Expert Forum Wrap

I would just like to thank everybody involved in ACPMH’s Many Paths, One Purpose Expert Forum which was held on 12 August at the State Library of Victoria. The feedback that I received throughout the day, and afterwards, was extremely positive. While the event provided the opportunity for so many of us to formally farewell Mark Creamer from ACPMH (at least as Director – for he will not disappear altogether), the forum also proved to be an extraordinary opportunity for knowledge transfer, updating skills and networking. How often do so many professionals in the field of posttraumatic mental health get together in the same place and get to swap experiences (and business cards)?

There are too many people to thank here but I do wish to mention the contributions from our expert keynote presenters, Professor Beverley Raphael, Professor Alexander McFarlane, Professor Derrick Silove, Professor Richard Bryant, Professor Jonathan Bisson, and, of course, Professor Mark Creamer. Not only were their presentations illuminating and well structured, but the panel discussion in which they kindly participated at the end of the day was thought-provoking and challenging.

While it was gratifying to see a packed house for the presentations, equally satisfying from my perspective was the atmosphere in which the symposia were delivered and received. Many thanks to all the ACPMH staff who participated in these, but particular thanks to our colleagues-in-collaboration, Associate Professor Brett McDermott and Dr Vanessa Cobham.

So to all those who presented, attended, and organised – many thanks.

David Forbes, Interim Director, Australian Centre for Posttraumatic Mental Health

See you at the Expert Forum

As we wrap-up our final preparations for the Many Paths, One Purpose Expert Forum we’d like to thank all those who have registered: we are now at full capacity!

Our list of attendees features people from a variety of professions and backgrounds, which should produce some interesting discussion on the day.

Although Melbourne’s weather seems determined to keep us indoors of late, what better way to spend Friday than the distinguished setting of Victoria’s State Library, hearing from some of the world’s leading thinkers and doers in the field of posttraumatic mental health.

We look forward to meeting you all on Friday August 12.

David Forbes, Interim Director, Australian Centre for Posttraumatic Mental Health

Introducing Professor Alexander McFarlane

Professor Alexander McFarlane is the Head of the University of Adelaide Centre for Traumatic Stress Studies and senior adviser in Psychiatry to the Australian Defence Force.

Professor McFarlane has a long history of advising the Australian Defence Force and holds the rank of Group Captain in the RAAF specialist reserve. He is interested in posttraumatic stress disorder (PTSD) in relation to disaster victims, military personnel and civilian accidents. His research focuses on the epidemiology and longitudinal course of PTSD as well as the neuro-imaging of the cognitive deficits in this disorder.

In his keynote address to the Many Paths, One Purpose Expert Forum hosted by the Australian Centre for Posttraumatic Mental Health on 12 August 2011, Professor Alexander McFarlane will overview the history of traumatic stress in the defence forces and how research in this area can be applied to other professions. He will trace changes in our understanding and lessons learnt since PTSD was first recognised as part of the Diagnostic and Statistical Manual of Mental Disorders (DSM) in 1980. Recently he said:

“In every major conflict we take significant steps forward in our knowledge, but this knowledge can get lost between conflicts. A whole body of academic work has blossomed as a result of having a standard definition of PTSD. The lessons are being learned – and held on to.”

Professor McFarlane also contends that the healthy levels of public scrutiny of measures taken to protect military servants should be applied to other organisations that protect the community such as Police, Fire and Ambulance officers.

His presentation will also tackle the notion of individual accountability in people suffering from PTSD, arguing that a focus on individual levels of vulnerability to conditions associated with the disorder can be a distraction from more important issues:

“The evidence from epidemiology is that accumulated trauma is very bad for our mental health, and that the more trauma people are exposed to, the greater the possibility that they will become symptomatic. Even the healthiest individuals will become unwell when exposed to enough trauma.”

Professor McFarlane will cite military research that highlights the need for a broader interpretation of trauma:

“For military populations, the lexicon of PTSD can be limiting. For example, major depressive disorders were far more common than PTSD in veterans of the first Gulf War. There’s also the profound underlying neurobiology of these different disorders and their links to physical conditions. The story of what happens to people who experience trauma often goes beyond what we understand as PTSD.”

For further information on the ACPMH Expert Forum, Many Paths One Purpose, click here.

Introducing Professor Beverley Raphael

Beverley Raphael is Professor of Population Mental Health and Disasters within the Medical School at the University of Western Sydney, Professor of Psychological Medicine at the Australian National University, and Emeritus Professor of Psychiatry from the University of Queensland.

