Veterans With PTSD Need Better Access To Care And Monitoring Of Treatments

Date: Jul-14-2012Veterans and service personnel with PTSD (post-traumatic stress disorder) must have proper and prompt access to evidence-based care, and their treatments should be tracked, including their outcomes, says a new report from the Institute of Medicine (IoM) that was mandated by Congress. Programs on offer should be thoroughly researched to make sure they are effective, the authors added; their findings should become freely available to the public immediately. The report directed its message to the US Departments of Defense and Veterans Affairs.

As the USA winds down its military involvement in the Middle East, an increased number of returning veterans are expected to require PTSD services. Congress asked the Department of Defense, in consultation with Veterans Affairs, to sponsor an IoM study to assess the PTSD treatment programs and services with the two departments. The report is entitled Treatment for Posttraumatic Stress Disorder in Military and Veteran Populations: Initial Assessment.

The authors explained that approximately 40% of those who served in Afghanistan and Iraq and were screened positive for PTSD were referred to additional treatment or further evaluation, of whom about 65% did get further treatment.

The tracking of veterans' treatments and outcomes needs considerable improvement, the report explained, emphasizing that it is not just a question of broadening access to care.

As is currently practiced in the Veterans Affairs (VA) system, screening for PTSD should be carried out at least once a year when primary care providers see military personnel at the Department of Defense (DoD) treatment centers or under TRICARE, the report added.

Committee chair Sandro Galea, professor and chair of the department of epidemiology, Mailman School of Public Health, Columbia University, New York City, said:

"DOD and VA offer many programs for PTSD, but treatment isn't reaching everyone who needs it, and the departments aren't tracking which treatments are being used or evaluating how well they work in the long term. In addition, DOD has no information on the effectiveness of its programs to prevent PTSD."

The authors explained that they have now completed the first phase of a study that is looking into PSTD programs within the DoD and VA - the programs are aimed at preventing, identifying, and treating PTSD.

Many of the PTSD-related services on offer at the moment could not be assessed properly, because of insufficient data. Request for data is being made continuously, the authors wrote, regarding service members with PTSD, their treatments, outcomes and costs. They say their requests for more data, in some cases, have resulted in helpful responses from DoD and VA regarding how many military personnel and veterans have PTSD, what treatments are being offered and given, their costs, and outcomes.

Their findings and recommendations may be "refined" in the second phase of this study if additional data are received.







Despite efforts to improve access to care, the authors (Committee) identified several obstacles that continue undermining the whole effort. They include:

Finding it hard, or impossible to allocate the time to get treatment
Service people's concerns about affecting their career prospects if they seek out help
The long distances from patients' domiciles to a mental health providing center
Transportation problems, which seem to be a major problem in war zones
Medications - there might be restrictions on where on when they can be used
Other logistical problems in getting veterans or service members to appointments

The DoD and VA need to gather more data on the obstacles to care so that they may be better understood. Then interventions can be put in place to overcome these barriers. Some research indicates that new and emerging technologies, such as telemedicine, have a role to play in PTSD treatment - they should be assessed, and then made available.
PTSD among service members and veterans in the USA
Before entering the military conflicts in Afghanistan and Iraq, in response to the September 11, 2001 attacks, injuries suffered by military personnel which were reported tended to include infectious diseases and catastrophic gunshot wounds. Since becoming militarily involved in Iraq and Afghanistan "the signature injuries suffered by U.S. military personnel involved in conflicts are blast wounds and the psychiatric consequences of exposure to combat, particularly posttraumatic stress disorder."

PTSD is triggered by a traumatic event, which may have occurred in combat. It includes a cluster of signs and symptoms, including the persistent recalling of the event, emotional numbness, avoidance of certain thoughts, feelings and conversations, as well as places which may be linked in some way to the trauma. People with PTSD may also suffer from hyperarousal - they may have an exaggerated startle response. Many find it hard to concentrate.

2.6 million service members from the USA have fought in Afghanistan or Iraq since 2001. Between 13% and 20% of them are estimated to have PTSD.

The Committee listed the following risk factors for military personnel developing PTSD:

Combat experience
Seeing people die, or seeing dead people
Handling human remains
Serving on graves registration
Being captured
Being tortured
Exposure to uncontrollable or unpredictable stress
Being the victim of sexual assault
Being the victim of sexual harassment

They also associated the following with higher rates of PTSD:

Longer deployments
Multiple deployments
Spending a long time away from base camp
Being exposed to suicide bombs (including car bombs)
Being exposed to improvised explosive devices
Being exposed to pocket-propelled grenades

In the Report Brief, the authors wrote:

"DoD and VA leaders are faced with the daunting challenge of healing these servicemen and women with invisible as well as visible wounds. How can their care be improved? Which innovative approaches could prevent PTSD before exposure to a traumatic event? Which treatments could best improve management of PTSD for service mem¬bers, veterans, and their families in the short- and long-term? Answering these key questions will be critical to improving care for our nation's wounded warriors."

Written by Christian Nordqvist

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