Many troops with PTSD aren’t treated

Troops with PTSD fail to be treated

Advocates blame stigma, lack of access
By Kelly Kennedy - Staff writer
Posted : Monday Apr 14, 2008 6:08:51 EDT

Post-traumatic stress disorder experts say service members aren’t seeking care, aren’t getting enough time to recover between deployments and aren’t receiving medications or therapies that are known to be effective.

“Problems related to getting troops adequate mental health treatment cannot be resolved unless two issues — stigma and access — are addressed,” Todd Bowers, director of government affairs for Iraq and Afghanistan Veterans of America, told the House Veterans’ Affairs subcommittee on health on April 1.

Almost 59,000 veterans of the wars in Iraq and Afghanistan have been diagnosed with PTSD by the Department of Veterans Affairs. Army post-deployment health assessments have found that 20 percent of active-duty and 40 percent of reserve-component troops had symptoms of PTSD, and some experts say the real numbers could be much higher.

But because PTSD hasn’t been addressed until fairly recently — the first scientific paper about the disorder in veterans of the 1991 Persian Gulf War didn’t come out until five years after that war ended — VA and Pentagon officials say much needs to be done to determine good screening techniques and therapies.

“This is the first war where DoD and VA recognized the psychological impact going in,” said Army Col. Charles Hoge, chief of psychiatry and neuroscience at the Walter Reed Institute of Research.

He told the American Legion on March 31 that he must “look through a completely different lens” from that used by therapists treating civilians with PTSD.

Combat vets are not sleeping, experience startle reactions and are hyper-alert.

“All of these things that we label as symptoms are things they need in combat,” Hoge said. “No sooner are they transitioned back home than they’re right back in rotation.”

At the House hearing, Hoge said an Army assessment last summer showed that the numbers of soldiers with PTSD is going up with each deployment.

“There’s a direct connection between mental health and multiple deployments,” he said, adding that troops also need more time between deployments.

In the meantime, research on good treatments and screening measures must improve, experts say.

David Matcher, of the Institute of Medicine’s Committee on Treatment of Posttraumatic Stress Disorder, said a recent study found that research has not shown serotonin re-uptake inhibitors, such as Prozac, Zoloft or Celexa, to be effective in treating PTSD.

Exposure therapy — reliving a traumatic experience by writing or talking about it — is the only therapy proved effective by independent research, he said.

Other treatments exist, but they have been tested mainly by the same people who developed them. This doesn’t mean those therapies don’t work — they just have not been proved independently. That’s an important point because the Defense Department and VA use several such methods, including group and drug therapy, to treat combat veterans.

“Our overall message here is that PTSD needs more attention from high-quality research,” Matcher said.

Hoge called the Army mental health report last summer “pretty sobering” news in another area: There are not enough therapists in Iraq to help U.S. troops in theater.

And that problem is not limited to the Iraq war zone. In a recent interview, Army Col. Terry Walters, commander of Womack Army Medical Center at Fort Bragg, N.C., said finding mental health workers continues to be a problem, in part, because of a contracting process that allows for only a one-year stint.

“We are on a one-year budget cycle by Congress,” she said. “If I could offer you a five-year contract, I could probably get you here.”

Walters said Womack has been short three psychiatry positions for more than a year, and she has begun hiring psychologists to fill government service positions she created herself. “I have basically put myself out on a fiscal limb and said I’m going to hire these people permanently,” she said.

As the 82nd Airborne Division begins returning from combat in a few months, it will bring a “tsunami” of mental health needs home with it, Walters said.

“We don’t have enough for surges,” she said. “We are OK on behavioral health, but we’ve had to ask for help, we’ve had to go downtown, we’ve had to screen all the consults and go, ‘Is this just a routine kind of consult for medication? I’ll send that one downtown.’ ‘This guy is really in crisis, he needs to be [taken care of now].’ So it’s a triage process.”

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