Professor Raphael has longstanding links with the Australian Centre for Posttraumatic Mental Health (ACPMH), and was involved in the development of the Centre’s Guidelines for the Treatment of Adults with Acute Stress Disorder and Posttraumatic Stress Disorder, working closely with Mark Creamer.

She brings over 50 years experience to the field of mental health and the discussion on trauma, loss, and grief. Her long history of working with patients in the community as a general practitioner and in community psychiatry, as well as her body of research, will inform her keynote address to the Many Paths, One Purpose Expert Forum hosted by the ACPMH on 12 August 2011.

As a general practitioner in the early 1960s, Professor Raphael treated many Second Word War veterans with psychiatric conditions, whose problems at the time were often labeled as ‘inadequate personalities’ or ‘anxiety neuroses’. Recently she said:

“I’ve always been curious about war and what it does to people’s lives. As a general practitioner I saw a common link between people who were significantly traumatised by war and I was convinced that the understanding of these conditions was limited by the social context and culture of the time.”

Professor Raphael will explore the broader context of psychological trauma – our understanding of trauma, models of care and human resilience, as well as the key factors that influence this understanding.

Considering the current state of play in the field of posttraumatic mental health, she sees new approaches as key to overcoming future challenges and addressing the effects of trauma as just one of the many adversities of human experience. She is also adamant that mental health professionals should keep questioning the assumptions underlying best practice in the light of cultural and social change:

“Even today our treatments and systems of care for people are based on our identification of problems within the boxes we have created in the Diagnostic and Statistical Manual of Mental Disorders – but our understanding of trauma needs to be much wider. We must be wary of complacency and ideologies that make us think we’ve solved this problem and we must stay curious about how we may best help people with these inevitable aspects of human experience.”

Further information about Professor Raphael’s work visit: www.uws.edu.au/medicine/som/key_people/professor_beverley_raphael

For further information on the ACPMH Expert Forum, Many Paths One Purpose, click here.

Introducing Professor Derrick Silove

Professor Derrick Silove is Director of the Psychiatry Research & Teaching Unit at Liverpool Hospital’s Mental Health Centre in New South Wales.

Specialising in the area of mass trauma and transcultural psychiatry, Professor Silove and his team are at the forefront of research in the field of refugee and post-conflict mental health worldwide.

He has played a key role in establishing services for traumatic stress amongst refugees and conflict-affected populations Internationally, and for anxiety disorders in general in Australia. Professor Silove holds a number of National Health and Medical Research Council grants and is working with leading researchers around Australia to examine the longitudinal impact of severe injuries.

In his keynote address to the Many Paths, One Purpose Expert Forum hosted by the Australian Centre for Posttraumatic Mental Health on 12 August 2011, Professor Silove will show how expanding our terms of reference from the large western-population based studies of the past to include newer studies in developing countries is improving our understanding of psychiatric problems across countries and cultures in general. Recently he said:

“Thanks to large-scale epidemiological studies across many countries we are getting closer to building a global picture of the mental health situation. This is something that just wasn’t there in the past.”

Although the assessment and measurement of traumatic stress and related reactions across cultures remains controversial, Professor Silove sees the aim of the research as identifying the needs of different populations to enable practitioners to tailor mental health services to match:

“The Composite International Diagnostic Interview is still the most widely used measure for making diagnoses across different countries and populations. I am concerned that these diagnoses, and the criteria used to identify them, may be limited in certain ways to a western notion of psychology and psychiatry.

Even though diagnoses like Posttraumatic Stress Disorder are relevant to other countries and cultures, we might be missing out on the ways people express feelings of distress that are specific to their cultural background. We also run the risk of underestimating mental health needs in the countries that need them most.”

Professor Silove will present research from Vietnam, and from Vietnamese populations living in Australia, that shows the benefits of using a culturally specific measure of mental distress and explores the diverse ways in which people express their distress following a traumatic experience.


For further information on the ACPMH Expert Forum, Many paths One Purpose, click here.

Introducing Professor Richard Bryant

Professor Richard Bryant is a Scientia Professor and Australian Research Council Professorial Fellow in the School of Psychology, University of New South Wales, as well as Director of the Traumatic Stress Clinic, Westmead Hospital.

