Veterans Affairs: PTSD

 

Introduction

Posttraumatic Stress Disorder (PTSD) is a common mental condition faced by many veterans. Common symptoms that have been identified include sleeplessness, feelings of numbness, loss of interest, nightmares, recurring memories, irritability, and being constantly on guard. The condition disrupts veterans’ lives, and this could lead them to destructive habits such as drug abuse (MTC, n.d.). The United States Department of Veterans Affairs (VA) has healthcare programs that cater to different Veterans’ needs among other services. However, according to a report commissioned by Congress, PTSD treatment among veterans has lacked in various ways (Zarembo, 2014).

Thesis: Veterans Affairs (VA) hospital still does not have effective treatment or services for PTSD.

Number of Soldiers Returning from Iraq and Afghanistan with PTSD

According to a study conducted by New England Journal of Medicine in 2004, 16 % of service members who served in Iraq showed symptoms of PTSD while those from Afghanistan are closely at 17 % (Associated Press, 2004). Another more recent report in 2015 puts the percentage of American veterans from suffering from the condition from Iraq or Afghanistan at 13%. Furthermore, 200,000 of the Vietnam War veterans still experience PTSD (Sifferlin, 2015). Of more concern is that the number keeps rising. TIME reports that between the years 2004 and 2012, the number of troops diagnosed with PTSD rose by 400 %.

A study by the VA is reported to have put the number of veterans diagnosed with PTSD at 247,243 of the 834,463 veterans who served in the Iraqi and Afghanistan war. This is 30 % of the total number, amid accusations by the general public that the VA has been underestimating the number (Reno, 2012). The VA in its defense says that the discrepancies in the figures are as a result of many veterans not seeking medical help.

A more recent study published in the Journal Military Medicine, involving a sampling of 120 service members involved in the Iraq and Afghanistan war showed that 6 % of them had PTSD (Tull, 2017). A study on veterans who served in for different US combat infantry units shows that the source of the PTSD differs. The major causes include being attacked or ambushed, being shot at, seeing dead bodies, and being familiar with a fellow soldier who was seriously maimed or killed.

Effectiveness of VA PTSD Treatment/Services

The two major treatments applied for treatment of PTSD condition are prolonged exposure (PE) therapy and cognitive processing therapy (CPT). PE is targeted at assisting the patients to face their fears and source of stress while CPT focuses on the changing dysfunctional thoughts (Sifferlin, 2015). The US Department of Veterans Affairs classifies these treatments as Trauma-focused Psychotherapies. Eye-Movement Desensitization and Reprocessing (EMDR) is also applied though less common. Other types of trauma-focused psychotherapy identified include Narrative Exposure Therapy (NET), Brief Eclectic Psychotherapy (BEP), Specific Cognitive Behavioral Therapies (CBT), and Written Narrative Exposure. These psychotherapies are recommended according to the patients’ PTSD condition (ptsd.va.gov, n.d.).

Research published in the Journal of the American Medical Association in 2015 revealed what many didn’t expect: that the treatments for PTSD were not as effective as they were thought to be. The statistics to support this report were that only a third of people undergoing treatment were reported to have been cured. The rest, although improved, still had PTSD diagnosis. The extended and repeated trauma makes it difficult for veterans to heal as compared to civilians.

The VA treatment services have however been found to be lacking. It is reported that although 247,243 veterans had been diagnosed with PTSD by 2012, only 56 % of them get disability benefits, leaving 44 % out in the cold (Reno, 2012), the blame was placed on President Obama’s ineffective policies on Veteran Affairs. According to a report published by the Journal Military Medicine involving a study of 120 veterans, only 62 % reported having obtained some mental health care since their return from either Iraq or Afghanistan (Tull, 2017). Of these veterans, about a half of them participate in a briefing or debriefing process. 11 % used some medication, 12 % were involved in a group therapy while 13 % had individual therapy, 10 % went for marital or family therapy, and the least number had treatment for substance abuse problems at 2 %. This data has been interpreted to mean that although many veterans have PTSD, few of them receive the care that they require. It has however been reported as impossible to assess the quality of care (Zarembo, 2014). The reason for this has been indicated to be the lack of consistently collected data by both the VA and the Defense Department. Both departments have been accused of lacking a coordinated system of treatment for PTSD. The Washington Post in 2014 interviewed several VA doctors with a specialization in PTSD on conditions of anonymity. The answers were shocking with the doctors admitting that they were frustrated that the prescription drugs were not effectively helping the suffering patients (Wax-Thibodeaux, 2014).

