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Fall 2014 Vol. 14 Number 1

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Improving Treatment Programs for PTSD

For many service members who were deployed to Afghanistan and Iraq, an internal battle continues in the form of post-traumatic stress disorder (PTSD). From 2003 to 2012, the overall number of veterans who sought care for PTSD at the VA more than doubled -- from approximately 190,000 veterans to more than a half million. An estimated 5 percent of all service members in the military health system, and 8 percent of those who have served in Afghanistan and Iraq, have been diagnosed with PTSD.

The U.S. Department of Defense and the U.S. Department of Veterans Affairs have responded to this rising tide with a multitude of programs and services to prevent, screen for, diagnose, and treat current and former service members who have PTSD or who are at risk for it. Although the departments are making strides in a positive direction, their treatment programs appear to be local, ad hoc, incremental, and crisis-driven, with little planning devoted to the development of a long-range approach to obtaining desired outcomes, says a recent report from the Institute of Medicine.

The report calls for both departments to develop a coordinated and comprehensive strategy to track outcomes of their treatment efforts. Without tracking outcomes, neither DOD nor VA knows whether it is providing effective or adequate PTSD care, for which they spent $294 million and more than $3 billion, respectively, in 2012.

"Given that the DOD and VA are responsible for serving millions, we found it surprising that no PTSD outcome measures are used consistently to know if these treatments are working or not," said Sandro Galea, chair of the committee that wrote the report. "They could be highly effective, but we won't know unless outcomes are tracked and evaluated."

The report also recommends that DOD and VA have an adequate workforce of mental health care providers to meet the growing demand for PTSD services. While the departments have substantially increased their mental health staffing, the pace has not kept up with the demand. Such staffing shortages can result in clinicians not having time to provide evidence-based psychotherapies readily. In 2013, only 53 percent of veterans of the Afghanistan and Iraq conflicts who had a primary diagnosis of PTSD and sought care in the VA received the recommended eight sessions within 14 weeks.

-- Jennifer Walsh & Sara Frueh

Treatment for Post-Traumatic Stress Disorder in Military and Veteran Populations -- Final Assessment. Committee on the Assessment of Ongoing Efforts in the Treatment of Post-Traumatic Stress Disorder; Institute of Medicine (2014, 300 pp.; ISBN 978-0-309-30173-4; available from the National Academies Press, tel. 1-800-624-6242; $57.00 plus $5.00 shipping for single copies).

The study was chaired by Sandro Galea, professor and chair of the department of epidemiology, Mailman School of Public Health, Columbia University, New York City. The study was sponsored by the U.S. Department of Defense. The report is the second of a two-phase assessment of PTSD services for service members and veterans.

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