GAO REPORT:  MANY WAR VETS' STRESS DISORDERS GO UNTREATED --

ONLY 22% OF TROOPS EXHIBITING PTSD SYMPTOMS ARE

REFERRED FOR TREATMENT -- VA BLAMES DoD --

PROJECT SEAMLESS TRANSITION IS NOT WORKING

Given recent reports about DoD and VA's miserable handling of Project Seamless Transition, this should come as no surprise.

Seamless Transition is supposed to make the move from military healthcare to VA healthcare as smooth as possible.

It isn't working!

Background:  VA underestimates number of PTSD cases... http://www.vawatchdog.org/old%20newsflashes%20MAY%2006/newsflash05-03-2006-6.htm

Background:  VA official says mental health care "virtually inaccessible"... http://www.vawatchdog.org/old%20newsflashes%20MAY%2006/newsflash05-06-2006-3.htm

Now we find that DoD is not referring those who need help.  The VA is blaming DoD for not performing their part of the Seamless Transition program.

But, what difference would that make?  The VA doesn't have the necessary staff to treat those who would be referred.  Blame poor planning and chronic underfunding.

We have the GAO report, then a story from the Washington Post.

Full GAO report here... http://www.gao.gov/new.items/d06397.pdf

Highlights of GAO report here... http://www.gao.gov/highlights/d06397high.pdf

Highlights of GAO report below:

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POST-TRAUMATIC STRESS DISORDER

DOD Needs to Identify the Factors Its Providers Use to Make Mental Health Evaluation Referrals for Servicemembers

Why GAO Did This Study

Many servicemembers supporting Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) have engaged in intense and prolonged combat, which research has shown to be strongly associated with the risk of developing post-traumatic stress disorder (PTSD). GAO, in response to the Ronald W. Reagan National Defense Authorization Act for Fiscal Year 2005, (1) describes DOD’s extended health care benefit and VA’s health care services for OEF/OIF veterans; (2) analyzes DOD data to determine the number of OEF/OIF servicemembers who may be at risk for PTSD and the number referred for further mental health evaluations; and (3) examines whether DOD can provide reasonable assurance that OEF/OIF servicemembers who need further mental health evaluations receive referrals.

What GAO Found

DOD offers an extended health care benefit to some OEF/OIF veterans for a specified time period, and VA offers health care services that include specialized PTSD services. DOD’s benefit provides health care services, including mental health services, to some OEF/OIF veterans for 180 days following discharge or release from active duty. Additionally, some veterans may purchase extended benefits for up to 18 months. VA also offers health care services to OEF/OIF veterans following their discharge or release from active duty. VA offers health benefits for OEF/OIF veterans at no cost for 2 years following discharge or release from active duty. After their 2-year benefit expires, some OEF/OIF veterans may continue to receive care under VA’s eligibility rules.

Using data provided by DOD, GAO found that 9,145 or 5 percent of the 178,664 OEF/OIF servicemembers in its review may have been at risk for developing PTSD. DOD uses a questionnaire to identify those who may be at risk for developing PTSD after deployment. DOD providers interview servicemembers after they complete the questionnaire. A joint VA/DOD guideline states that servicemembers who respond positively to three or four of the questions may be at risk for PTSD. Further, we reviewed a retrospective study that found that those individuals who provided three or four positive responses to the four PTSD screening questions were highly likely to have been previously given a diagnosis of PTSD prior to the screening. Of the 5 percent who may have been at risk, GAO found that DOD providers referred 22 percent or 2,029 for further mental health evaluations.

DOD cannot provide reasonable assurance that OEF/OIF servicemembers who need referrals receive them. According to DOD officials, not all of the servicemembers with three or four positive responses to the PTSD screening questions will need referrals for further mental health evaluations. DOD relies on providers’ clinical judgment to decide who needs a referral. GAO found that DOD health care providers varied in the frequency with which they issued referrals to OEF/OIF servicemembers with three or more positive responses; the Army referred 23 percent, the Marines about 15 percent, the Navy 18 percent, and the Air Force about 23 percent. However, DOD did not identify the factors its providers used in determining which OEF/OIF servicemembers needed referrals. Knowing the factors upon which DOD health care providers based their clinical judgments in issuing referrals could help explain variation in the referral rates and allow DOD to provide reasonable assurance that such judgments are being exercised appropriately.