 

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The Different Types of Counseling Available to Soldiers/Veterans and their Effectiveness

Make the connection website (MTC) differs slightly from the two types of treatment identified for PTSD by TIME, instead, naming counseling and medication as the effective treatments (MTC n.d). Counseling has been found to assist PTSD patients to learn coping techniques and understand their thoughts and reactions. Specific types of counseling have been identified as very effective for treating PTSD (Military.com, n.d.). These include the Cognitive Behavioral Therapy. This is a type of counseling for veterans with PTSD where a therapist assists the patient to comprehend their thought patterns. The objective of the process is to assist PTSD patients to come to terms with their trauma by identifying their source of fear or trauma. In this way, they achieve a sense of control over their fears. The veterans can, therefore, avoid lapsing back into negative thoughts upon the encountering of a trigger. Eye Movement Desensitization and Reprocessing (EMDR) is also another type of therapy used by therapists. The approach used here is the side-to-side movement of the eyes aimed to address the brain differences among the sufferers. The Human Givens therapy has also been identified for cognitive restructuring aimed at doing away with the link between the emotional responses to the trauma. The therapy applies what is known as a rewind technique.

 

The Different Types of SSRIs and their Effectiveness

Selective serotonin reuptake inhibitors (SSRIs) are the main class of medications majorly used for PTSD treatment (MTC, n.d.). Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) are also used though on a lesser scale. These medications fall under the class of Antidepressants and hence treat depression and anxiety. They function by altering the levels of either serotonin or norepinephrine or both, in the brain. These two chemicals are relevant in PTSD treatment because they have the function of brain cell communication and affect emotions. The different types of SSRIs most effective and recommended for PTSD include paroxetine such as Paxil, sertraline such as Zoloft, and fluoxetine such as Prozac. In the case of SNRIs, the most effective is venlafaxine such as Effexor (ptsd.va.gov, n.d.).

To improve the care given to veterans, the US army in 2012, moved to standardize the diagnosis and treatment of PTSD (Vergun 2012). The move is reported to have been aimed at increasing the soldier’s trust in the system of veteran care, as well as ensuring fairness. One of the standardization recommended is the patient-centered care approach. This approach focuses on the patient’s primary concerns to avoid damaging the therapeutic rapport between the doctor and patient. Over 6000 mental health care providers were also trained by 2014 in the field of cognitive processing therapy and prolonged exposure therapy. Despite these efforts, the report said that more needed to be done for the veterans with PTSD (Zarembo, 2014).

Why Veterans Fail to Seek Treatment

Several reasons have been highlighted as to why veterans with PTSD fail to seek treatment. According to Vergun, 2012, some of these reasons include having a negative perception of mental health care, stigmatization, low trust in the military health professionals, among other barriers to care. One of the army’s recommendations is that the professionals should put in all their efforts to advocate for and provide the veterans with the best care in a patient-centered manner. The motive of this step is to reassure the patients that they will be understood instead of being judged harshly and that all their concerns will be taken care of.

In a post by the Los Angeles Times, Zarembo, 2014 reported that billions of dollars are pumped into the treatment of veterans and military service members every year.  In the case of veterans, the government spent 3 billion dollars on the treatment of PTSD in the year 2012 and 294 million more for the service members with the same condition. Despite all these funds, there is little to show for the effectiveness of the healthcare.  This is according to a report commissioned by Congress in 2012. The report is shown to have indicated that the care of veterans with PTSD was not effective at all. It was described as crisis-driven, ad hoc, and incremental (Zarembo 2012).

