experts to ensure that those who experience trauma and PTSD receive the best possible evidence-based treatment.
PTSD was officially added to the Diagnostic and Statistical Manual of Mental Disorders in 1980 – primarily due to the experiences of Vietnam veterans and the learnings they brought to the mental health field.
“The Vietnam generation returned from conflicts with a range of mental health problems,” says Professor David Forbes, Director of Phoenix Australia.
“What we learnt from the Vietnam veterans led to linkages being made between their experiences and those of survivors of other kinds of trauma like sexual assault, accidental injury and, to an extent, Holocaust survivors. The links and consistencies resulted in PTSD eventually becoming a diagnosis.”
The veteran community and the Department of Veterans’ Affairs (DVA) were pivotal in progressing recognition and research of PTSD and helped champion the establishment of the National Centre for War-Related PTSD in 1995.
“The first ten years were spent trying to better understand the nature of the disorder, how it differed from other mental health disorders, developing scientific methods of assessing PTSD, and getting GPs and mental health practitioners to be able to recognise and identify it,” says Professor Forbes.
From 1990 onwards the focus shifted to identifying the best treatments for PTSD, with researchers looking at how to adapt existing treatments to manage PTSD.
“We have made big inroads into the assessment of PTSD, improving practitioner awareness of PTSD, increasing community awareness of what PTSD is – and we have made significant inroads into what best practice treatment looks like,” says Professor Forbes.
“In the past 20 years we have seen a greater focus on understanding the nature of treatment and a raft of predominantly psychological treatments have been developed that have now got a solid evidence base. Yet, even with those effective treatments, about a third of people with severe PTSD don’t seem to respond to the best treatments, and some of those who respond will still have significant problems after treatment. We still have some way to go to ensure more people benefit.”
One focus of Phoenix Australia has been to increase awareness that PTSD isn’t exclusive to the military and veteran communities, but affects 75 per cent of the community as survivors of assault, sexual assault, family violence, accidental injury or natural or manmade disasters.
“We’ve done significant longitudinal research and that aims to better identify the patterns of recovery for different people after trauma, and the factors that influence recovery or otherwise. The results of this research mean that we can help practitioners understand those factors, and provide advice to agencies and services of what to put into place to support people, to minimise risks of developing mental health problems and bolster protection,” says Professor Forbes.
Phoenix Australia’s longitudinal research has contributed to a deeper understanding of PTSD and trauma. The Longitudinal Australian Defence Force Study: Evaluating Resilience (LASER): 2009-2019 report studied General Entry and Officers over the first three to four years of their military career. It amalgamated findings from a series of reports produced over the course of the study that highlighted key variables of importance for wellbeing and resilience in the early years of a military career. Variables associated with the maintenance of wellbeing during periods of stress were social support, leadership, coping styles, sleep, alcohol use and anger.
The LASER-Resilience program focussed on understanding individuals who adjust successfully to their military career and the factors that enable them to do so. Of particular interest was identifying the potentially modifiable factors that promote resilience, with the ultimate aim of informing future policy, programs and strategic development to support and build resilience in current and future ADF members.
Other key research projects have examined screening for PTSD and depression following traumatic injury. Phoenix Australia has also researched the effectiveness of early psychological intervention for PTSD, anxiety disorders and depression following serious injury.
A predictive screening index for PTSD and depression was designed to facilitate the early identification of individuals most at risk for developing PTSD and/or depression after a traumatic injury. It is one of the first adult screening instruments specifically developed to identify risk for poor psychological adjustment following trauma and is a first step in the process of developing public health models of early intervention following traumatic events.
Other injury-focussed research has looked at how best to simply and feasibly deliver effective treatments at the right time to the right patients.
Phoenix Australia has also been instrumental in providing mental health practitioners, policy makers, industry and people affected by trauma with access to recommendations that reflect current evidence on the most effective treatments for PTSD. The first national guidelines for the treatment of PTSD were developed in 2007. An update in 2013 included treatment recommendations for children and adolescents. .
The latest version of the guidelines, Australian Guidelines for the Prevention and Treatment of Acute Stress Disorder, Posttraumatic Stress Disorder and Complex PTSD, approved by the National Health and Medical Research Council in June 2020, include the diagnosis of complex PTSD for the first time. They are published in an innovative online ‘living guideline’ format so can be updated when there is sufficient new evidence to do so.
Looking ahead, Professor Forbes says Phoenix Australia will continue to research, innovate and educate. Improving awareness of the extent of PTSD with medical practitioners and communities and improving community education about how to effectively self-manage PTSD remains a focus.
“We know that if someone with PTSD sees a mental health practitioner, the likelihood of them getting best evidence-based treatment is around 50 per cent, so we have work to do to bridge that gap,” says Professor Forbes.
“We want to continue to improve community awareness so family, friends and networks can better support people with PTSD and point them in the direction of professional care. There is also more we can do to educate the community and those with PTSD about what self-management might look like and what they can do to help themselves.
“We also want to reduce the stigma around help-seeking, so people are more prepared to seek care if they are struggling. And we will continue to work with governments and agencies that deliver care to make sure treatments that work are made available to people in a way that they can access.”
Challenges remain in terms of refining treatments so they have broader impact and to develop new treatments for those for whom existing treatments don’t work. There is also a gap around prevention and a major focus for Phoenix Australia and international colleagues is to look upstream and build evidence around prevention.
“Phoenix Australia’s work now extends well beyond our origins in military and veteran mental health. We are contributing to research, to knowledge generation and to knowledge translation and changing things on the ground,” says Professor Forbes.
“The field of posttraumatic mental health has come a long way in 25 years. Now we can put our hand on our heart and say ‘if you come forward, we have treatments that can help you’. That’s a massive step.”