Much Room for Improvement in PTSD Care, Report States

“The Departments of Defense and Veterans Affairs must rapidly improve prevention, diagnosis, and treatment of both posttraumatic stress disorder and traumatic brain injury,” said a presidential commission on the care of wounded service members. “The VA should provide care for any veteran of the Afghanistan and Iraq conflicts who has PTSD, and both departments must work aggressively to reduce the stigma of PTSD.”

The President's Commission on Care for America's Returning Wounded Warriors was co-chaired by former Sen. Bob Dole, a wounded World War II veteran, and Donna Shalala, president of the University of Miami and former secretary of Health and Human Services. The commission was established in the wake of revelations by the Washington Post of poor treatment and bureaucratic delays at Walter Reed Army Medical Center earlier this year. Dole and Shalala discussed the commission's report to the president, titled “Serve, Support, Simplify,” at a news conference on July 25.

Only six of the 35 steps suggested by the panel require congressional action, said the commissioners. The others could be implemented by action within either or both of the cabinet departments.

The commission also recommended more support for the families of wounded veterans, better coordination of information between the two departments, a restructuring of disability and compensation systems, and comprehensive recovery plans for each patient.

The commission noted that while the VA had experience treating combat-related PTSD, “knowledge generated through research and clinical experience is not systematically disseminated to all DoD and VA providers of care.”

“Laudable” efforts to prevent or diagnose psychological symptoms have overextended the capacity of both uniformed and VA mental health personnel, they said. Professionals in the armed services have been leaving at the end of their enlistments, and not enough new personnel have been entering the services, especially the Army. Attrition of Army psychologists increased 55 percent between 2004 and 2006, for instance. VA hospitals in isolated areas are also having a hard time recruiting professionals, a problem worsened by shortages in the civilian sector as well.

The commission echoed the findings and recommendations of other investigations and task forces, many of which seem to have gone“ nowhere,” according to an interview on National Public Radio with Harry Walters, who is a a former assistant secretary of the Army and served on one of those commissions.

Like the Department of Defense's recent mental health task force (Psychiatric News, June 15), the Dole-Shalala commission called for reducing stigma about mental health within the armed services. Many troops who spoke to the commission said they feared that reporting psychological symptoms would harm their careers or delay their return home.

More than 2,700 service members have sustained a traumatic brain injury preventing a return to duty within 72 hours, according to the commission. The Department of Defense and the VA should work together to disseminate or develop practice guidelines for traumatic brain injury and PTSD to all providers and train military leaders, medical personnel, troops, and family members to understand these conditions.

The commission also recommended development of “a patient-centered recovery plan for every seriously injured service member.”

Furthermore, each patient should be assigned a trained recovery coordinator to serve as an advocate to move the patient through the military and VA medical systems and to serve as a point of contact for families. The commission said that 20 to 30 coordinators would be needed to deal with the approximately 3,100 troops seriously wounded so far in Iraq and Afghanistan.

Finally, the commission recommended creation of a personal Web page to let each service member track benefits and confidential health records and make appointments. Current online information is “disparate, confusing, and cumbersome,” said the commission, and would benefit by a unified approach from both the Department of Defense and the VA.

Further information about the President's Commission on Care for America's Returning Wounded Warriors is accessible at<www.pccww.gov>. The commission's report, “Serve, Support, Simplify,” and reports from its subcommittees can also be accessed at this site. ▪