The program opened with remarks by State Rep. David Yaccarino (R-North Haven), who is a Ranking Member of the Committee on Veterans' Affairs. Rep. Yaccarino is a strong advocate for veterans, and has worked closely with CSMS on veterans' mental health issues.
Dr. Burgo-Black’s talk, titled From the War Zone to the Home Front: Supporting the Mental Health of Veterans and Families, provided a detailed overview of post-traumatic stress disorder (PTSD) and traumatic brain injury (TBI) for physicians and other clinicians, and familiarized them with available mental health resources. She also discussed the challenges of reintegration into civilian life and the importance of care coordination for returning combat veterans and their families. "We don't come home from war, we come home with war," noted Dr. Burgo-Black. "War is a transformative experience."
The primary care setting can be the point of entry into the health care system for many veterans. These patients often present with minor complaints; because they may not share their veteran status, physicians need to take the initiative and ask about military service. Without that context, it can be difficult to make the correct diagnosis. There is growing awareness of the importance of physicians outreach - from the 2012 JAMA essay The Unasked Question to the Joining Forces program and the recent inclusion of military medicine questions on licensing exams for medical students and residents.
Dr. Burgo-Black discussed the physical and psychological health risks of combat. The most common diagnosis for returning veterans is musculoskeletal injuries (59.2%), followed by mental disorders (55.3%). All returning combat veterans are screened for TBI, depression, and anxiety. Mild TBI (mTBI) is considered the signature wound of the conflict in Iraq and Afghanistan; some 60% of those service members have some degree of blast exposure. Complex comorbidities are also common: for example, 42% of returning veterans present with pain, mTBI, and PTSD.
However, "not everything is PTSD," said Dr. Burgo-Black. Physicians should not be too quick to diagnose or pathologize - it is important to provide patients with time to readjust, and to monitor their progress and comorbidities by working with families and support networks.
Dr. Burgo-Black was joined by Erin Blatchley, RN, MS, Program Manager for the VA Outreach Program. Ms. Blatchley gave an overview of the outreach program, and provided details on readjustment counseling and veterans center services. The veterans centers are not part of the VA EHR system, and can provide confidential services for the members and their families. "You have to treat the family, not just the veterans," explained Ms. Blatchley. She also described the Connecticut Military Support program, which provides 15 free sessions for the service member and anyone connected with them (spouse, significant other, children).
The 2014 Choice Act (Veterans Access, Choice and Accountability Act/VACAA) provided the VA with new authority, funding and other tools to support reforms, improve veteran access to healthcare, and shift to some of the care to the private sector. The Choice Act also includes funding to increase the number of residency slots in the VA to 1,500, and increase debt relief from $60,000 to $120,000.
At the end of the program, Dr. Burgo and Ms. Blatchley took questions from the audience, which included several physicians with prior military service.
Physician Resources & Reading
PTSD Consultation Program - for providers who treat veterans
Military Health History - pocket card for clinicians
The Unasked Question. Brown JL. JAMA. 2012;308(18):1869-1870. doi:10.1001/jama.2012.14254.
Post-Deployment Care for Returning Veterans. Spelman JF, Hunt SC, Seal KH, Burgo-Black AL. J Gen Intern Med. 2012 Sep; 27(9): 1200–1209.
Patient Aligned Care Teams (PACT)
Make the Connection - Clinician Resources
Veterans Crisis Line
VA Connecticut Health Care System
