Late Breaking News
Best Practices in the Diagnoses and Treatment of PTSD and TBI
WASHINGTON, DC—Navy Capt Paul Hammer is hoping that one of these days servicemembers will be as comfortable sharing about having PTSD as they are a knee injury. The perceived stigma of having a mental health injury, he hopes, will be a thing of the past. “My ultimate goal is to make PTSD like a knee injury,” said Dr Hammer, a psychiatrist. “If you see a guy limping along and you go, ‘hey what happened,’ and he says, ‘I injured my knee,’ he is not ashamed of it. I want the same thing for PTSD.”
As director of the Naval Center for Combat & Operational Stress Control, Dr Hammer oversees an organization that was stood up last year to educate members of the Navy and Marine Corps about stress and to help improve care for patients with PTSD andTBI.
The Center staff work to promote resilience and to investigate and implement the best practices in the diagnoses and treatment of PTSD and TBI. The center performs various tasks, such as supporting PTSD andTBI studies, assuring uniform standards for PTSD treatment and evaluation at Navy facilities, and educating servicemembers and military medical providers on psychological health. “We don’t treat patients, but we hopefully make patient care better,” he said. “We have an obligation to look at this. What can we understand, what can we learn, how can we do things better and what do we need to know?”
Furthering PTSD Research
As servicemembers return from the battlefield with PTSD, there is still much that is unknown about the condition, particularly when it is sustained in the battlefield. “Most of the PTSD research relates to automobile accidents to rape victims, sexual assault victims and that sort of thing. There is relatively little that relates to combat victims—except for Vietnam veterans—but we are talking about many years after combat not right after combat.
As a way to encourage and aid military research on PTSD, NCCOSC has a department that is responsible for research facilitation. While the department does not actually conduct the research, Dr Hammer explained that it does work “to make the research happen,” by collaborating with Navy Fleet, Fleet Marine Forces and Navy Medicine clinicians who might lack time, experience, funding or support to collect and analyze data or publish results. “For example, you have a busy provider who is in the fleet or at an MTF and he says, ‘you know, the last five patients that I saw with PTSD had x, y and z,’ and he is about to ask a really good research question. Often times, the next phone call he receives before he can answer that question, or even start to think about it, is that his next patient is there and he needs to keep going.”
Doctor Hammer said the Center’s staff can assist that clinician with the work associated with setting up the study. “We have a staff of research psychologists, research assistants, analysts and folks that can help do those things so it isn’t such a difficult task,” he said. “They help fill out the forms, pick the right measures and develop the tools. In addition, we can also help the military treatment facility folks partner with people outside who have a lot of expertise.”
Getting the Information Out
The center is also hoping to help educate sailors and marines and those with no medical background on psychological issues. Mindlines is a newsletter aimed at making psychological health issues understandable to the average sailor or marine, Dr Hammer explained. “A lot of times I think one of the mistakes that we in the medical community make is we are too clinical. We are focused on the amygdala and hippocampus when the average 20-year-old doesn’t talk about that. The challenge for us when we talk about, ‘how do we develop resilience and improve psychological health,’ is making it relevant to your average 20-year-old sailor or marine. The idea behind Mindlines is to break things down and take an aspect of psychological health and make it a theme for that issue’s newsletter.”
The center also is targeting its education to medical providers and those in the medical community. It recently debuted a new publication called Combat & Operational Stress Research Quarterly, which is a compilation of relevant research on combat and operational stress. The publication gives readers a quick summary of journals they might not have looked at or read. “We summarize journal articles under various categories….This is helpful to a busy clinician who can flip through this and can get the key points from the journals that might otherwise be sitting in a stack on his desk unread,” Dr Hammer said.
Reducing Stigma and Building Resilience
NCCOSC is also part of an effort to develop combat and operational stress training throughout the Navy. “The Navy wide thrust is to do training from boot camp to war college,” he said.
Doctor Hammer explained that training is important in educating about stress and helping to create an environment where people feel it is okay to seek mental health help. “When people talk about it, it is like agreeing with motherhood and apple pie. I think the difficulty people have is, what does that look like in my place of work in my world? How do I do that where I work?”
Doctor Hammer cited training at the Command Leadership School and the Senior Enlisted Academy as examples of efforts to help navy leaders build a culture where servicemembers do not feel stigma in seeking mental health care. “I think that is where we are really going to make inroads in decreasing stigma and really getting the culture change that we need, so that it is okay for people to ask for help,” he said.