What are the common mental health issues faced by military personnel, and how should I approach their management in primary care?

Common mental health issues faced by military personnel include post-traumatic stress disorder (PTSD), complex PTSD, and symptoms such as re-experiencing traumatic events, avoidance, hyperarousal (including hypervigilance, anger, and irritability), emotional numbing, dissociation, emotional dysregulation, interpersonal difficulties, and negative self-perception including feelings of shame, guilt, or worthlessness.

These issues often arise from combat-related trauma, which may involve exposure to traumatic incidents that are similar to those encountered by civilians but can also include morally injurious events causing shame or guilt. Complex PTSD may develop after prolonged or repetitive traumatic events that are extremely threatening or horrific, such as torture or prolonged abuse.

Management approach in primary care should involve GPs taking responsibility for the assessment and initial coordination of care for military personnel presenting with clinically important symptoms of PTSD. This includes a comprehensive assessment of physical, psychological, and social needs, as well as risk assessment.

Care should be coordinated between primary and secondary services with clear agreements on monitoring responsibilities, ideally documented and involving the patient and their family or carers. Access to services should be promoted by reassuring patients that PTSD is treatable, offering flexible modes of delivery, and providing multiple points of access including self-referral.

GPs should also consider the use of validated screening tools for PTSD, especially in those with unexplained physical symptoms or those at high risk. Peer support groups should be offered if appropriate. Treatment should not be delayed due to court proceedings or compensation claims, but timing should be discussed with the patient to support informed decision-making.