Treatment Online

GAO: PTSD Going Untreated
> 5/11/2006 9:26:47 AM

Today's entry for outraging failure to protect our servicemen comes from the newly released Government Accountability Office (GAO) study into the screening for post traumatic stress disorder of soldiers returning from Iraq and Afghanistan. As USA Today reports, the GAO's study found that only 22% of returning servicemen who screened positive for combat-related stress disorder were referred for future mental health evaluation.

Now, you might be saying to yourself, that sounds pretty low, but allow me to unpack this a little to illustrate just how awful a situation this is. Returning vets are screened for PTSD using, primarily, a set of four questions.

From the USA Today article:
The military health screening process includes four questions to help identify combat-induced stress.

The questions relate to nightmares, severe memories that will not go away, feeling numb and being constantly on guard, watchful or easily startled.

Positive answers to three or four of the questions indicate a possibility of PTSD, the report says.

Of 9,145 servicemembers who returned from combat from 2001 to 2004 and answered yes to three or four of the questions, 2,029 � or 22% � were referred for mental health treatment, the report says. The Army and Air Force referred about 23% of their personnel who answered the questions positively; the Navy referred 18%; the Marines 15%.

So what we have is a situation where over 9,000 soldiers are reporting that they experience nightmares, persistent memories, feeling numb and a constant guardedness, in some combination of three. Somehow, 78% of these folks are being sent home to their families and civilian lives.

Now there are a couple of things that we know. First, the signs of PTSD may take months to truly surface. Second, the DSM IV definition of PTSD requires that only one of five different possible symptoms be present. Therefore, the screening process is most likely missing some suffering vets because it is too early for some signs to show up, and despite the fact that the screening process appears to be more rigid than one employed by civilian doctors fewer soldiers are being referred for further evaluation.

What is also clear is that the Veterans Administration has done an admirable job of improving their resources for PTSD treatment. The National Center for PTSD, the VA's department for caring for soldiers and their families affected by PTSD, is better suited than perhaps anywhere else for dealing with the particulars of combat-related stress disorders.

This information makes the GAO's report all the more troubling. Should we not be airing on the side of caution, to the benefit of our servicemen and women. We have already seen how untreated stress disorders can have catastrophic reverberations. This cannot be an issue of dollars and cents. We owe the men and women who serve our country the best. Somewhere there is a disconnect right now, and for their benefit, we need to eliminate it.

Comments
Regarding Post Deployment Health Evaluations:1) The referral rate is a problem perhaps, however I would bet a fair proportion of those who answered the positive questions were further screened by a provider and only those who met further criteria AND agreed to cooperate with referral were referred. I've personally done hundreds of these, and sadly the ones that need referral the most are the ones most resistant to referral (and visa versa - folks looking for a disability and a ticket out are eager to be referred).2) If you have been away for a year, and you can't be released to get home until your referral is completed, are you going to own up to stuff that will be viewed by some of your buddies as demonstrating weakness AND delaying getting home?3) Community/DOD and VA psych resources are not adequate to meet demands. Look at the PTSD problems after Katrina, and imagine whatever the next large scale disaster (natural, man-made or terrorist induced) will do to our inadequate mental health system.
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Posted by: epador 5/23/2006 4:19:27 AM
I am a veteran and so is my boyfriend whom I have been living with for almost a year. While we were still in Iraq, we both filled out the assessments. My boyfriend was given a referall to mental health for PTSD having shown almost all the symptoms before even leaving country. He left the base after we came home from Iraq with a referral. After several months trying to get in the VA healthcare system, he attempted to commit suicide while I was out of town. Within a few months he was finally in the system. Unfortunately, their idea of treatment involved lithium without regularly testing his blood levels to make sure he was taking the right amount. When he started having memory loss, they didn't follow up when he missed appointments with his psychiatrist. Eventually he asked to be put in an inpatient program so he could focus and be in a controlled environment so he couldn't hurt himself, other people, and his medicine and therapy would be monitored. He was discouraged from doing that due to the wait lists instead of at least being placed on a wait list. Within weeks, he lost it and went to the VA Emercency Room to check himself in because he felt strongly that he was dangerous and couldn't control himself "out there". Again he was discouraged and after about 6 hours they put him in a psych ward for 3 days, not allowing visitors or smoking by himself. There was no treatment or therapy for PTSD, rather he was told he had to play BINGO where he talked to a man who told him he was there because he killed a bunch of kids in Vietnam and was very mentally ill. Not the greatest type of intervention. After 3 days he was released under the conditions that he report to an inpatient program 8 hours away within two days. After traveling there, he was again told that he would have to wait (now with nowhere to live, no phone, no car, and no money with a major change to his medication made that day). After being there for over a week trying to get in I contacted my State Reps caseworker about it. Two hours later he was directed to go to a different VA hospital altogether where he could be in the next day. After all of this runaround, finally he is there, though still waiting to collect disability to pay the bills his ventures for treatment and inability to work have caused. It's so sad to know that every soldier is nothing but a statistic or a number on a waiting list.

Posted by: Rachel McNeill 10/24/2006 7:30:48 AM