In this email, Dr Phil Parker, veteran and community GP, shares some advice on how to better connect and support patients with symptoms of PTSD and some tools available to healthcare professionals.
With over 27 years’ experience in the Australian Defence Force (ADF), Phil is committed to veteran health.
- Engagement with veterans with PTSD
The keys to providing care for patients with PTSD are patience and trust. The development of a strong relationship and support over time will allow the patient opportunities to open up about their condition.
Knowing that patients have served in the military allows GPs to open discussions about their service and whether this has had an effect upon their physical and mental health. It is important to find out if they suffer ongoing symptoms and if these conditions affect their social and occupational functioning. When it comes to conversations relating to posttraumatic stress disorder, some patients will not like to be pushed and it’s essential that this is respected. Veterans should be allowed to open up in their own time.
The stigma of any mental health disorder is a significant factor amongst all veterans, particularly the older veterans who believe there is nothing wrong with them and that their symptoms are normal. It’s important we explain to them that their symptoms could be a result of PTSD and talk about how it affects their life and their functioning.
We can add to this by asking about their families, who are often the people that protect and support them. If we can highlight to the patient the affect it can have upon those closest to them, they’re more likely to open up about their condition and potentially accept it.
These days, younger veterans are more open and understanding of PTSD. We now see greater acceptance and support throughout the community for people with the condition.
The role of the family in the ongoing care of the PTSD patient is also very important. For many families, they’ve had to endure years of hardship living with a patient who suffers the symptoms of PTSD. For most, they are the primary source of security for the patient. It’s important that GPs ask about families, how well they are coping, and address their own health concerns.
It’s important that GPs show a willingness to invest time in the care of the patient and their families. All PTSD patients should be provided with the opportunity to have psychological support with an appropriate mental health provider. The more acute patients may require psychiatry referral and that should be arranged promptly by the GP.
Another resource you have at your disposal is the
Veterans and Veterans Families Counselling Service (VVCS). VVCS is a counselling service that provides a wide range of therapeutic options for veterans who suffer mental health disorders, and their families. This is a free service and is available twenty four hours per day, seven days per week.
The Department of Veterans Affairs (DVA) has a number of online resources, including treatment sheets, which can assist the GP with the management of PTSD patients. The DVA At Ease website is also very useful.
Phoenix Australia operates the Centre for Posttraumatic Mental Health. Their online resources are very useful for screening and diagnosis of patients with PTSD.
Once a provisional diagnosis of PTSD has been made by the GP, a more comprehensive assessment should be carried out. This assessment will guide decisions about treatment options. First line treatment for a PTSD patient is trauma-focused psychological therapy with an appropriately qualified psychologist. It is important the GP monitors the progress of the patient through every stage of the treatment plan.
If initial therapy is not effective, modification to that program should take place. Medication may be considered if symptoms are preventing the patient from engaging in their therapy. For those who present with severe symptoms, a psychiatric referral or even in-patient therapy should be considered.
- Issues for veterans with PTSD and their GPs
PTSD is an important condition that we as GPs should be able to manage in the community. There are many ex-serving members who have left the defence force and have been exposed to a whole new world of healthcare that they don’t really understand or know how to access.
The system for civilian healthcare relies on them actively seeking out treatment, which is in contrast to the military system where they are obliged to undertake treatment for any conditions they suffer. We as GPs need to understand the conditions that they suffered from their time in service as well as be willing to identify any new conditions as they arise later on.
The development of PTSD symptoms generally occurred while veterans were serving this country. Those veterans should feel that they are entitled to obtain medical care for these symptoms. We know PTSD is a debilitating condition and that it affects social and vocational functioning and potentially fracture the lives of families. Anytime a patient presents with a history of military service the GP should be alerted to the fact that the patient might have long-term conditions including PTSD. Some patients will take time to open up about the symptoms relating to this condition and it’s important that the GP develops a strong relationship with the patient to allow this to happen.
- Item numbers & assessment tools
There are several good screening and diagnostic tools available to GPs. The Phoenix Australia website has many online resources. A wide-range of resources is available on the GMRF website.
The initial approach for every veteran after separation is a post-discharge health assessment which is a time-based health assessment using the normal mental health assessment numbers of 701 703, 705 and 707. This assessment can be carried out any time after they have separated from the ADF but can only be performed once.
DVA have an online assessment tool that can be downloaded which can be given to the patient prior to their consultation. Further assessment tools can be found on Medical Director and Best Practice. It is also important that veterans have sought to have their mental health condition recognised and accepted by DVA. Providing they have completed a period of full-time ADF service, all veterans are entitled to DVA-supported mental health care, irrespective of whether the condition was related to service or not. Veterans should complete this form – D9213, and send to DVA for processing.
Once a relatively unknown condition, many Australians now understand that PTSD is a condition suffered by individuals employed in roles where their safety has been put at risk. Acceptance of PTSD by the general population as a ‘real’ condition is increasing, and veterans are now more confident in coming forward and seek help for their symptoms. As health professionals we have a big part to play in fostering this confidence.
Phil is a GP based in the Brisbane suburb of Newstead. Phil began his career in 1988 as an Army soldier. In 2005 he commenced medical studies at the University of Queensland and returned to the Army as a medical officer. In 2012 he was deployed to Afghanistan as the task force surgeon. Dr Phil was awarded his general practice fellowship in 2014 and transitioned to full-time community general practice in late 2015. He is committed to supporting the health of military veterans as they endeavour to establish new lives outside the ADF.
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