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The Military and Veteran Mental Health: Innovations in Treatment Practitioner Forum was recently held in Melbourne by Phoenix Australia’s Centenary of Anzac Centre in partnership with the Departments of Defence and Veterans’ Affairs, and the Veterans and Veterans Families Counselling Service. The forum was attended by a diverse range of over 400 delegates working in military and veteran mental health and delivered an engaging, challenging, and inspiring two days to those with a shared passion for improving mental health care. The theme of the forum was innovation, with a focus on what is new, exciting, and challenging in research, treatment, and service delivery.
The forum also enabled a showcasing of the Centenary of Anzac Centre offerings. The Minister for Veterans’ Affairs, the Hon Darren Chester MP, launched the Practitioner Support Service, a free service which provides expert guidance and support for practitioners working with veterans with mental health issues, including those in rural and remote areas. The Minister paid tribute to past and current serving men and women, and commended Phoenix Australia for engagement in long-term work in researching improved treatments for, and recovery from, posttraumatic stress disorder (PTSD) and other posttraumatic mental health problems.
Master classes: Using evidence-based therapies
Two master classes were held on the first day and were presented by internationally renowned specialists in military and veteran mental health. Professor Barbara Rothbaum is Director of Emory University’s Veterans Program and Trauma and Anxiety Recovery Program. She is a pioneer in Prolonged Exposure Therapy, and her master class guided delegates through the application of this established evidence-based intervention for the treatment of PTSD. She also generated great interest in her use of virtual reality for the treatment of PTSD, and, on the second day, the pharmacological enhancement of psychological therapy for PTSD, such as using MDMA to enhance the extinction of fear.
The second master class was presented by Professor Marylène Cloitre, Clinical Professor of Psychiatry and Behavioural Sciences at Stanford University and Associate Director of Research at the National Center for PTSD Dissemination and Training Division, Palo Alto VA Healthcare System. Her extensive research and clinical work has focussed on PTSD and complex PTSD in military veterans. Professor Cloitre developed Skills Training in Interpersonal and Affective Regulation (STAIR) therapy, and her master class was a practical demonstration of this effective skills-focussed intervention that can be used as a standalone treatment or integrated with trauma processing therapies. Professor Cloitre highlighted that low social connection makes people more vulnerable to PTSD, and that interventions should seek to improve social support networks.
The challenges of treating military personnel and veterans
Day two of the forum included keynote addresses from Professors Rothbaum and Cloitre, followed by multiple symposia showcasing innovations in military and veteran mental health in Australia. A breakout session during lunch break provided the opportunity for delegates to share their ideas for innovations and improvements in military and veteran mental health.
The challenges of effectively treating the military and veteran population were discussed over the two days. It was acknowledged that with support from mental health professionals, family and friends, many members of the military and veterans recover from their mental health difficulties. For some though, mental health problems can be complex and persistent and do not resolve. While evidence-based treatments are available, accessibility, effectiveness, and treatment response rates all need to be improved. Veterans in particular do not derive as much benefit from current treatments as other populations, with high attrition rates from treatment and only a proportion fully recovering from PTSD.
The two keynote speakers and presenting academics, experts, agency heads, and practitioners discussed these challenges. Professor Rothbaum discussed the potential for the use of biomarkers that may identify differential outcomes in PTSD. By asking questions such as whether biology can predict who might improve with PTSD treatment, or whether biology predicts different PTSD subtypes, there is a possibility of working towards precision medicine (i.e., which treatment for whom?).
Professor Cloitre similarly questioned how to identify the most appropriate treatment for any one person. She observed that PTSD treatments tend not to be discrete, and so a modular approach by which one problem is addressed at a time is a possible future direction. Her STAIR narrative therapy is an example of this approach. Given that drop-out is 50 per cent less in patients who receive their choice of treatment, patient choice of treatment might also be privileged.
Several presenters highlighted barriers to the implementation of evidence-based interventions, such as the lack of uptake of interventions by practitioners, and suggested solutions to this such as the importance of ongoing supervision following training in new treatments. The proceedings also highlighted that in recent years little progress has occurred in the development of medication treatments for PTSD. The limitations of the current evidence base to inform the treatment of complex clinical presentations were discussed.
Exploring treatment enhancement strategies
The emerging importance of treatment enhancement strategies was emphasised throughout the symposia. Proposed adjunctive treatments ranged from biological treatments to emerging interventions focussing on exercise and yoga. Some preliminary evidence was presented that Theta Burst Stimulation may be an effective treatment for PTSD in reducing clinical symptoms and improving cognition. The take home message was the importance of substantive evidence for new and innovative biological treatments before they are promoted and utilised in clinical practice.
The Centenary of Anzac Centre: Creating a veteran mental health network
Ultimately the forum reiterated the timeliness of the establishment of the Centenary of Anzac Centre, emphasising the key role it will play in the future through the integrated work of its two components. The Treatment Research Collaboration will enable Phoenix Australia to collaborate with partners in conducting innovative research into PTSD and other complex mental health issues. The Practitioner Support Service will support a range of practitioners and organisations across Australia, especially those in remote and rural areas where there are fewer professional supports. It will facilitate professional development and networking opportunities across Australia for those supporting veterans.
The forum was a great opportunity for delegates to discuss established evidence-based and newer interventions under development and how to ‘close the gap’ in terms of people who are not recovering. For practitioners and researchers alike, the forum provided a fantastic networking opportunity. If the intensity of the talk fest during the symposia, breaks, and networking drinks was any indication, the information exchanged and connections made will strengthen the military and veteran healthcare community and lead to productive future collaborations in both practice and research. Fundamentally, we work better towards improved military and veteran mental health when we do so as part of a community.