The Wait-Time for Appointments

In a devastating turn of events, it was reported by the Boston Globe in September 2017 that 35 veterans died while awaiting care. This is according to an investigation by the VA (Estes, 2017). The matter is said to have been so grave that they led to the resignation of VA Secretary Eric Shinseki. Before long, it had become clear that delays were quite common in the majority of the 152 VA hospitals nationwide. According to another report by Hot Air in May 2017, over 100 veterans died while awaiting care at the Los Angeles VA hospital (Shaw, 2017). These deaths occurred in a span of nine months up to August 2015. The delays are reported to have been partly caused by failure to follow procedure on the part of VA employees.

VA Refusal to Endorse New Treatment

In an article by The Washington Post on November 2015, the plight of veterans who need medical marijuana to deal with PTSD was highlighted. Reports show that at the time, veterans were increasingly calling for the government to recognize marijuana as a legitimate treatment for the condition, claiming that it helped them cope with both physical and psychological pain (Wax-Thibodeaux, 2014). Experts have indeed found evidence that cannabis assists in the treatment of PTSD as well as pain. However, the studies are reported to have been inadequate and more research recommended on the best strains. The fact that the federal government classifies cannabis as a schedule I drug puts the VA hospitals in a tight position since they cannot prescribe marijuana as a treatment. The refusal by the federal government to legalize and allow marijuana has been further termed as hypocritical given that the opioids that VA hospitals prescribe for pain are as equally addictive.

Furthermore, as Psychology Today reports, Veterans affairs have demonstrated resistance towards studying of PTSD (Kashdan, 2014). The VA national Centers for PTSD were reported to be ignoring all the evidence on malingering of PTSD in the system. It has, therefore, failed to conduct rigorous research aimed at addressing the concern. Furthermore, it has been found that evidence exists showing that PTSD evaluators are heavily discouraged from the use of forensic measures that might come in handy in the identification of symptoms misrepresentation (Kashdan, 2014).

Frequency of Veterans Being Misdiagnosed

The appropriateness of acute psychiatry was put into question as reported by Smith, 1997. A veteran is said to have been misdiagnosed and treated for depression and suicide feelings instead of the PTSD. Cases have also been reported where doctors provided poor quality care such as in South Carolina, at the William Jennings Bryan Dorn VA Medical Center, where a certain doctor didn’t know giving a spinal injection (Estes, 2017). In yet another failure, anesthetics failed to give patients sufficient anesthesia, leading to operations having to be canceled. This incidence happened at the Fayetteville VA Medical Center in a neighboring state, North Carolina. The unprofessional conduct has been evidenced by the regular complains from the VA employees. The whistle-blowing has been reported to be an indication of the lack of standards by the VA hospitals. Among the cases reported include those of falsifying data to give a false illusion that patients were receiving timely care.

 

Failure of Doctors to Share Effective treatments with Their Counterparts

VA hospitals have been marred by cases of lack of effective treatment and negligence (Estes, 2017). Many whistleblowers across the country have reported lack of professionalism in ways such as lack of practical knowledge on the procedure. The Veterans Affairs employees are said to have reported 1887 cases in the year 2016 alone ranging from low-quality care to total neglect of the veteran patients.

Reasons for Veterans and Family Members Out-sourcing Treatment for PTSD

The election of President Trump has come along with the suggestion that Veteran health care ought to be privatized (Shane, 2017). The move has however been resisted by the Veterans instead countering with the argument that the existing VA hospitals should be improved. The lack of quality care in the VA hospital constantly leads to veterans with PTSD outsourcing for treatment for various reasons as shown.

