The Defense Department and the VA cannot say if their own doctors are successfully treating hundreds of thousands of troops and veterans with PTSD because neither agency is adequately tracking long-term patient outcomes, the Institute of Medicine said Friday.
Combined, the two departments spend $3.3 billion annually on medications and therapies meant to curb or cure Post Traumatic Stress Disorder.
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But physicians at the DoD and Veterans Affairs Department also don’t share with one another information on the medical hits or misses they’ve documented from their differing attempts to ease PTSD symptoms, IOM members claim in a new report.
Those tracking and communications lapses all seem to lead to one question: Do some or most ex-troops with post-combat anxiety eventually get better?
“We are hoping this serves as a clarion call and blueprint to guide where we should be,” said Dr. Sandro Galea, chair of the IOM committee that carried out a Congressionally mandated assessment of PTSD programs at the two departments.
“We found it surprising that no PTSD outcome measures are used consistently to know if these treatments are working or not," added Galea, professor and chair of the department of epidemiology at Columbia University in New York City. "They could be highly effective, but we won't know unless outcomes are tracked and evaluated.”
The IOM, an independent, nonprofit organization, also urged the two agencies to begin collaborating on the health progress of all current and former military members diagnosed with PTSD –- “regardless of where they receive treatment.”
In response, the VA’s Acting Under Secretary for Health, Dr. Robert Jesse, said he and his colleagues “appreciate and respect” the IOM’s exhaustive review, adding the agency "will address these recommendations to better serve and meet the expectations of our veterans."
Defense officials similarly lauded the "thorough assessment," which recognized the resources DoD has devoted to collect symptom severity and PTSD outcome data "at all points of service" by using a series of clinical outcome measures, said Lt. Col. Cathy Wilkinson, a DoD spokesperson for Personnel and Readiness. She added that Defense already "is collaborating" with VA to "identify a common set of outcome measures and quality metrics for monitoring, assessing, and improving the mental health care provided to service members and veterans."
"We agree with the IOM that although great strides have been made, critical gaps remain," Wilkinson said. "We are already taking practical steps to address many of these issues."
During 2012, DoD spent $294 million -– while the VA invested more than $3 billion –- on programs and services “that range in their intensity” to prevent, screen, diagnose, and treat current and ex-service members who have PTSD, or who are at risk for it, the IOM said.
PTSD is the third most common service-connected disability following hearing loss and tinnitus, or ringing in the ears. During 2012, 13.5 percent of U.S. soldiers had a PTSD diagnosis as well as 10 percent of Marines, 4.5 percent of Navy personnel, and 4.4 percent of Air Force members, the IOM noted.
The Congressional Research Service says that between 2002 and Jan. 10, 2014, military doctors diagnosed more than 118,000 American troops with PTSD symptoms, which may include nightmares, fears of crowds and driving, feelings of isolation, lack of trust, sleep deprivation and a chronic feeling of hyper-vigilance.
The IOM also found:
- The Defense Department’s PTSD programs "appear to be local, ad hoc, incremental, and crisis-driven, with little planning devoted to the development of a long-range approach.”
- Leaders within DoD and the service branches “at all levels” are not consistently held accountable for failing to implement programs meant to effectively manage PTSD in troops.
- It’s unclear whether VA hospital administrators around the country follow the agency’s minimum-care requirements for veterans with PTSD.
Kris Goldsmith, 28, who deployed to Iraq in 2005 as an Army forward observer, says he's received very different treatment at two separate military facilities.
In February 2007, Goldsmith, then an active-duty soldier, began receiving mental-health attention at an Army base -– Fort Stewart, Georgia -– for what VA physicians later would identity as severe PTSD, he said.
“I was treated with a certain level of hostility by the (Army) doctors,” Goldsmith said. “They had explicit instructions to either get troops deployable or get them out of the Army.
“The DoD system exacerbated my symptoms,” Goldsmith added. “The lack of treatment I was getting there did lead to my eventual suicide attempt.”
On Memorial Day in 2007, Goldsmith says he ingested a dangerous mix of Vodka and pills. He was found unconscious after a friend noticed he was missing.
These days, Goldsmith attends college on Long Island, New York. For medical treatment, he goes to the Northport VA Hospital. He calls the care there “fantastic.” Unlike the VA facilities assessed by the IOM, doctors at Northport still track his mental health.
“The care there doesn’t have anything to do with the VA system as a whole; that has to do with the individual team I happened to be assigned,” Goldsmith said.
“When I began seeing him, my (VA) doctor, he recognized I was in enough of a crisis that he would skip lunch, and he would stay late so he could treat me. He basically made sure,” Goldsmith said, “that I was safe with myself.”
First published June 20 2014, 8:00 AM