What GAO Recommends

GAO recommends that DOD identify factors that its providers use in issuing referrals for further mental health evaluations. DOD concurred with GAO’s recommendation, but disagreed with GAO’s finding that DOD has not provided reasonable assurance that servicemembers who need referrals for further mental health evaluations receive them. DOD identified factors that may affect referrals, but did not provide data on how its providers apply these factors. VA concurred with the facts related to VA in the report.

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Washington Post story here... http://www.washingtonpost.com/wp-dyn/content/article/2006/05/10/AR2006051002195.html

Washington Post story below:

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GAO: Few Troops Are Treated for Disorder

Post-Traumatic Stress Risk Gauged

By Shankar Vedantam
Washington Post Staff Writer
Thursday, May 11, 2006; Page A08

Nearly four in five service members returning from the wars in Iraq and Afghanistan who were found to be at risk for post-traumatic stress disorder (PTSD) were never referred by government clinicians for further help, according to a Government Accountability Office report due for release today.

The report says Defense Department officials were unable to explain why only some troops were referred for help. Many veterans groups have accused the government of playing down the risk of PTSD because of concerns over skyrocketing costs.

Service members were determined to be at risk for PTSD, a serious psychiatric disorder characterized by disruptive memories and anxieties following traumatic episodes, if they gave three or more positive answers on a screening questionnaire asking whether they had nightmares about frightening experiences, had avoided situations that reminded them of such events, were constantly on guard, or felt numb or detached from everyday life.

In all, 9,145 of 178,664 service members who took the screening test were found to be at risk. Of those at risk, 22 percent were referred for help. The Army and Air Force each referred 23 percent of those at risk, the Navy 18 percent and the Marines about 15 percent, according to a draft of the report obtained by The Washington Post.

The final report will have the formal responses from the Defense and Veterans Affairs departments. In the draft report, Pentagon officials are quoted as saying that not all service members who gave positive responses on the screening test needed help, but the report said the officials could not specify what factors are involved in referring some people but not others.

Asked to comment late yesterday, the Defense Department said only that it has "several comprehensive and proactive programs to deal with PTSD." Spokeswoman Cynthia Smith said the most knowledgeable officials were not available so late in the day.

"You would think that [referrals for treatment] would be the point of the whole screening tool," said Veterans Affairs spokesman Jim Benson. He said that the Defense Department was solely responsible for administering the screening test and making referral decisions.

The questionnaire is given to returning service members as part of a post-deployment health assessment. Veterans Affairs and Defense Department experts jointly determined that three or more positive answers indicate a risk of PTSD, according to the report.

After the questionnaire is completed, the responses are reviewed by a Defense Department health-care provider, who interviews the service member and decides whether to make a referral for a thorough mental health evaluation, the report said. Providers range from physicians to medical technicians.

Deciding whether to refer service members for help involves judgment, the report said, but the Defense Department "cannot provide reasonable assurance that all [Iraq and Afghanistan] service members who need referrals for further mental health or combat stress evaluations receive such help."

Rep. Michael Michaud (Maine), the ranking Democrat on the House Veterans' Affairs subcommittee on health, said screening service members for PTSD was the right thing to do, but questioned the utility of the screening if people at risk did not receive help.

"When 78 percent of the service members who are at risk of developing PTSD do not get a referral for further evaluation, then it's clear the assessment system is not working," he said in a statement. "Early assessment can prevent tragedy. Untreated PTSD can lead to substance abuse, severe depression and even suicide."

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Larry Scott

(go back to VA Watchdog dot Org Home Page)

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