Although privatization has received resistance from various groups, President trump signed into law, a policy labeled as the “Veterans Choice” that would allow veterans to receive care from local hospitals closer to them rather than having to travel to far VA hospitals (Shane, 2017). Another reason that makes veterans outsource treatment is due to the poor quality healthcare offered at the VA hospitals. The VA hospitals are marred by many scandals. Veteran patients are not treated as patients, but rather as just another number. For instance, in a rather shocking turn of events in the year 2008, an email by a VA employee was leaked advising other VA employees not to diagnose patients with PTSD to avoid applications for compensations (Dombeck, 2008). This evidence, among many more leads veterans to seek treatment at local hospitals where there are treated with more care. The waiting time is also another issue. As shown earlier in the essay, many deaths have been reported due to delays in the VA hospitals causing veterans to look for better options.

 

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Effective Ways to Combat VA Shortfalls

VA ought to regularly hold conferences aimed at gauging the effectiveness of treatments as well as consolidating information on new treatments. Recommendations have been made aimed at standardizing the treatment and the diagnosis of PTSD such as patient-centered practices. So far, VA seems to be very discordant with infighting between the employees and their blowers as demonstrated by the recent cases of whistleblowing. Conferences would be effective in bringing professional together to decide on the best way forward.

Outsourcing appointments can also assist combat the VA shortfalls. President Trump has partially fulfilled one of his campaign processes of allowing veterans with PTSD to seek health care at local hospitals. With the increasing number of veterans diagnosed with PTSD being on the rise, the move is highly encouraged as it removes the heavy load from the VA hospitals.

Requesting a second opinion when unsure if diagnose is correct will also improve care in VA hospitals. Reports have been made where procedures went wrong in certain VA hospitals (Estes, 2017). Although it demonstrates a lack of professionalism, it also shows a lack of consultation among doctors on various issues.

Placing a soldier in charge of VA instead of civilian could also prove very effective. It is quite obvious that a soldier would connect in a much better way and relate to the needs of fellow veterans. Civilians lack an understanding of what the veterans go through in their struggle with PTSD.

 

 

Conclusion

A high number of Iraq and Afghanistan war veterans have been reported to suffer from PTSD. Also, there are a high number of veterans who have not reported their suffering with PTSD in fear of stigmatization. The Department of Veteran Affairs charged with the provision of healthcare to veterans has, however, failed to take up its responsibilities with many VA hospitals being found to treat veterans with neglect among other major crisis. The VA hospital shortcomings, therefore, require being addressed in the strive to offer our veterans with the best quality care and comfortable lives.

References

Associated Press. (2004). 1 in 8 returning soldiers suffers from PTSD. NBC News. Retrieved from http://www.nbcnews.com/id/5334479/ns/health-mental_health/t/returning-soldiers-suffers-ptsd/#.Weo1fGZryUk

Bender, B. (2016). Veterans groups fear Trump will ‘burn down’ VA. Politico. Retrieved from https://www.politico.com/story/2016/12/veterans-affairs-trump-232088

Dombeck, M. (2008). Why the VA doesn’t want to diagnose Iraq war veterans’ PTSD. Mental Help. Retrieved from https://www.mentalhelp.net/articles/why-the-va-doesn-t-want-to-diagnose-iraq-war-veterans-ptsd/

Estes, A. (2017). VA hospitals flooded with complaints about care. Boston Globe. Retrieved from https://www.bostonglobe.com/metro/2017/09/16/staff-veterans-hospitals-lead-federal-government-criticizing-their-employer-far/gHc8SYqcVze3tk2Xn8YAeI/story.html

Kashdan, T.B. (2014). 11 Reasons that Combat Veterans with PTSD Are Being Harmed. Psychology Today. Retrieved from https://www.psychologytoday.com/blog/curious/201409/11-reasons-combat-veterans-ptsd-are-being-harmed

