A recent report released by the Institute of Medicine (IOM), calls into question the care provided to veterans by the Department of Defense (DoD) and Department of Veteran Affairs (VA). The study, headed by Professor Sandro Galea, examines the treatment provided to victims of Post-Traumatic Stress Disorder (PTSD). PTSD is an anxiety disorder caused from experiencing traumatic events. It can cause insomnia, depression, hyper-vigilance and paranoia, chronic anxiety, and a variety of other symptoms.
The Spending Statistics
Currently, 5% of all U.S. veterans report suffering from PTSD. That number increases to 8% when veterans from the Iraq conflicts are examined. Over half a million veterans came to the VA for PTSD care in 2012, a number which is expected to increase. The DoD and VA have spent $9.3 billion on PTSD treatments for veterans from 2010-2012, with an estimated $3.3 billion spent annually.
If the demand for treatment continues to rise at the current rate, PTSD treatment cost for the DoD alone will rise from the $294 million spent in 2012, to more than $500 million in 2017. The report mentions that these figures may actually “underestimate the incidence and prevalence of PTSD, [but] they demonstrate that action is needed to respond to this growing problem."
The DoD and VA emphasize that PTSD is one of the biggest health issues affecting veterans, and according to the IOM study, “both departments have made a sustained commitment to PTSD management and invested substantial financial and programmatic resources to provide care to service members and veterans."
However, the 300 page report details numerous criticisms concerning the implementation of this care. Dr. Galea stated that “neither the DoD nor the VA has a system that documents patients' progress and uses standardized instruments to chart long-term treatment." Many treatments are reported as being “local, ad hoc, incremental, and crisis-driven, with little planning devoted to the development of a long-range approach to obtaining desired outcomes."
As PTSD is treated by Cognitive Behavioral Therapy over a series of many psychiatric sessions, documenting the progress and effectiveness of this long-term treatment is integral to ensuring that veterans are improving. While the VA and DoD both have electronic health record systems, neither of these are used to track progress of PTSD care. As a result, while PTSD treatment in the VA and DoD may be highly effective, there is no way to know which programs are working and which ones aren't.
How Will This Change the Future of PTSD Care?
The IOM assessment contains more than just questions concerning the effectiveness of PTSD care: it also includes comprehensive recommendations for improving the effectiveness of these health care systems, with a focus on implementing clinical standards and documentation.
Both the DoD and the VA have already responded to the report, with spokeswoman Cathy Wilkinson stating that "[the organizations] are already taking practical steps to address many of these issues." Dr. Galea remained optimistic, stating that the report will help the DoD and VA “respond more strategically and effectively to the increasing prevalence of PTSD among U.S. service members and veterans."
Date of original publication: June 25, 2014.
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Washington, DC: The National Academies Press. Treatment for posttraumatic stress disorder in military and veteran populations: Final assessment. IOM (Institute of Medicine), 2014.