By Gregg Zoroya
February 18, 2016
The U.S. military is struggling to provide adequate therapy sessions for thousands of active-duty troops suffering from post-traumatic stress disorder and depression, a massive study released Thursday concludes.
The RAND Corp. study of 40,000 cases, the largest ever, found that only a third of troops with PTSD and less than a quarter who are clinically depressed receive the minimum number of therapy sessions after being diagnosed.
A RAND review of U.S. military and Department of Veterans Affairs treatment guidelines concluded that troops diagnosed with PTSD should receive at least four therapy sessions within eight weeks or at least two sessions to manage newly prescribed medications.
The good news in the study: vast improvement in how the Army and other service branches follow up with inpatient cases of PTSD after servicemembers are released from mental hospital care, a crucial period when many suicides occur.
“We just don’t have enough mental health professionals to meet the demand,” said Brad Carson, acting principal deputy undersecretary of defense for personnel and readiness.
He said the military will turn increasingly to civilian therapists available through Pentagon contracts. Carson also plans to examine the RAND findings "to see ways that we can improve."
Since 2009, the military has increased mental health professionals on staff by 42% to 9,295.
The study examined treatment for a year following diagnoses in 2012. There were 8,286 diagnosed with PTSD, 24,251 with depression and 6,290 suffering from both illnesses.
RAND described the study as the largest independent examination of mental health treatment in the military.
Army research found that one of the most vulnerable periods for suicide by soldiers is during the year after being released from hospital care. The suicide rate for soldiers in this group was 264 per 100,000, far outpacing the national suicide rate of 13 per 100,000 people.
The RAND study shows the military has become more aggressive in treating servicemembers after they are released from in-patient psychiatric care. About 86% of those with PTSD or depression had a follow-up session with a mental health specialist within seven days after being discharged, and the rate jumped to more than 95% for seeing a therapist within 30 days, according to the study.
"This is a very important, high-risk time for these servicemembers," said Kimberly Hepner, a clinical psychologist and lead author of the RAND study. "This is a prime example of where they (the U.S. military medical system) really out-performed all other available data."
She said the military's rate of success in this category was higher than in civilian medical care and the Department of Veterans Affairs.
But the study also shows the military must provide more therapy quickly after a diagnosis of PTSD or depression, Hepner said.
“Are there enough visits at the beginning to give the servicemember a good start at getting effective treatment? And that’s really a key place where we saw that the military health system could improve,” she said.
The RAND study cited a 2014 internal Army medical command memorandum emphasizing the need to see soldiers within 72 hours of being discharged from a hospital. It urges commanders to require a soldier to attend a session if one is missed. It also says no one will be discharged during a weekend or holiday to avoid losing track of follow-up care.
About 2.6 million U.S. servicemembers served in Iraq or Afghanistan from 2001 through 2014. Rates of PTSD among these troops ranged from 4% to 20%, with depression rates ranging from 5% to 37%, depending on the study.
RAND researchers found that the Pentagon could improve how rapidly doctors review the progress of a servicemember who was placed on medication after being diagnosed with PTSD or depression. Only 45% of those with PTSD and 42% of those with depression had their medication progress reviewed within 30 days after diagnosis, which is a proper standard, according to the RAND study.
About 70% of those studied were in the Army, more than 90% of those who had PTSD had been deployed and the average deployment was 20 months. The average profile of a patient in the military with PTSD or depression was a soldier 34 years old or younger, white and married.