The RAND Corporation recently put out a new study on mental health services for members of the military, and the results may not have been surprising but they should certainly be sobering to all Americans. Traumatic brain injury (TBI) is known as the “signature wound” of the War on Terror, and its link to PTSD, mental and physical health issues, and even suicide have been well documented. But if TBI is the signature wound of the War on Terror, it must be asked whether or not military personnel are being properly screened, diagnosed, and treated.
Sadly, it seems there is a lot of room for improvement with no time to waste.
Military mental health care providers were surveyed for the RAND study, and though only about half of eligible providers responded to the survey, it gives a glimpse into the mental health services being provided to military personnel. The main objectives of the study were to find how well health care providers were adhering to the government’s guidelines on treating mental health issues — particularly post-traumatic stress disorder (PTSD) and major depressive disorder (MDD) — and what barriers or obstacles were standing in the way of better treatment.
What the study concluded was that improvements must be made for service members’ mental health care. Some obvious gaps were found in mental health care at military treatment facilities, along with a few red flags that could require a much closer look. These included time spent with patients, continued monitoring for mental health issues, the amount and type of medications that service members were prescribed, and training for health care providers in mental health treatment options.
Treatment and Medication
While nearly three-fourths of health care providers surveyed said they routinely screen patients for PTSD and MDD, only about half actually monitored their patients’ progress and treatment for the same conditions over time. While this means that a lot of service members experiencing PTSD, MDD, or other traumatic brain injury related symptoms are being diagnosed, many may not be getting the help they need where routine monitoring and follow-up is not being performed. Correctly diagnosing a condition is only the first step in a long road to recovery, and treatment cannot start and end with just a diagnosis and hope for the best.
Another troubling finding from the RAND study was the amount of medication being taken by service members at military health facilities. Reportedly, nearly a quarter of patients with PTSD were prescribed four or more medications. More than 80 percent were prescribed at least more than one medication. Eleven percent of the service members were said to be prescribed medications that were known to be potentially harmful to patients with PTSD by VA/DoD clinical practice guidelines.
More Training Needed
Patients with PTSD or MDD aren’t the only ones getting the short end of the stick under current military health care, though. Of the 520 military health care providers in the study, more than a quarter of health care providers said that travel and time restrictions “affected their ability to access additional professional training.” That is a troubling find, since physicians need to have the proper training in order to treat their patients.
“The PTSD psychotherapy with the highest provider confidence level was cognitive processing therapy,” the RAND study found, but “fewer than half of providers felt ‘very confident’ in their ability to deliver it.”
Travel and time were also a factor in providing treatment and simply seeing patients, the study also found, with less than half of the health care providers reporting that they can see patients on a weekly basis. Most military health facilities were only able to see and treat patients with PTSD every other week or even less often.
The RAND study is not new information to most in the military, veteran, or medical fields, but it does give new numbers and more concrete evidence that there are gaps and red flags in the military’s treatment of mental health issues. The RAND study recommended that military health facilities adopt “a systematic, broad-based approach to training and certification in guideline-concordant therapies, and track provider progress; and reduce barriers to receiving training in guideline-concordant therapies.”
In short, our service members in each branch need more access to better mental health care — not next year, not next month, but today.