I was also fortunate enough to visit the Army Centre for Enhanced Performance.  This is a team that was originally started in West Point academy training of high performance athletes at the Army college in sports psychology.  Its no expanded into units across the Army providing Positive Psychology training to service personnel including recruits and soldiers in the Warrior Transition Programme.  I managed to get a workbook that included some of their positive psychology exercises and have there website details as well.  Their works includes goal setting, imagery, energy (stress) management techniques like bio feedback, amongst others.  It was really interesting how many of the techniques I’ve used with patients in the past can be utilised in a non-clinical setting to enhance performance.

It was another interesting an interactive day.  I have most of the briefs copied on powerpoint which will be useful to show other colleagues when I return.

We then had presentations from the Surgeon Generals dept on BH policy initiatives.  We had a presentation on ‘Soldier 1st’ which is an initiative to trained laymen soldiers through a 3 day training course in being able to spot MH problems and knowing who to refer the soldier to (e.g, Chaplains, MH).  It’s similar to TRiM but without the traumatic focus.

We spend sometime on Traumatic Event Management and started some cover some training in Debriefing.  It’s used a lot here and similar to TRiM but instead it is seen as a medical role and is facilitated by BH providers and chaplains. 

We also had a presentation on Resilience training which was some basic tips on keeping ourselves well emotionally, mentally, physically, socially and spiritually.

Today involved a meet and greet, finding out more about COSC doctrine, learning about the Air Force and Marines COSC programs.

COSC course is the pre-deployment course for all behavioural (mental health) providers.  COSC is the name of the deployed team in theatre. I put more details as the course progresses

I was able to spend time with the social work manager of the Warrior Transition Unit which provides out-patient mental health care to wounded warriors from Brooke Army Medical Centre.  Although a clinical service they come under the control of the executive in Fort Sam Houston and that enables them to keep good links with the command on the management of soldiers.  They main remit is in risk management but they are also involved in the treatment of personnel and their dependents with mental health problems including PTSD.  It seemed to work in the similar way to out DCMHs with a key difference is that their Social Workers carry out the work that our community mental health nurses do.  Their psychiatric nurse practitioners seem to be mainly hospital based and heavily involved with the prescription of medication and delivery of medical model based care.

I was then fortunate enough to take a tour of the Centre for the Intrepid which is the US version of our rehabilitation facility at Headley Court.  Its creation was fully funded by donations and built in just 16 months.  The running of it is now funded by the DoD.  Not surprisingly the facilities are state of art.  I’ve not visited Headley Court but I don’t expect it has anything like the resources of CFI.  These include a $1.5 virtual reality training room that helps train people to use their prosthetic limbs and is able to recreate Iraqi landscapes as well as jet skiing!  Their pool includes a wave rider so people can practice surfing whilst working on their core conditioning.  It includes a Behavioural Health section but I wasn’t able to speak to them during the visit which was a shame.  However, I was told they work closely with the physiotherapists and provide mental health care when and where appropriate.  It’s a truly amazing facility.

This includes Traumatic Event Management (including Battlemind Debriefing – similar to CISD), Battlemind deployment brief training, Battlemind life cycle briefing training.  The training are well packaged and look professional.  Although only the post deployment briefings and battlemind debriefing have research evidence proving their efficacy, there is planned research looking at the life cycle elements.

The key advantage seems to be that it all comes under one package with a common message of utilising the service persons resilience.  This is in comparison to the usual illness model of most stress management presentations.  The suffer a bit from mission creep sometimes and other agencies wanting to take on the Battlemind product but generally this is well advanced of anything on offer in the UK (bar TRiM debriefing).

They have given copies of various resources including training booklets and CDs of presentations, which will be great to spend more time examining when I get back to the UK.

I was also able to spend time with the sleep lab staff finding out about some of their findings around optimal sleep levels and the advice they given command on sleep hygiene.

In addition I gave a presentation on the UK Defence MH services and some of the research that has been coming out of the ACDMH, which was well received.

Other aspects they are involved in includes providing liaison to any medical patient within the hospital with psychiatric or mental health related issues.  They also provide psychiatric liaison for the Emergency Department.

During my time I was able to sit in on morning and afternoon rounds of the team.  I was able to escort one of the army psychiatrists on his patient visits and be present during the trauma teams ward round in which there is a psychiatric input.  I also spent time discussing the use of hypnotherapy for anxiety and pain management (a intervention used a lot in the team).  I also sat in on MDT discussion and patient consults.

This is another example of a really comprehensive service that tries not only to support those in need but helps avoid service personnel ‘slipping through the net’ by seeing and screening all returnees.