The Pentagon and VA are not ready for a potential flood of war-related post-traumatic stress disorder among troops and veterans, particularly from the Iraq and Afghanistan conflicts, a panel of leading scientists report in a study released Friday.
"We are at the cusp of a wave of PTSD," says Sandro Galea, a physician, epidemiologist and professor at Columbia University who chaired the committee of 16 experts for the Institute of Medicine, the health arm of the National Academy of Sciences.
The committee, directed by Congress, spent four years producing a 300-page report on how the Defense Department and the Department of Veterans Affairs handle PTSD.
"We greatly appreciate and respect the extensive scientific review and insights of the Institute of Medicine committee," says Robert Jesse, the VA acting undersecretary for health. "We will address these recommendations."
The Pentagon issued a statement acknowledging "critical gaps" and said corrective steps are being taken.
A key failure cited by the committee is delay in treating those who need therapy, a central element of the current wait-time scandal that led to the May 30 resignation of VA Secretary Eric Shinseki.
The scientists cite data showing dramatic growth in the mental illness after 13 years of war, with numbers of soldiers and Marines who returned from war with PTSD increasing tenfold between 2004 and 2012.
Slightly fewer than 200,000 Iraq and Afghanistan veterans were found to have service-connected PTSD in 2003. By last year, that number had surpassed 650,000, the report says. And many of those veterans were not seeking treatment at the VA.
There are about 22 million veterans in American, of whom 2.2 million served in Iraq and Afghanistan.
While applauding some of the initiatives taken by the Defense Department and the VA in dealing with PTSD, the scientists say both agencies show inconsistent and sometimes poor practices in helping patients.
"We still do not have a PTSD system that is delivering high-quality care for all service members and veterans," Galea says.
Neither department systematically tracks whether servicemembers or veterans are improving after receiving therapy. In some cases, counseling is delayed, interrupted or cut short. Without data on success or failure rates, improving overall care is not possible, the report says.
"To deliver high-value health care, an organization must be able to determine patient outcomes," the report says. "However, neither DoD nor VA is in a position to do that."
Army Lt. Col. Catherine Wilkinson, in a response from the Pentagon, said all service branches were directed last September to begin collecting data on how troops improve while in therapy for PTSD, anxiety and depression. She said the RAND Corp. has been asked to survey military hospitals on the quality of their counseling.
The science panel, in the report released Friday, noted that great sums of money are being spent. Congress has authorized $900 million for mental health and traumatic brain injury care. The Pentagon expenditures on PTSD grew from $30 million 2004 to nearly $300 million in 2012. The VA spent more $3 billion treating the illness in 2012, including $673 million on Iraq and Afghanistan veterans.
Much of the money goes to private-sector counselors, because neither agency can handle all their patients, but the qualifications of these contracted therapists are not evaluated, the report says.
Other problems cited:
• One-third of VA hospitals and clinics report mental health staffing that is inadequate. Patients wait an average of nearly eight weeks to see a VA counselor for PTSD and 2½ months to get into intensive treatment programs.
• The percentage of the VA research budget devoted to PTSD has declined in recent years from 32.4% in 2010 to 24.6% in 2013.
• Communication between VA and Pentagon mental health leaders and clinicians is so poor that it "can lead to duplicative, expensive, ad hoc and perhaps ineffective programs and services while other programs that may be effective languish or disappear."
• Veterans are not getting a full round of counseling. The VA reported that in 2013, only 53% of Iraq and Afghanistan veterans in therapy received the standard-of-care minimum of eight sessions in 14 weeks.