A report from the Institute of Medicine (IOM) finds that the U.S. Department of Defense (DOD) and U.S. Department of Veterans Affairs (VA) do not measure the effectiveness of treatment of post-traumatic stress disorder (PTSD), calling into question millions of dollars spent to improve service members' mental health. The report also found that neither agency has kept pace with growing demand for PTSD treatment.
"Both departments lack a coordinated, consistent, and well-developed evidence-based system of treatment for PTSD and need to do a better job tracking outcomes," said Sandro Galea, MD, DrPH, chair of the IOM committee, and chair of the Department of Epidemiology at Columbia University's Mailman School of Public Health. "Mental health is among the most important factors behind successful re-entry after military service, and we don't know if treatments are working."
The IOM issued this report on the heels of a scandal at the Department of Veterans Affairs that led to the resignation of VA Secretary Eric Shinseki on May 30. Federal investigators determined that service members were systematically denied timely care in a network of more than 1,700 healthcare facilities that suffers from inefficiency and bureaucracy.
PTSD is diagnosed by combination of symptoms, including hypervigilence and sleeplessness, and can be treated pharmacologically and psychologically with cognitive behavioral therapies involving multiple sessions with trained counselors.
An estimated 5 percent of service members have been diagnosed with PTSD; for veterans who served in Iraq and Afghanistan conflicts, the number rises to 8 percent. In 2012, more than half a million sought care for PTSD in the VA - 9.2 percent of all VA users. In 2012 the DOD and VA spent $294 million for PTSD care. If treatment demands continue to climb, the total cost for PTSD could exceed $500 million by 2017.
The report also recommends that the DOD and VA enlist a workforce of mental health care providers to meet the growing need for PTSD treatment. While the departments have substantially increased mental health staffing, these increases do not appear to have kept pace with the demand.
The most surprising outcome over four years of deliberation, according to Dr. Galea, is the dissonance between the intention of senior leadership and how a PTSD management system is implemented. "There is generally good will and spikes of excellence in both departments. Substantial effort has been made toward providing service members excellent PTSD care. However, there is tremendous variability in how care is implemented and an absence of data that tell us if programs are working or not," Dr. Galea said.
"In many respects our findings that neither the DOD nor the VA has a system that documents patients' progress and uses standardized instruments to chart long-term treatment are not surprising," he added. "We are hopeful that the report will provide a blueprint for where we need to get to."
The report is the second of a two-phase assessment of PTSD services for the military. The first report of the committee, also chaired by Dr. Galea, was issued in July 2012.
Interview with Columbia University's Dr. Sandro Galea, IOM Committee Chair, on report findings: