Is the US Doing Enough for Veterans With PTSD?

By Martha McLaughlin

PTSD pillsPost-traumatic stress disorder (PTSD) is estimated to affect seven to 12 percent of Americans.1 Multiple factors influence the rate of PTSD among military personnel, with lifetime rates above 30 percent for certain populations.2 In an attempt to better address the issue, a study was recently released which examined how well the Military Health System (MHS) meets the needs of patients suffering from PTSD or depression.3

Strengths and Weaknesses of the Current System

Study authors noted a number of things that the Military Health System does well. The MHS was found to have high rates of screening for suicide risk and substance use. Most patients were found to have received psychotherapy, which was also noted as a strength. In addition, the MHS was determined to be strong in following up with patients after a psychiatric hospitalization.

Weaknesses were also found. The study determined that many patients received an inadequate amount of initial care when they began treatment for PTSD or depression.

Also, the provided psychotherapy wasn’t always evidence-based and that there was a lack of appropriate follow-up for patients at high risk of suicide. Coordination of care was noted as a concern, as well as the disparity in quality of care as related to service branches, geographical regions and patient characteristics.

How to Improve

The report wasn’t merely a critique, it also outlined several recommendations for improving the quality of care:

  1. Focus on specific care processes. The authors suggest that procedures be put in place to ensure that service members, when they begin treatment, receive it in adequate intensity and with sufficient follow-up. Only 36 percent of patients with PTSD and 25 percent of those with depression were found to have received adequate initial care in the first eight weeks after diagnosis. Adequate care was defined as receiving either four psychotherapy or two medication management visits. Less than half of the patients studied (45 percent for PTSD patients and 41 percent for depression patients) received a medication management visit within 30 days of starting a new medication. The report also suggests implementing a plan to study, monitor and improve patterns of medication prescribing.The authors stress the importance of adequate follow up for patients at risk of suicide. Only 30 percent of depressed patients found to be at risk received appropriate follow-up care. This includes an assessment of the patient’s plan and ability to carry it out, a referral or future appointment and a discussion of limiting access to lethal means of self-harm when necessary.
  1. Routinely assess the quality of psychological healthcare. Currently there is no coordinated system for monitoring both direct and purchased care, and the study notes that these measures could become part of a system that addresses multiple health conditions. Assessment requires reporting of quality measurements, which, the study suggests, could be required under contracts with purchased care providers.The authors recommend both external and internal reporting, with the internal reporting being broader and more descriptive or explanatory. In 2016, an online public reporting system was launched by the MHS and Defense Health Agency which tracks patient safety, satisfaction and access to care, along with care outcomes and quality. The authors note that psychological health measures could be added to the one outpatient and two inpatient measures now included. For quality improvement, the report suggests incentives, which might include monetary rewards for administrators and providers, special recognition  or additions to the discretionary budget.
  1. Monitor and use treatment outcomes. Currently, symptom monitoring for PTSD and depression is mandated by policy, but information which is part of the behavioral health data portal (BHDP) is not electronically linked to the medical record, so the report suggests increased integration. It also suggests determining how care providers are using the information and making sure that the data collected becomes part of treatment planning and adjustment. Although the authors commend the goal of assessing psychological health outcomes through the BHDP, they note that it has a few limitations, including that data is not collected if patients don’t return to specialty behavioral health care departments associated with military treatment facilities or if they receive their care in primary care clinics.
  1. Investigate the variations in quality of care. The study states that quality of care was found to vary significantly among service branches, regions and patient populations. The authors recommend studying disparities in an attempt to eliminate them. They note that the first step is to collect necessary data.

Whether in the military or civilian population, it is important to take PTSD seriously. Addressing it thoroughly and in as timely a manner as possible is wise. Fortunately, PTSD is treatable, and people who have been affected can regain their peace, stability and quality of life.

1 Norris, Fran H. and Laurie B. Slone, “Understanding Research on the Epidemiology of Trauma and PTSD.” PTSD Research Quarterly, Vol. 24, No. 2-3, 2013.

2PTSD: A Growing Epidemic.” NIH Medline Plus, Winter 2009.

3 Kimberly A. Hepner, et al. “Quality of Care for PTSD and Depression in the Military Health System.” RAND Corporation, 2017.