Post traumatic stress disorder (PTSD) plagues thousands of veterans, and a report released by the Institute of Medicine reveals that treatment for the disorder is extremely inadequate. Congress directed a committee of 16 experts for the Institute of Medicine, who spent four years compiling the 300-page report detailing how the Department of Defense (DOD) and the Department of Veterans Affairs (VA) deal with PTSD.
According to the report, one of the main problems is the absence of information available about specific treatments that patients receive, and whether they improve or get better. The current computer system that the VA uses for health records does not allow clinicians to completely track what types of therapy are being used. They are only able to track what medications patients are prescribed. Although a new template for the system was supposed to be introduced in November 2013, the report indicated that as of January 2014 it was not yet operational.
The report explained that in order to deliver top-notch health care, patient outcomes must be determined by the organization. “However, neither DOD nor VA is in a position to do that,” the report says. If patient outcomes are not tracked, then neither department is aware if the provided care is adequate and efficient. It is not possible to improve overall care without this vital information, the report indicated.
The report said leaders in the DOD are not held accountable for employing programs and policies to efficiently manage PTSD. It also criticized the Department of Defense’s current treatment programs calling them “ad hoc, incremental, and crisis-driven.” It went on to say that there is minimal planning allocated to developing “long-range” approaches to achieve the desired goal.
Another failure highlighted is delayed treatment for those who need therapy, which played a pivotal role in the scandal that prompted VA Secretary Eric Shinseki to resign. Despite efforts made by the VA, of the veterans that served in Afghanistan and Iraq that were diagnosed with PTSD last year, only about half received the recommended therapy. Last year, the VA reported that about 53 percent of these veterans got the minimum standard-of-care, eight therapy sessions in 14 weeks. This is short of the VA’s 67 percent target. In some instances, counseling may have been interrupted, cut short, or delayed.
The report also noted that for active duty military, each branch of service does things its own way. Prevention programs are established by each specific branch, mental health staff are trained per branch, and programs and services for PTSD are unique to each branch as well. The branches are without an all-encompassing authority for the enforcement of PTSD treatment, screening, and prevention policies.
Data indicated that after 13 year of war, there is a marked increase in mental illness. Military members returning from war with PTSD increased tenfold between 2004 and 2012. In 2003, a little less that 200,000 Iraq and Afghanistan veterans had service-related PTSD. In 2013 that number was over 650,000, with many veterans not seeking VA treatment for the disorder.
Despite millions of dollars being spent on PTSD, veterans are still plagued and, as the report revealed, treatment is still inadequate. In 2012, the VA and DOD spent a combined $3.3 billion on treating PTSD sufferers. This includes $673 million solely on Iraq and Afghanistan veterans. The total amount spent on PTSD treatment by the Pentagon increased drastically from 2004 to 2012, going from $29.6 million to $294.1 million. Outside care for the disorder, paid for by the Department of Defense’s healthcare program Tricare, jumped from $22.4 million in 2007, to $131 million in 2012. Nine hundred million dollars was authorized by Congress for traumatic brain injury care and mental health. According to the report, plenty of money is spent on private therapists due to an insufficient amount of staffing among the two agencies, but the qualifications of these counselors are not evaluated. A PTSD patient may wait eight weeks on average to see a VA therapist, and over two months for intensive treatment programs.
Staffing inadequacies are among several other problems cited by the report, despite efforts made by the VA and the DOD. There has been poor communication between Pentagon mental health leaders and the VA. The amount of the VA research budget for PTSD has gone down in recent years, despite the numbers of PTSD sufferers going up. Between 2010 and 2013 the percentage went from 32.4 to 24.6. The amount of PTSD cases in patients from conflicts besides the Iraq and Afghanistan wars have gone up. Last year, 62,536 new cases were diagnosed in veterans from other conflicts. PTSD ranks third among the most common major service-related disability. It comes after hearing loss and ringing of the ears.
The report recommended that the DOD and the VA work together to develop and use a system of management that would oversee and document the patient’s progress throughout their treatment, no matter where that care is received. It also recommended that annual screenings for PTSD be performed on soldiers returning from Iraq and Afghanistan, and more research should go into finding out which treatments work.
The report revealed that not only is treatment inadequate, but there has been a surge in the amount of veterans plagued by PTSD. But it is not over. According to Sandro Galea, professor at Columbia University and chairman of the study “We are at the cusp of a wave of PTSD.”
By Twanna Harps