ADF Health September 2000 - Volume 1 Number 3Letter to the EditorMilitary psychiatryTO THE EDITOR: John Ellard's article on military psychiatry 1 was a timely reminder of the importance of the principles of proximity, immediacy and expectancy in the treatment of combat stress reactions. These therapeutic guidelines were formulated by the work of Salmon and colleagues in World War I, 2 and remain the recommended approach today. 3 As Ellard described, these principles are effective in returning soldiers to duty. There is even some evidence that they can be effective in reducing the development of post-traumatic stress disorder. Solomon et al reported that the rate of post-traumatic stress disorder in Israeli veterans was inversely related to the number of Salmon principles that were put into practice in their treatment. But were these principles employed in the care of ADF personnel during the recent conflict in East Timor? Or was the temptation to evacuate too great, with Darwin just 60 minutes away by air? Martin and Cline described the consequences of the failure to adhere to these principles: "The worst mental health outcomes follow inappropriate evacuation out of the combat theater; soldiers can be lost to military service or effective civilian functioning." 5 Duncan Wallace, FRANZCP References
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