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What are the latest developments in veteran and military mental health?

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Professor Richard Bryant, Scientia Professor in the School of Psychology at the University of New South Wales, shares his thoughts and insights.

Professor Richard Bryant believes there are two key factors behind an increase in research in veteran and military mental health. Firstly, a series of major deployments, particularly in the Middle East, has seen military personnel being exposed to trauma and psychological injury.

“That flows into the second factor – a lot of Departments of Veterans’ Affairs around the world have realised that for the next ten, 20, 30 or 40 years they are going to be picking up the pieces of the fallout of those deployments,” Richard explains. “So, there’s been a phenomenal amount of research and practice funding to increase our knowledge so that it can result in better mental health services.”

Suicide within the military and veteran community has been one area of focus. Richard believes a multi-pronged approach to preventing suicide is the way forward. He says there has also been an important shift in understanding suicide.

“For many years there’s been the notion that a suicidal risk is driven by desire to die – the person is going through so much psychological or emotional pain and they can’t cope with it anymore and it’s more palatable to get out of that painful situation,” he says.

Richard says new research is highlighting factors that help better predict whether someone is at risk of suicide. Effective interventions can then be used, and these also need to be multi-pronged.

“For example, training up GPs and getting primary care to really understand how to detect suicidal risk and how to refer and act on it – that actually does have a demonstrated effect,” he says. “But then you’ve also got to have practitioners who then know how to help a person with more intra-psychic factors.” The most recent Transition and Wellbeing Research Program in Australia also found people transitioning from the Defence Force are at greater risk of mental health problems.

“The study found that one in two people have had a psychological problem in the last 12 months, but what stands out is the anxiety disorders, and particularly PTSD and panic,” says Richard.
He says future research needs to continue focusing on how to develop more effective treatments for veterans with mental health issues and adds that greater use of evidence-based care is vital. The study looked at pathways to care and found that most veterans, after they left Defence, did seek care but not many were receiving evidence-based care. “And that’s the worry,” says Richard.

“Because it means a lot of veterans are going out there and getting assistance, but they are not getting the assistance that we know is going to give them the best chance of recovery.”

Richard says there is value in using existing trauma and exposure focused therapies to foster extinction learning. “Put very simply, if I get repeatedly exposed to the reminders of the trauma, I’m going to learn that it’s no longer hurting me. And what we’re pretty sure is happening is that there is a rewiring of the brain,” he explains.

Research suggests that when people don’t respond to these treatments, it’s because of co-morbidities such as entrenched depression, strong rumination and interpersonal difficulties.

“In those cases hammering away at the extinction learning might not really be getting at the core reasons why a person is not responding,” suggests Richard.

The veteran community often presents with complex and multi-layered mental health problems and the clinicians who support them often require support themselves to best help their clients. Richard says the Centenary of Anzac Centre’s Practitioner Support Service continues to be an important initiative to help clinicians across Australia.

Looking ahead, Richard believes further research into military and veteran mental health will see treatments and support become more tailored.

“I think we need to broaden things a lot more from PTSD and we need to get away from diagnosis. Because we label somebody with PTSD or depression or panic disorder and then, as a package, throw a treatment module at that person,” he says.

“I think the research will lead to practitioners following more tailored, nuanced approaches that actually meet the individual need of a particular veteran, rather than just a whole diagnosis approach. I think the field is just starting to open that door.”

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