As a committee advisor to the Diagnostic and Statistical Manual of Mental Disorders (DSM), he will introduce the coming changes to the clinical diagnosis of posttraumatic stress disorder (PTSD), acute stress disorder (ASD), as well as the addition of complicated grief as a new diagnosis, in his keynote address to the Many Paths, One Purpose Expert Forum hosted by the Australian Centre for Posttraumatic Mental Health on 12 August 2011.

The addition of complicated grief to the DSM is very controversial, and the subject of much debate. Despite the widespread reluctance to clinically diagnose grief, Professor Byrant puts forth both a human and economic argument for its inclusion in the DSM. Recently he said:

“People have argued that medicine and psychiatry shouldn’t touch grief, but we have research from around the world showing that some people still have a persistent grieving response six to twelve months after a bereavement, which can't be explained by depression or anxiety, and this occurs across different cultures.

“This is a problem that affects ten to fifteen per cent of the population of bereaved people. A prolonged yearning for a loved one can lead to a range of health problems, including increased risk of suicide, psychiatric disorders, increased cancer rates, cardiovascular disorder, substance use – it's a huge public health issue. Having a diagnosis means we can identify and channel people towards getting the right kind of treatment.”

Professor Bryant will outline emerging research that shows the benefit of psychological treatment and new ways of identifying those at risk of developing complicated grief.

Less controversial, but no less significant, is his review of two other diagnoses for stress reactions after trauma: PTSD and ASD. Traditionally, PSTD was only diagnosed one month or more after a trauma because of a reluctance to over-pathologise stress reactions that were likely to disappear. ASD, introduced to the DSM in 1994, enabled practitioners to make a diagnosis within the first month after a traumatic event.

Revisions to the DSM are a critical way to reflect new research and developments in the field, and ensure that changes to diagnoses are recognised internationally. Professor Bryant’s keynote presentation will describe these changes in more detail and outline his rationale for refining the diagnoses.


Further information about Professor Bryant’s work:
http://www.wmi.org.au/ourpeople/Pages/RichardBryant.aspx

For further information on the ACPMH Expert Forum, Many paths One Purpose, click here.

Introducing Professor Jonathan Bisson

Professor Jonathan Bisson is Director of Research and Development, Cardiff University School of Medicine & Cardiff and Vale University Health Board in the United Kingdom. Developing his interest in traumatic stress during his time in the British Army, Professor Bisson is consultant psychiatrist, with an active research profile, as well as a clinician and teacher in this area.

Professor Bisson’s keynote address to the Many Paths, One Purpose Expert Forum hosted by the Australian Centre for Posttraumatic Mental Health on 12 August 2011 will show that evidence-based guidelines can play a key role in establishing a common response to trauma across national borders and across all stages of patient recovery.  He will also argue that Psychological First Aid should be embedded in society as an essential skill. Recently he said:

“One of my passions is working to identify the best ways of helping individuals following a traumatic event to prevent psychiatric disorders like posttraumatic stress disorder.”

Of his various studies, two widely cited randomised controlled trials of early psychological interventions following traumatic events and three Cochrane systematic reviews in the traumatic stress field have informed a new set of guidelines for helping people who have experienced a traumatic event. Professor Bisson has been working to circulate the guidelines across Europe as part of a European Union-funded project, which involved training programs and establishing collaborations between countries in the east and west to promote a common standard.

Professor Bisson emphasised that the guidelines are applicable to countries like Australia and New Zealand:

“A large part of the evidence was informed by studies conducted in Australia by groups run by ACPMH’s former Director, Mark Creamer and the work of Richard Bryant. Although much of the evidence base is transferable across different countries, we recommend that it is reconsidered in the light of cultural and organisational differences.”

He also believes that everybody can play a role in helping those who have experienced trauma, not just mental health professionals:

“What we need immediately after a traumatic event is good, practical support delivered in a sympathetic and empathic manner. That won’t necessarily be delivered by a mental health professional, it will more than likely be other individuals such as emergency service first responders, who are key to providing that initial support. I think the main role of the mental health professional in the immediate aftermath will be training front-line individuals to support others as part of a stepped-care pathway.

“Aside from any psychological interventions, people also need continued social support. For most of us, depending on the nature of the trauma experienced, that will come from friends and family. But we also need to offer social support to people who don’t have this option and equip communities to support each other. The power of an informed community response in helping individuals come through difficult times cannot be underestimated.”

Further information about Professor Bisson’s work visit:
http://medicine.cf.ac.uk/en/person/prof-jonathan-ian-bisson/

For further information on the ACPMH Expert Forum, Many Paths One Purpose, click here.