Experts on PTSD in Military Searching for What Works
Publication: Psychiatric News
An Institute of Medicine committee released an initial assessment of treatments for posttraumatic stress disorder (PTSD) July 13 and wasted no time beginning work on the study’s second phase at a meeting in Washington, D.C., August 27.
The new round of information gathering, again chaired by Sandro Galea, M.D., Dr.P.H., a professor and chair of epidemiology at Columbia University, will look at practices and studies under way by the Department of Defense and Department of Veterans Affairs (VA) (Psychiatric News, August 17).
The VA has been conducting a range of research studies on PTSD, as well as other mental illnesses, and coordinating with the Department of Defense to avoid research duplication, Antonette Zeiss, Ph.D., the VA’s chief consultant for mental health services, told the panel.
Working with its National Center for PTSD, the VA has set up mentoring and consultation programs to advise VA clinicians on both clinical and administrative aspects of PTSD care.
An update on PTSD-related neurobiological and epidemiological research conducted by the VA will be presented to the committee later in the year, said Zeiss.
The push to “do something” about mental health problems among military personnel half a decade ago resulted in Congress’s funding many programs of varying substance and quality.
Now it is necessary to sort out which ones are actually effective in helping troops with PTSD symptoms.
However, even defining a “program” isn’t easy, said RAND Corporation health policy researcher Carrie Farmer, Ph.D. There is no master list of such programs within the Department of Defense, for example.
Farmer and her colleagues initially identified 650 entities, which they finally whittled down to 211 programs that fit a working definition of providing “services, interventions, or other interactive efforts to address [the] psychological health” of service members or their families.
These programs were targeted at preventing mental health problems, identifying individuals in need of help and connecting them to care, and providing clinical services.
The present nonsystem has many drawbacks, said Farmer. Programs often began based on someone’s clever idea, rather than on evidence that the approach can be effective.
“Most programs are not collecting data that could be used for outcome evaluation, so it is hard to compare them,” Farmer pointed out. “And it is difficult without needs assessment to see if needs are being met.”
Psychotherapy for PTSD in military populations is a complex, difficult process, Navy Capt. Paul Hammer, MC, director of the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury, told panelists at the Institute of Medicine. “It’s more like chemotherapy than giving a pill for pneumonia.”
DCoE
The Department of Defense is also trying to evaluate its own programs, said Navy Capt. Paul Hammer, MC, director of the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury.
Hammer reiterated the need to measure the outcomes of care for service members and veterans.
“The difficulty is getting everyone on board with agreed measures that are integrated into electronic health records,” he said. He noted that the long-promised interconnection of Department of Defense and VA electronic records was still not a reality.
Also, medical practices in the Army, Navy, and Air Force are governed by the decisions of each service’s surgeon general. Getting the surgeons general to agree on any clinical matter has been a matter of persuasion within working groups at the Pentagon, Hammer said.
Efforts to reduce stigma are bearing fruit after many years, but more progress needs to be shown, he said. He expects that as many senior noncommissioned officers retire, they will seek treatment once they are no longer worried about how entry into mental health care would affect their careers.
At the same time, Hammer also cautioned against overidealizing to troops or the public the capabilities of psychotherapy to treat PTSD.
“We have to come to terms with the fact that exposure-based therapy is really difficult stuff for both the patient and the therapist, too,” he said. “It’s more like chemotherapy than just giving someone a pill for pneumonia.”
Nor are military veterans in the same category as people with serious mental illness, he said. “We have numerous effective treatments, but too many clinicians are working on a chronic mental illness paradigm rather than getting aggressive with treatment.”
Hammer, who served two tours of duty in Iraq, imagined the day when a couple of battle-hardened veterans would be walking across the base, and one would say to the other: “I’m going to see my therapist now.”
“And it wouldn’t matter if it was a psychotherapist or a physical therapist,” he said. 
“Treatment for Posttraumatic Stress Disorder in Military and Veteran Populations: Initial Assessment” is posted at www.iom.edu/Reports/2012/Treatment-for-Posttraumatic-Stress-Disorder-in-Military-and-Veteran-Populations-Initial-Assessment.aspx.
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Published online: 21 September 2012
Published in print: September 21, 2012
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