Government efforts to identify and treat veterans with posttraumatic stress
disorder (PTSD) appear to have succeeded in reaching the vast majority of
returning combat troops affected by the condition, according to a leader in
the veterans mental health care system.
The revelation by psychiatrist Ira Katz, M.D, Ph.D., deputy chief for
patient care services at the Department of Veterans Affairs, that up to 80
percent of veterans with PTSD have been identified and received treatment came
during a congressional hearing before the House Veterans Affairs Health
Subcommittee on April 30.
A 2008 Rand Corporation report stated that an estimated 14 percent (or
132,359 service members, according to Katz) who returned from Iraq and
Afghanistan suffer from PTSD. If that figure is accurate—and some
dispute it as either inflating or underreporting the extent of PTSD—then
veterans health officials have reached a significant number of affected
service members. Records from the VA indicate that through the end of Fiscal
2008, 105,465 veterans had received PTSD care in VA medical centers, clinics,
or Vet Centers, which is about 80 percent of former combatants diagnosed with
"We can be happy about [the high treatment rate], but we're not
satisfied," Katz told Psychiatric News after the hearing about
the need to reach more affected veterans.
Katz said that the apparently large percentage of PTSD sufferers who seek
care indicates that the veterans who really need care are more likely to seek
treatment through the VA system. However, others who follow veterans health
issues have emphasized that many who need psychiatric care have gone
For instance, Rep. Michael Michaud (D-Maine), chair of the House Veterans
Affairs Health Subcommittee, emphasized at the April hearing a key finding on
mental illness from the Rand study, which was that more than half of service
members affected by mental illnesses are not seeking or receiving the care
Michaud and others have expressed some optimism that the VA will further
improve its mental health care, in part, through the dedicated $3.8 billion
approved for mental health care in Fiscal 2009 and a new Uniform Mental Health
Service handbook, which defines standard and minimal mental health care for VA
Adrian Atizado, assistant national legislative director for the group
Disabled American Veterans, praised many VA efforts and the addition of
dedicated funding to improve the care of veterans with mental illness, but
noted that much more work remains. For example, the VA has no way of tracking
the availability throughout its system of labor-intensive, evidence-based
treatments for PTSD. A March report on veterans facilities in Montana by the
VA Office of Inspector General, for example, found "limited
availability" of evidence-based PTSD therapies for veterans in that
Inspector-general reports in Montana and elsewhere "raise concern
that [the amount of labor-intensive, evidence-based treatments] have been
falling, even in the face of evidence that effective services for PTSD require
much greater intensity of services," Atizado told the panel.
Many veterans groups are concerned that inadequate treatment for PTSD and
other serious mental illnesses will continue to be common, despite promises to
treat psychiatric problems among returning warriors aggressively.
Ralph Ibson, a senior fellow for health policy with the Wounded Warriors
veterans group, said that the directors of veterans health care programs
nationwide are facing the end to supplemental funding provided through the
Mental Health Initiative. Funds for this initiative have been approved every
year since Fiscal 2005 to implement the Mental Health Strategic Plan, which
directed the overhaul of the VA's approach to mental health care.
The Obama administration plans to phase out this program beginning in
Fiscal 2010, according to veterans' advocates.
The end to such dedicated mental health funds will likely impact the
quality and availability of care for veterans with PTSD or other conditions
that require time-intensive care, he said.
Although President Obama's proposed Fiscal 2010 budget document, released
in May (see Federal MH Agencies
Win Small Funding Boost), did not directly
address the status of Mental Health Initiative funding, it increased overall
VA mental health funding by 7 percent, to $4.5 billion. Funding for treatment
of traumatic brain injuries increased even more sharply, 16 percent, to $298
The focus on the VA's approach to mental health care and increasing the
percentage of veterans who seek care through that system may, however, leave
some veterans out of the equation. Katz said that the VA's extensive
experience in studying and treating PTSD and other psychiatric problems should
encourage psychiatrists and other mental health clinicians who encounter
patients with service-related psychiatric conditions to refer them to the VA
"Veterans really should come to us" for care, Katz said.
However, veterans' advocates said many returning combatants are not going
to the VA for a variety of reasons, such as lack of accessibility in rural
areas or their preference for using providers identified through an employer's
private insurance plan.
A report in the May Health Affairs concluded that national efforts
are needed to better prepare community health care providers to treat
service-related psychiatric conditions because many veterans rely on private
practitioners rather than the VA for treatment of those disorders.
Information and testimony on VA treatment for PTSD is posted at<http://veterans.house.gov/hearings/hearing.aspx?NewsID=366>.
The Rand study "Invisible Wounds of War: Psychological and Cognitive
Injuries, Their Consequences, and Services to Assist Recovery" is posted