New Army General Leads PTSD, TBI Initiatives

The day dawned cloudy with threatening rain, but on May 9, Loree Sutton, M.D., was, as that famous pop song goes, “walking on sunshine.”

In early March she was promoted from U.S. Army colonel to brigadier general, making her the highest-ranking military psychiatrist not only in the Army but also in the Department of Defense (DoD), the largest employer in the country. President Bush had nominated her the previous May when she was commander of the Carl R. Darnall Army Medical Center at Fort Hood, Texas. The Senate confirmed her appointment a few weeks later.

Now a year later, she was finally carving out a day from her tight schedule to celebrate her promotion in the Terrace Theater at the John F. Kennedy Center for the Performing Arts in Washington, D.C.(see Original article: Ceremony, Praise Accompany Promotion). In the audience of a couple of hundred people were former APA President Carolyn Robinowitz, M.D., and APA Medical Director James H. Scully Jr., M.D.

“I first met Doctor/General Sutton at APA working with the late Jay Cutler,” Robinowitz told Psychiatric News, referring to the person who had headed APA's government relations efforts for many years.“ Even that early in her career, she clearly was outstanding, and it was easy to see that she would become a leader,” Robinowitz said.

Sutton now serves as the director of the newly established Defense Center of Excellence (DCoE) for Psychological Health and Traumatic Brain Injury (TBI).

“She heads up not only the Army ... but also the DoD initiatives on posttraumatic stress disorder and traumatic brain injury and other psychological consequences of war for military members and their families,” one of her mentors, Robert Ursano, M.D., chair of the Department of Psychiatry at the Uniformed Services University of the Health Sciences in Bethesda, Md., told Psychiatric News.

The one-star general is to bring together under one umbrella the DoD's scattered and complex mental health care system to benefit all the branches of service; to seek ways to increase the system's manpower; and to establish quality standards for research, clinical care, education, training, prevention programs, and outreach to patients, families, and communities.

“She has been asked to do that in one year of time,” noted Ursano. “To successfully accomplish that takes a tremendous sense of vision, organization, knowledge, and commitment of one's time and energy and life, and she meets all those characteristics.”

Brave Soldier and Caring Doctor

Sutton stepped up to this assignment around the time when DoD was being pummeled by news media and Congressional inquiries that suggested that perhaps the military health system was unprepared and ill equipped to care for military members who were coming home from Iraq and Afghanistan with TBI or symptoms of PTSD.

A 2007 DoD “Task Force on Mental Health” report stated“ Our involvement in the Global War on Terrorism has created unforeseen demands not only on individual military service members and their families, but also on the Department of Defense itself, which must expand its capabilities to support the psychological health of its service members and their families.”

“It's a tremendous challenge to keep our arms around them,” Sutton said of these war casualties in an interview with Psychiatric News in her office not far from the Pentagon. “We are committed to absolutely providing the best tools and resources—in clinical care, education and training, research, outreach”—to assist them.

It's about the three “Rs,” she says: providing care and support that encourages resiliency, recovery, and the healthy reintegration of military members back into the lives of their families, communities, and society at large.

Not Family's Only Physician

Sutton, who was born and raised in Loma Linda, Calif., was no stranger to medicine when she chose it as a vocation. Her mother was a cardiac-care nurse, and she fondly recalls occasionally carrying the medical satchel of her physician grandfather—“an old time country doctor [who] looked liked he walked out of a Norman Rockwell painting”—as he made house calls.

After graduating from Pacific Union College, she entered medical school at Loma Linda University and completed her psychiatry residency at Letterman Army Medical Center at the Presidio of San Francisco.

Why psychiatry? “I loved everything I did in medical school. I loved all my rotations,” Sutton said. But then she met psychology professor Blake Keasey, Ph.D. “He was so passionate—passionate about his patients, passionate about the intersection of what we were learning about the brain and all of the science and technology and imaging.... I just followed my heart from there.”

Following her residency, Sutton was on the move. After serving as a mental health officer in the Sinai, Egypt, she was promoted to a division psychiatrist and deployed to operations Desert Shield and Desert Storm. Among the postings that followed were as chief of inpatient psychiatry at William Beaumont Medical Center in Texas, commander at DeWitt Army Community Hospital/Health Care Network in Virginia, and command surgeon, U.S. Army Forces Command, in Fort McPherson, Ga. Her two-year Fort Hood command followed.

Building System Brick by Brick

Last winter, with basically a phone and a skeleton staff of maybe six, Sutton officially opened up the Defense Center of Excellence for Psychological Health and Traumatic Brain Injury. She said it is now a far-flung workforce of more than 150 military and civilian mental health care professionals and their administrative staff.

“We are now a center of centers,” Sutton said, referring to six existing organizations that until now had operated independently of one another.

One of the centers is DCoE's global headquarters, Sutton's hub of operations, or as she refers to it, the “dugout.” Among the other centers are the Defense and Veterans Brain Injury Center (DVBIC) and the Deployment Health Clinical Center (DHCC), both located at Walter Reed Army Medical Center in Washington, D.C.; the Center for Deployment Psychology; and the Center for the Study of Traumatic Stress located at the Uniformed Services University of the Health Sciences. The DVBIC and DHCC will ultimately relocate with Walter Reed Army Medical Center to its new Bethesda, Md., campus. Also on the campus and now under construction adjacent to the new Walter Reed Military Medical Center will be center number seven: the National Intrepid Center for Excellence (NICoE).

NICoE will serve as the hub of the global collaborative network of public and private partners working together to ensure the most advanced care for military member in need and their families. At NICoE they will receive intensive outpatient evaluation, advanced diagnostics, treatment plans/modalities, and long-term follow-up, said Sutton, who took part in the June 5 groundbreaking.

At DCoE no day is the same. One day Sutton is responding to a time-sensitive inquiry from Congress; another day she is attending a promotion of “Talk, Listen, Connect,” a Sesame (Street) Workshop-produced multimedia, support kit for children that addresses the feelings they have about a parent or loved one who's been sent off to war.

Most recently Sutton has been hosting “summits” around the country to build what she views as DCoE's larger supporting team—a world network of experts, military and civilian, to help develop the best treatment standards for mental illness and outreach practices for returning members of the military.

DCoE “is the best thing that could ever come up for me at this point in my career,” she reflected. “We can fool ourselves by thinking that perhaps our own personal skills, attributes, and abilities are what matter most. But I tell you, there's nothing like standing up something from nothing to both humble one and to be reminded that without a team nothing happens.”

Information about the Defense Center of Excellence and Sutton's vision for it is posted at<www.dcoe.health.mil/about.htm>.▪