Kinney, W. (2012). Comparing PTSD among returning war veterans: Post-traumatic stress disorder (PTSD) among returning Afghanistan and Iraq wars veterans. Symptoms and suffering similar to ordeals of Persian Gulf and Vietnam war veterans. Command and General staff college. Journal of Military and Veterans Health20(3), 21. Retrieved from http://jmvh.org/article/comparing-ptsd-among-returning-war-veterans/

Maguen, S., Luxton, D. D., Skopp, N. A., Gahm, G. A., Reger, M. A., Metzler, T. J., & Marmar, C. R. (2011). Killing in combat, mental health symptoms, and suicidal ideation in Iraq war veterans. Journal of anxiety disorders25(4), 563-567. Retrieved from https://msrc.fsu.edu/system/files/Maguen%20et%20al%202011%20Kiling%20in%20combat%20mental%20health%20symptoms.pdf

Military.com (n.d.). Post-Traumatic Stress Disorder. Military.com. Retrieved from https://www.military.com/benefits/veterans-health-care/posttraumatic-stress-disorder-overview.html

MTC. (n.d.). What is posttraumatic stress disorder (PTSD)? Make The Connection. Retrieved from https://maketheconnection.net/conditions/ptsd

Pelley, S. (2014). Robert McDonald: Cleaning up the VA. CBS News. Retrieved from https://www.cbsnews.com/news/robert-mcdonald-cleaning-up-the-veterans-affairs-hospitals/

Reno, J. (2012). Nearly 30% of Vets Treated by V.A. Have PTSD. The Daily Beast. Retrieved from https://www.thedailybeast.com/nearly-30-of-vets-treated-by-va-have-ptsd

Shane, L. (2017). Federal union slams VA health reforms as dangerous for vets. Army Times.

Retrieved from https://www.armytimes.com/veterans/2017/10/17/federal-union-slams-va-health-reforms-as-dangerous-for-vets/

Shaw, J. (2017). Horror Show. More Than 100 Veterans Died Waiting for Care at Los Angeles VA Hospital. Hot Air. Retrieved from https://hotair.com/archives/2017/05/08/horror-show-100-veterans-died-waiting-care-los-angeles-va-hospital/

 

Sifferlin, A. (2015). How effective are PTSD treatments for veterans? Time. Retrieved from http://time.com/3982440/ptsd-veterans/

Smith, M. (1997). Many local veterans unhappy with new PTSD treatment program. Disability Rights Washington. Retrieved from http://www.disabilityrightswa.org/advocacy-news/many-local-veterans-unhappy-new-ptsd-treatment-program

The Conversation. (2016). Fighting another war: How many military personnel and veterans will have PTSD in 2025? The Conversation. https://theconversation.com/fighting-another-war-how-many-military-personnel-and-veterans-will-have-ptsd-in-2025-65542

Tull, M. (2017). PTSD and the Military. Verywell. Retrieved from https://www.verywell.com/overview-of-ptsd-and-the-military-2797443

Vergun, D. (2012). Army standardizes PTSD diagnosis, treatment. US Army. Retrieved from https://www.army.mil/article/84928

Wax-Thibodeaux, E. (2014). More veterans press VA to recognize medical marijuana as treatment option. The Washington Post. Retrieved from https://www.washingtonpost.com/politics/more-veterans-press-va-to-recognize-medical-marijuana-as-treatment-option/2014/11/15/51666986-6a7b-11e4-b053-65cea7903f2e_story.html?utm_term=.3ccf976c73a9

Zarembo, A. (2014). Government’s PTSD treatment for veterans lacking, report finds. Los Angeles Times. Retrieved from http://www.latimes.com/nation/la-na-ptsd-report-20140621-story.html

Zeiss, A. M., & Batten, S. V. (2012). Treatment for PTSD: clinical practice guidelines and steps toward further knowledge. Journal of Rehabilitation Research & Development49(5), ix-ix. Retrieved from https://www.rehab.research.va.gov/jour/2012/495/zeiss495.html

 

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