An important program in the MHS to respond to PTSD and TBI is the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury [DCoE]. DCoE identifies best practices and quality standards for suicide prevention and the treatment of psychological health conditions, combat stress, and traumatic brain injury for service members. DCoE leads what has become a groundbreaking collaborative effort that includes the Department of Veterans Affairs [VA], civilian agencies, community leaders, advocacy groups, clinical experts, and academic institutions that are dedicated to expanding the state of knowledge of psychological health and TBI. Already DCoE has provided significant support to DoD and [VA] efforts to establish the Federal Care Coordination program. They have also created a TBI care coordination system to integrate local, state, and federal resources in order to eliminate gaps in care for patients in transition between DoD and VA. DCoE works to build resiliency in warriors, veterans, and their families to facilitate recovery from psychological health injuries and TBI and ensure successful reintegration back into their own communities.

For several years now, the DoD leadership has been dealing with a growing number of military personnel suicides. What have your office and DoD been doing to stem this flow, and what do you feel can be done to encourage “at risk” personnel to get help when they need it?

Clearly, even one service member suicide is too many and DoD is taking a proactive and comprehensive approach towards prevention, with efforts to address the stigma of psychological health issues, reduce barriers to care, and research best practices. The MHS already provides extensive resources for service members seeking help, ranging from behavioral health care in the deployed unit to toll-free call centers, and mental health providers and staff at every military clinic and hospital. Last year we established the Department of Defense Task Force on the Prevention of Suicide by Members of the Armed Forces, which has recently released its report. Membership on the task force consisted of DoD and non-DoD experts, and included at least one representative each from the Army, Navy, Air Force, and Marine Corps, along with one family member with a background in working with military families. Recommendations from the report have included calls for more efforts to reduce stigmas; wellness enhancement and training; faster access to mental health care; and more comprehensive surveillance aimed at identifying individuals who are at risk.

The greatest challenge in this fight still remains the barriers some military personnel feel when it comes to seeking mental health care. Meeting this challenge requires a joint effort by the military services and the MHS. Working closely with the services and through programs such as the Real Warriors Campaign – a DCoE-led initiative which promotes resilience, facilitates recovery, and supports reintegration of returning service members, veterans, and their families – we are helping to address service members’ fear of seeking treatment and [giving] them the tools they need to build resiliency as well as knowledge about the many programs available to help them. The bottom line is that no service member should fear seeking the help that they need. Psychological issues are medical issues.

Traumatic brain injury is emerging as one of the signature injuries of the present American overseas wars, along with the daily lives of physically active U.S. citizens. What is the current state of DoD TBI research, treatment, and policy, and what do you see ahead in the next few years in this area?

TBI is an issue that the DCoE and its component center, the Defense and Veterans Brain Injury Center [DVBIC], are addressing for the MHS. DCoE uses a collaborative approach to work with all branches of the military to address the issue of diagnosis and treatment for TBI to ensure our service members, veterans, and families have access to the resources they need. The most significant finding in the emerging science and research on TBI is that symptoms following repeat concussions may be more serious and resolve themselves at a slower rate than previously thought. As a result, DoD is working to ensure service members exposed to incidents that could result in a concussion are screened and provided with an opportunity to heal before returning to active duty.

In June 2010, Deputy Secretary of Defense William J. Lynn III signed a memorandum on management of concussion and mild TBI in theater with new guidelines requiring injured service members to report symptoms. It also requires mandatory screening by a medic or corpsmen for anyone involved in or near an explosive blast, or any incident which may affect the head. DCoE plays a leadership role in developing research investment strategies related to TBI. In addition, DCoE is working to ensure both military and civilian providers have access to the latest clinical practice guidelines for treatment of each level of TBI severity. Since 2009, DCoE has distributed thousands of VA/DoD mild TBI guidelines to providers, and this year [2010] DCoE produced a pocket guide for providers that outlines clinical practice guidelines for mild TBI. Finally, earlier this year, DoD opened the new National Intrepid Center of Excellence [NICoE], an advanced facility dedicated to research, diagnosis, and treatment of military personnel and veterans suffering from mild TBI and other psychological health issues. The 72,000-square-foot facility, located on the campus of the National Naval Medical Center in Bethesda, Md., is designed to act as both a research and clinical center for individuals who suffer from these issues.

We’re coming up on the 30th anniversary of the clinical diagnosis of post-traumatic stress disorder in 2012. What do you and your office see ahead for PTSD diagnosis and treatment within DoD MHS/TRICARE, and what do you think needs to be done to better educate the force and public overall about this condition?

The DCoE is taking the lead in educating service members and their families on the importance of early intervention for psychological health concerns, including PTSD. Treatment works – the earlier the intervention, the better chance for a successful outcome for service members who come forward. For example, through the Real Warriors Campaign, service members and their families can receive guidance, information, and assistance with all psychological health issues. DCoE also staffs a 24/7 Outreach Center [1-866-966-1020] for service members in crisis, and sponsors an interactive website, which provides online wellness and behavioral health information. We also continue to ensure our providers are trained in the use of state-of-the-art, evidence-based treatments for PTSD, such as prolonged exposure and cognitive processing therapy. Next year, DCoE and the VA will be releasing new psychological health and PTSD clinical practice guidelines to civilian and military providers who treat service members, as well as a PTSD toolkit reference guide for providers. In short, we are making tremendous strides in educating our force, and making clinical advances in treating PTSD and other psychological ailments.

What is the current state of the TRICARE system, and how is it dealing with the current loads of patients coming into the system?

TRICARE is currently in exceptional shape as it continues to deliver the best possible health care to our more than 9.6 million beneficiaries around the world. These beneficiaries – active duty, National Guard and Reserve members, family members, retirees, and their families – have comprehensive, affordable health coverage with several health plan options, a robust pharmacy benefit, dental options, special programs, and demonstrations.