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As a consultation service funded by the Department of Veterans’ Affairs (DVA) and operated by a centre of excellence in posttraumatic mental health, the DVA Practitioner Support Service and Advice Line recognises that policies and research only offer value if utilised by the practitioners who offer clinical support to veterans.
We strongly believe in learning from the questions, challenges and reflections of practitioners who contact the service. Our consultations are a bi-directional exchange, where practitioners gain support, information and tailored advice, while the service’s consultants and researchers learn more about the needs of veterans and their health practitioners.
In this article, we take a moment to reflect on a veteran case that came through the consultation service that highlights this exchange. In order to protect the privacy and confidentiality of the practitioners and their client, this article is presented as a reflection piece. It will explore the challenges for the service’s multidisciplinary team, the learnings we gained, and the challenges ahead for our community.
The DVA Practitioner Support Service and Advice Line
The DVA Practitioner Support Service is a nationwide consultation service for health practitioners and support organisations working with ex-serving members of the Australian Defence Force who have mental health problems. The aim of the service is to improve the mental health and wellbeing of Australia’s veterans by enhancing their quality of care through the provision of consultation and advice to treating practitioners. Through the consultation service, practitioners can consult with a team of multidisciplinary practitioners highly experienced in veteran mental health.
In the time that the consultation service has been active, we’ve heard from a broad range of practitioners including psychologists, social workers, occupational therapists, nurses, GPs, psychiatrists, and welfare staff in ex-service organisations.
Practitioners contacting the service describe complex situations, ask challenging questions, and demonstrate commitment to a gold standard of care.
Team A is a team of inpatient, outpatient and community multidisciplinary practitioners, located in regional Australia. They were caring for a highly complex and challenging veteran client who was assessed as at high risk of suicide. Team A contacted our service seeking a multidisciplinary panel consultation.
A consultation with the service’s expert panel was convened within 24 hours, delivered via a videoconferencing platform. The expert panel members included a Clinical Psychologist, General Practitioner, Mental Health Social Worker and two Consultant Psychiatrists. Two 60-minute consultation sessions were provided, and the recommendations and advice consisted of: addressing therapeutic relationship dynamics, reviewing the appropriateness of specific psychological therapies and medications, and making modifications to the veteran’s living environment.
Team A’s case highlighted a number of key issues: the incredible yet challenging role of practitioners in rural and remote communities, the impact of clinical risk on practitioners, and the benefit of a second opinion and multidisciplinary consultation perspective.
Rural and remote practitioners, we exist!
Supporting practitioners in regional, rural and remote (RRR) Australian communities not only falls within the remit of the DVA Practitioner Support Service, but it is a priority. So, when we realised that Team A was from outer regional Australia, we were very pleased to hear that word of the service had reached them. Through our engagement, we recognise and understand the challenges that practitioners based in RRR communities are faced with, especially as we navigate through the COVID-19 pandemic and its mental health consequences.
Practitioners working in RRR communities are providing vital care to veterans presenting with highly complex and challenging symptoms, while facing barriers to professional support and development. The risk for stress, burnout and resignation is higher for this cohort of practitioners.
When we critique and reflect on the scope of our consultation service provisions and processes in the context of RRR health services, we are grateful for the recent and widespread uptake of videoconferencing technologies across the health sector, allowing us to respond in a timely and responsive manner all over Australia.
We ask you to let your colleagues in regional, rural and remote areas know about the free consultation service that is here to support all practitioners caring for Australian veterans with mental health problems.
The impact of clinical risk on practitioners
A considerable amount of practitioner effort is dedicated to managing risk of patient self-harm in veteran mental health services, but is there equal emphasis on discussing and reflecting on the cumulative impact on practitioners?
Team A’s patient presented with multiple lethal self-harm and suicide attempts within a very short period of time. The sense of urgency, concern and distress within the team was evident during the consultation. The panel was able to provide several supports to the treating team through the consultation. Firstly, the panel created a supportive and non-judgemental environment for the practitioners to express their worries and concerns, which in turn created space for mental clarity and intervention planning. Secondly, the panel offered a fresh set of eyes and suggested other interventions that may actively prevent further harm to the veteran. Finally, the panel provided a solemn reminder of the inherent risks of caring for acutely mentally unwell individuals.
Veteran practitioners must be knowledgeable about suicide risk and actively intervene to keep their patients alive. However, they must also realise that despite their best efforts they may not always be able to prevent suicide. Even with implementation of best practice interventions to prevent suicide, such events can and do occur. Suicide of a veteran is traumatic for all involved, including those providing clinical support. Personal care for these providers is important and affected clinicians should be encouraged, and willing, to accept support.
We can start by creating open and supportive spaces for these discussions to occur, as well as using our platform to share information.
A helpful article on self-care strategies for psychologists working with suicidal clients can be found here.
Multidisciplinary and integrated care
Being competent in veteran culture and prepared for the complex and comorbid health concerns reported by veterans requires a multidisciplinary, integrated and iterative approach. The request for consultation from Team A was our first from a team, and it highlighted the topic of multidisciplinary care as a continuum ranging from parallel practice to collaboration and integration. Team A consisted of psychologists, psychiatrists, mental health nurses, a dietician and social worker, working in a range of settings.
As a multidisciplinary advisory panel, we acknowledge the inherent difficulties of collaborative care, and aim to help providers problem-solve and brainstorm paths to enhanced collaboration with their colleagues.
We model consultative and collaborative advice during consultations, advocating for the relevance of multi-disciplinary care, providing specialised and discipline-specific advice, and offering insights into discipline-specific policies, procedures and culture.
In providing assistance to Team A, the panel was able to offer insights into what was currently working well for the team, as well as identify gaps and suggest what could add value that aligned with the treatment needs of the veteran.
Contact the DVA Practitioner Support Service
It is always a rewarding experience consulting with practitioners across Australia. We are committed to supporting communities, organisations and clinicians to develop collaborative practices, skills and knowledge to provide person-centred, culturally-appropriate, evidence-based and effective treatments to veterans. Keep an eye out for next month’s newsletter, where we will continue to discuss these issues and provide you with an update!
The DVA Practitioner Support Service is available to all Australian practitioners providing treatment to Australia’s veterans. If you would like a one-on-one consultation or multidisciplinary consultation, contact the advice line Monday to Friday, 9am to 5pm AEST on 1800 838 777, or submit an enquiry at phoenixaustralia.org/working-with-veterans/dva-practitioner-support-service/ .