Wednesday, May 28, 2008

Spike in Rates of PTSD in 2007 Iraq Vets and Mental Health Parity

Very important article in today's Chicago Tribune reporting on the significant increase in reported cases of Post Traumatic Stress Disorder in Iraq vets, as reported by Army Surgeon General Eric Schoomaker yesterday:

Nearly 14,000 U.S. service members who had previously served in Iraq and Afghanistan were newly diagnosed with post traumatic stress disorder last year, according to statistics released today by Army Surgeon General Eric Schoomaker.

The detailed figures for the four military services shows about a 46 percent increase in the number of troops diagnosed with PTSD in 2007--a spike that coincided with the most violent year of the Iraq war. Overall, nearly 40,000 have been diagnosed with the illness since 2003, though it is likely many more haven't sought help out of fear of being stigmatized.

Lt. Gen. Schoomaker, the Army's top medical officer, said that the Army needs to improve facilities and has too few mental health care providers.

"I think we can say as a nation that our mental health facilities and access to mental health providers is not adequate to the need right now," Schoomaker said. "So part of the problem that we as a military are suffering is a shared national problem."

This, combined with the recent RAND study indicating that PTSD and depression was being experienced by near 300,000 veterans of Iraq and Afghanistan, makes several points eminently clear:

1) PTSD and depression are serious disorders. For those who do not know, PTSD is a particularly intractable disorder which requires specialized and often long-term treatment. Depression, an often co-occurring illness, also, as is a clinical syndrome that is much more than simply "being sad", and that causes significant impairment in functioning, work, and relationships.

2) VA resources are not sufficient to meet the need of these significant disorders, in those who sacrifice so much for our country,

3) Therefore, for both the above reasons, these veterans are in great need and deserving of the specialized treatment that their sacrifice deserves, and that these disorders require.

4) Current, most health insurance plans do not cover such illnesses on a parity with so called "physical syndromes"--despite the artificial and archaic distinction here, as indicated by MRI and f-MRI scans of patients that indicate physical concomitants to these illnesses. The research is clear--these illnesses exist, have powerful effects on functioning--including the reduce ability to work, and with further consequent effects on national as well as individual wellbeing.

5) Mental Health Parity--meaning that insurance companies should cover such illnesses at the same rate and to the same degree as they cover so called "physical illnesses" is therefore a particularly important issue, as these returning vets face a need for care that is met by a shortage of resources, and an inability to cover the costs of necessary treatment for these serious disorders. Without such parity legislated by Congress, many of these deserving vets, as clearly indicated by Schoomaker's statement, will be unable to receive the treatment needed for the serious injuries that they received during service for our nation.

6) The candidates's positions on the issue of such Mental Health Parity for these injured, sacrificed men and women on behalf of our country are as follows:

Candidate Positions on Mental Health Parity:

McCain: Does not favor mental health parity (note that this is in spite of his generalized image of "supporting the troops")

: Favors mental health parity for specialists who understand how to treat these disorders

Clinton: Favors parity only for "at home services"

The issue of specialists is important here. Many "treatments" for PTSD have consisted only of generalized "talk groups" alone that have not been empirically validated as effective for treatment of the disorder.

There is little point in utilizing a treatment if it has not been demonstrated to be effective. The RAND study strongly emphasizes the use of empirically validated treatments for the disorder.

If we are going to devote our national resources to treating these deserving citizens, we should use the treatments that have been demonstrated to work for this disorder.

Currently, only Obama supports this mental health parity coverage for the necessary and demonstrably effective treatments for this serious disorder, now sharply increasing in our returning vets.