Hospital takes proactive approach to post-traumatic stress disorder

In that role, he supervises other psychiatrists, psychologists, social workers, nurse practitioners, psychiatric nurses and others.

His position as a supervisor of divergent mental health service providers is not standard in the VA system. Sometimes psychiatrists, psychologists and social workers function autonomously in their own departments, each with their own boss.

That was the case at the Loma Linda VA in 1997, when Otero took over the hospital's psychiatric service.

"That was inefficient," he said. It meant that the heads of the three mental health services had to agree before resources could be moved.

Otero, who had been head of psychiatry since 1997, took over as chief of the psychologists after their boss retired. The social workers merged more recently.

"Consolidation is a much more efficient way of delivering care," Otero said. It allows him to redeploy professionals to where they are needed.

Among the pieces Otero must orchestrate are five community clinics, that in addition to the Loma Linda VA, must be appropriately staffed. The community clinics are located in Corona, Palm Desert, Sun City, Upland and Victorville.

War spawns a period of



The War on Terror, which sent troops to Afghanistan and Iraq following the attacks of Sept. 11, 2001, has caused an upsurge of patients for the VA hospital system.

From 2002 to 2008, the number of mental health outpatient visits at the Loma Linda VA increased 76 percent, from 47,489 to 83,728.

So contrary to the direction of the national economy, the VA is in growth mode.

"The VA central office in Washington is spending significant amounts of money," Otero said. "We are getting a large number of new positions. In the 14 years I have been here, I have never seen so much."

For this newest group of veterans, behavioral health services has an increased role than what the Vietnam-era vets experienced.

"The government wants to avoid some of the mistakes made subsequent to the Vietnam War when a lot of Vietnam veterans were disenfranchised for many years." he said. "A lot of harm was done to their lives.

"The field of psychiatry has changed over the past 30 years. There were a lot of misdiagnosis; many of the veterans' experiences with the VA didn't go well, because post-traumatic stress disorder was not well understood."

Some veterans got proper treatment 20 or 30 years after the issue should have been recognized, he said.

Many returning Vietnam veterans sought refuge from PTSD with addictive behaviors. They were frequently misdiagnosed with schizophrenia and other psychological abnormalities, Otero said. In reality, they were driven to those addictions to mask the increasing severity of flashbacks to horrific combat experiences.

"One of the differences between the current war and the Vietnam conflict is that current vets are receiving counseling and education (about PTSD) before they go and immediately after they return, he said.

"We are trying to catch PTSD early - undiagnosed, it becomes a much more disabling condition," he said.

While the VA mental health community is much more in tune to the workings of PTSD for the new group of veterans, these veterans face some stress issues the Vietnam era combatants did not.

As many Vietnam-era veterans were drafted, they served in the combat zone for a year and were discharged back to civilian life, Otero said.

But for veterans of the "War on Terror," returning stateside from the front line isn't necessarily the end.

Many will hook up with their old National Guard and Reserve units where they could be called to serve in a combat zone again.

"Because of the possibility of being redeployed, they are not in a position to get on with their lives," Otero said. "The possibility of being redeployed carries its own stress. That creates a different dynamic. We are not sure what the history will be."

While much of Otero's time is spent with administrative matters, he still sees patients - some he has been following for 14 years.

Otero said he had his sights set on becoming a doctor since the age of 4, when his father bought him a Visible Man anatomy model.

Otero completed his undergraduate studies at Virginia Commonwealth University in three years, graduating magna cum laude.

He took a year off to work for a volunteer rescue squad as an emergency medical technician and used his spare time to take additional college courses in computer science, physics and math.

While attending Medical College of Virginia, he thought he would specialize in neurology. But when he graduated in 1989, the field of psychiatry was rapidly changing, so he opted for that as a specialty.

During his residency in the Fresno-Central San Joaquin Valley Medical Education Program of UC San Francisco, Otero started working with veterans. He continued to do so during a fellowship in clinical psychopharmacology and psychobiology at UC San Diego.

He was hired as a staff psychiatrist at the Loma Linda VA in 1995. Otero, 45, lives in Redlands.


Symptoms of Post-Traumatic Stress Disorder

Intrusive memories of war, so that a person experiences flashbacks so vivid they are almost hallucinations;

Nightmares, flailing around at night;

Irritability, anger at work and at home;

Hyper-vigilance, meaning odd behavior resulting from a heightened state of readiness, such as walking around the house all night to protect the family.

Source: Dr. Jay M. Otero, chief of Behavioral Medicine Service at the Jerry L. Pettis Memorial VA Medical Center

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