Wright-Patt, Dayton VA medical centers work to combat PTSD

  • Published
  • By Amy Rollins
  • Skywrighter Staff
WRIGHT-PATTERSON AIR FORCE BASE, Ohio --  The Wright-Patterson and Dayton VA medical centers are working together and separately to create greater understanding and awareness of post-traumatic stress disorder as well as other mental health challenges.

Noting their efforts is important during June, which is National PTSD Awareness Month, with June 27 recognized as National PTSD Awareness Day.

PTSD is a normal reaction to an abnormal situation, said Maj. (Dr.) Jeffrey Guina, medical director, Mental Health Clinic, 88th Medical Group, Wright-Patterson Air Force Base. The clinic covers 23 bases and units in Michigan, Indiana, Ohio, Pennsylvania, Kentucky and parts of New York.

"Unfortunately I think a lot of people, after something traumatic happens, experience a lot of distress and dysfunction that persist for a long period of time, and they feel like they are broken," Guina said. "It's important we reassure people that it's very normal to have difficulty shaking memories of bad things that happened to us. It doesn't mean someone can't get better."

A recent survey involving Wright-Patterson Medical Center and the Mental Health Clinic found about 29 percent of people visiting the clinic met the criteria for PTSD. In contrast, 8 percent to 9 percent of the general population of the United States has PTSD.

"You would expect it to be higher in the military and higher in the Mental Health Clinic because of the people who are seeking care," he said.

Symptoms of PTSD include persistent sleep or concentration difficulties, nightmares, irritability, difficulty with relationships, hypervigilance, perception of danger in otherwise-safe situations and more.

"There's kind of a battle with PTSD between remembering and forgetting and being on alert and being avoidant," Guina said. "When people have PTSD, they are constantly in fight, flight or freeze mode, and it can be quite distressing - making it difficult to get your job done, be present with your family or do the things that make you happy and living a full life."

The gold-standard treatment for PTSD is trauma-focused psychotherapy. The Mental Health Clinic offers it in the forms of cognitive processing therapy, prolonged exposure, and eye movement desensitization and reprocessing therapy (EMDR), he said.

Guina credits Capt. Amy Roberts, psychiatric mental health nurse practitioner, with helping arrange for the clinic to be the first Department of Defense site to be trained in EMDR.

What is exciting, said Maj. Thomas Smith, social work residency training director and officer in charge, Mental Health Clinic, is the clinic is a residency site for multiple health disciplines, so next year psychiatry, psychology and social work residents will be moving throughout the Air Force, already having received EMDR training.

"We feel like we are kind of 'seeding' the Air Force with clinicians who are qualified to do more to help people suffering from PTSD," Smith said.

Advances in the last 10 to 20 years have resulted in PTSD treatments with up to a 90 percent success rate, with many patients' symptoms going into remission.

"We can help people get better; it's not easy, but we have good success rates," Guina added. "We're the only clinic in the Air Force that has all of the residencies and specialties."

Military combat is only one cause of PTSD. The Mental Health Clinic frequently sees people who have never been in combat, who may have suffered child abuse, domestic violence, the violent deaths of loved ones and a variety of other traumas, or are people for whom combat uncovered preexisting issues or traumas, Guina noted.

"One of the biggest difficulties with PTSD is the natural instinct is to not want to think or talk about it or remember it. It makes perfect sense, but avoiding the trauma is one of the biggest risk factors in developing and continuing to have PTSD," he said.

"People have to go against those instincts to come in and get help and talk with someone about the trauma. The important thing we do here is talk to people at their own pace; we don't force anybody to divulge anything they aren't comfortable with. Often if they can put what they're experiencing into words, then that doesn't come out of them in other ways," he continued.

Smith said he wants to encourage people to seek help.

"When I brief people, I often say, 'I promise you that today, there is a Vietnam veteran going to his or her first appointment to deal with the PTSD that they have suffered since that time. ... People can be very functional with PTSD ... but part of our job is to help them understand there can be more to their quality of life."

Guina credited Col. Timothy Ballard, former commander of the 88th Medical Group, with strengthening the relationship between Wright-Patterson AFB and the Dayton VA Medical Center.

"Now that we see VA medical beneficiaries at the medical center, there's even more of a connection," he said.

Smith said the two entities try to share resources such as training and expertise as much as possible.

The Mental Health Clinic's psychiatry residents train at both sites.

"Dr. Guina has done a lot of work in developing and fostering a good relationship with the Dayton VA's administration so there is good dialogue going back and forth," Smith said. "Continuity is extremely important; it may sound like a simple thing, but just making sure we're talking when a patient has been hospitalized (at the VA) and they need to come back to outpatient care (at WPMC) is key."

With no inpatient psychiatric unit at Wright-Patterson Medical Center, the Dayton VA Medical Center is where psychiatric patients who have to be hospitalized go.

William Wall, LICSW, BCD, retired from Wright-Patterson AFB as a lieutenant colonel and deputy flight commander, Mental Health Flight, in 2006. He served as a combat stress team commander in Iraq and Kuwait. Now at the Dayton VA he is the coordinator of the Social Work Ambulatory Program and the program manager of the Freedom Center, a post-deployment clinic where veterans of deployments are screened for physical injuries and disorders, blast-related injuries, mental health issues, substance abuse problems as well as PTSD.

Case managers in the Freedom Center work with the veterans to get them any treatment and medication support they need.

About 9,000 veterans have come through the center since 2007, Wall said, with about 3,000 of them having suffered from PTSD.

"We build a really strong relationship with a new veteran. If they have any problems, we can get them back on track," he said.

Wall himself is a significant part of the relationship between Wright-Patterson AFB and the VA, having worked on the reunion reintegration plan.

"Because we know each other, there is always that sense of how we are doing things, inviting each other to workshops and training together in evidence-based practices so we're delivering similar practices and levels," he said.

"Wherever we're doing treatment, we want to make sure we are mindful that combat veterans often have other things going on besides PTSD. We're focused on combat and other military experiences, but out there are sexual and physical assaults and abuse, violent or accidental injury or death of a loved one, serious accidents, natural disaster events and terrorist attacks," Wall added. "The extent of trauma experience is pretty high in the U.S. population. It is estimated that up to 80 percent of the population experiences trauma by the time they are 18 years old."

He has advice about PTSD: "If you think you are or see someone struggling with PTSD, see your family doctor or nurse practitioner and let them know so they can help screen and assess you to get you into the stream of care. Walk-in clinics are available at WPMC and the Dayton VA."