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Insights into treating complex trauma in veterans

News, Veterans, Our experts, Clinical practice

Dr Geoff Thompson is a psychiatrist and an advisor to the Centenary of Anzac Centre. When he began his career in the healthcare profession, Geoff had no plans to become a psychiatrist. Since then, he has spent decades navigating complex trauma, particularly within the veteran community.

Shortly after beginning emergency medicine training, Geoff Thompson realised it was not the field for him. But when he landed a job at the former Mont Park asylum and Larundel psychiatric hospital in Melbourne’s northern suburbs, he found his calling.

“In medicine, you get exposed to different things and hopefully you find the thing that clicks with you – for me, that was psychiatry,” he says.

“It’s seeing people – particularly those in an institution who are struggling – and knowing you can make a difference. And a key thing for me has always been how much I learn from my patients, particularly in my work with veterans.”

After Larundel, Geoff moved to the veterans’ unit at Heidelberg Repatriation Hospital where he completed his psychiatric training, qualified and spent 15 years as a consultant while in private practice.

“The specialist unit was dedicated to providing the best possible care for veterans. Their commitment to that community was quite inspiring,” recalls Geoff.

“Veterans can be a challenging group to treat, but they have an amazing loyalty and camaraderie with one another and that extends to those who are motivated to help them. They are incredibly resilient people who served their country and were exposed to potentially traumatic experiences and it’s a worthy purpose to help them.”

When Geoff joined Heidelberg Repat in the early 1990s, knowledge and expertise around trauma-related mental health was evolving, and much of the understanding of trauma began with the work done with veterans.

“In the early years, I was predominantly looking after Vietnam veterans and the striking thing about them is that most were young men when they went to combat. Which means that they were still developing and evolving as individuals when they were deployed to combat zones, and that is one reason for the impact that trauma had on so many of them – their experiences occurred at a time when they were still in evolution,” explains Geoff.

“That underpins my approach to treating veterans and trauma in general. It is centred around understanding the person. If you can understand the person and who they were before and at the time of their trauma, it gives an insight into how that event affected them. That helps you to tailor your treatment to that individual. You can tap into how to help them to reconnect with the essence of their person so they are not just defined by their trauma and their PTSD.”

Geoff believes that the cornerstone of supporting a veteran with complex trauma is forming a solid and committed therapeutic relationship.

“That adds strength to what the two of you can do together through the inevitable ups and downs that occur with trauma-related illnesses. As a psychiatrist, it is a privilege when someone entrusts their mental health and care to you,” he says.

“As a psychiatrist, you assess their mental health, identify their needs at particular points and provide a holistic approach that includes attending to elements like physical health and medication if needed. You need to have a good formulation of a person and of their current and past state of health – it’s not just about looking at the symptoms today but having a more developed and complete formulation of the person and their condition and using that as a guide to treatment.”

Patience and persistence are also key in helping veterans with complex trauma issues. Working in a multidisciplinary team with assorted expertise is also highly effective, says Geoff.

“You don’t achieve good outcomes in treating trauma-related mental health in weeks or months, it’s usually measured over years. Health will fluctuate and you have to be responsive and adaptive to that, including at times when things become more acute and when keeping a veteran safe is an important part of your role,” says Geoff.

“But the effect you can have is tangible. If you maintain an ongoing effective therapeutic relationship, over three to five years you can see quite dramatic improvements in a person’s mental health, quality of life and day-to-day functioning. And you see their partner and family benefit from the improvement, too – and that’s so rewarding.”