PTSD Ignored in American Neighborhoods


Post-traumatic stress disorder, more commonly known as PTSD, is being effectively ignored in American neighborhoods, according to a recent study by ProPublica.  Americans in violent neighborhoods are apparently being diagnosed with the mental health issue at a rate similar to those of veterans, and very little is being done to acknowledge it.

Chicago’s Cook County Hospital decided to undertake some research in 2011 and began screening its patients for PTSD.  2,000 patients yearly come through the doors of the hospital’s emergency room, victims of gunshots, stabbings, and violent injuries in general.  Researchers at the hospital suspected at least some of those 2,000 patients would meet the criteria for a diagnosis of PTSD, but when 43 percent of patients met the criteria for PTSD diagnosis, they were stunned.

PTSD is diagnosed using criteria from the Diagnostic and Statistical Manual of Mental Disorders, or DSM-5, and when the researchers from Cook County Hospital conducted a screening process on their patients to determine which ones would fit the PTSD bill, they realized there was a significant concern.  The ProPublica study then decided to take a look at the 22 cities with the highest murder rate, and New Orleans was the only one that had any screening procedures in place for patients with PTSD.

While it can be safely acknowledged that veterans with PTSD have garnered a great deal of attention worldwide, PTSD is effectively ignored in American neighborhoods, and civilians with the condition have largely slipped through the system unnoticed.  Kimberly Joseph, trauma surgeon at Cook County Hospital, suggested that $200,000 yearly be spent to help hospital staffers screen for PTSD patients and then connect them for treatment.  When she brought her suggestion to the hospital board, she was met with a flat refusal.  Hospital administrators suggested she look for alternative sources for funding, given the hospital runs on a tight $450 million US taxpayer-funded budget.

Dr. Kerry Ressler, lead investigator of the Grady Trauma Project in Atlanta, said researchers interviewed some 8,000 inner-city patients.  67 percent said they had been violently attacked and over half said they knew someone who had been murdered.  According to Ressler, conservative estimates are that a third of those interviewed have shown characteristics consistent with PTSD at some point in their lives.

In a 2012 paper, Ressler and his co-authors said ignoring civilian PTSD was tantamount to compromising public safety.  Drexel University in Pennsylvania was of a similar mindset; researchers there suggested that those civilians who have been diagnosed with PTSD might possibly start carrying a weapon in order to enhance their sense of personal safety.

There are several hospitals who are interested in implementing PTSD screening for their patients, but the biggest problem is lack of financial resources, particularly for public hospitals.  The question often becomes who will get laid off in order to support resources to help screen for and treat PTSD patients.

Medicaid is often the resource that many hospitals turn to for coverage of low-income patients, but hospitals don’t have any ideas as to how they can get reimbursed through Medicaid in order to screen for PTSD.  In addition, states aren’t given guidance about how to reimburse hospitals via Medicaid, or they simply don’t know if hospitals can be reimbursed for PTSD screening and treatment programs.

The American College of Surgeons (ACS) is apparently preparing to set standards stating that top-level trauma centers need to routinely screen for PTSD, but it’s more likely that the ACS will say that PTSD screening is simply recommended practice rather than a mandated requirement.  Unfortunately, according to Chris Cibari, chair of the subcommittee that determines whether hospitals are meeting ACS standards, hospitals won’t put the money towards PTSD screening and treatment unless it becomes an ACS regulation.

While hospital administrators wait to see if PTSD screening becomes a regulation, PTSD continues to be ignored in American neighborhoods.  There are those who are struggling with paranoia, flashbacks, and drug and alcohol issues as a result of PTSD, and few realize that PTSD is the cause until the person lands in hospital.  By then, knowing that this mental health disorder could be the cause of the person’s injuries might be too late.

By Christina St-Jean


National Center for PTSD

National Center for PTSD

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