Kaiser Daily Health Policy Report

Kaiser Daily Health Policy Report
Coverage & Access Depression, Post-Traumatic Stress Disorder Among Service Members Will Cost U.S. up to $6.2B Over Two Years, According to Report
[Apr 18, 2008]

Nearly one in five, or about 300,000, soldiers who has served in Iraq or Afghanistan has post-traumatic stress disorder or major depression -- illnesses that could cost the U.S. as much as $6.2 billion over two years in care, lost productivity and lost lives through suicide, according to a RAND report released on Thursday, the Washington Post reports (Scott Tyson, Washington Post, 4/18). The study was based on telephone interviews conducted from August 2007 to January with 1,965 soldiers who have served in Iraq or Afghanistan, in some cases more than once. The soldiers interviewed live in 24 communities with high concentrations of service members, reservists and veterans. Researchers also conducted focus groups. About 1.6 million people have served in Iraq or Afghanistan in the past five years (Alvarez, New York Times, 4/18).In total, 31% of Iraq and Afghanistan soldiers have experienced a brain injury, stress disorder, or both, the report found. The study found that 19.5% of service members experienced a concussion or other traumatic brain injury during their service (Barnes, Los Angeles Times, 4/18). Of soldiers who reported having a traumatic brain injury, 43% were evaluated by a physician. The report also found that about 7% of soldiers surveyed have a probable brain injury and currently have PTSD. PTSD and major depression were most prevalent in women and reservists, according to the report (Jelinek, AP/Miami Herald, 4/18). The treatment costs for brain injuries have not been determined, but according to the report, based on the number of traumatic brain injury cases diagnosed through June 2007, the cost is expected to be between $600 million and $900 million. According to the report, the stress of war has resulted in a disproportionately high psychological toll compared with physical injuries. The report warns of "long-term, cascading consequences" for the U.S. if the mental health problems are not treated. Consequences include higher rates of drug use, suicide and unemployment, and increased marital problems (Washington Post, 4/18). The study was funded by a grant from the Iraq Afghanistan Deployment Impact Fund at the California Community Foundation (Carter, Washington Times, 4/18).
Treatment The report also found "serious gaps in mental health care," according to the Post. According to the report, 53% of service members with PTSD or depression had sought treatment from a provider in the past year, about half of whom received "minimally adequate" treatment. To care for all of the service members, thousands more certified mental health professionals are needed in both military and civilian sectors, as some veterans are seeking care outside of the Department of Veterans Affairs system because of stigma attached to mental illness, according to the report (Washington Post, 4/18). Terri Tanielian, one of the study's authors, said, "When we asked folks what was limiting them from getting the help that they need, among the top barriers that were reported were really negative career repercussions." While the treatment costs might seem high to government officials, failure to treat mental illness could cost the government billions of dollars, according to Lisa Jaycox, another one of the study's authors. She said, "We make the case that investing in treatment early would prevent some of the negative consequences from unfolding and save money."
Recommendations The study recommended allowing service members to receive mental health care "off the record," to avoid any possible stigma. Researchers also recommended that fitness-for-duty reports for redeployment not be based on a soldier's decision to seek mental health care (Los Angeles Times, 4/18). According to Jaycox, Department of Defense Secretary Robert Gates is considering removing a question from security clearance questionnaires about soldiers' health care history. Col. Loree Sutton, head of the Defense Center of Excellence for Psychological Health and Traumatic Brain Injury, said removing the question would be a "big step forward to help our service members understand that seeking care, in fact, is a sign of strength" (New York Times, 4/18).Gerald Cross, the VA's principal deputy undersecretary for health, said VA was increasing outreach to veterans, regardless of whether they reported mental illness. Ira Katz, the VA's mental health chief, said the VA budget for mental disorders increased from $2 billion in 2001 to $4 billion next year. However, Paul Sullivan, executive director of Veterans for Common Sense, said, "The VA is completely unprepared for the tidal wave," adding, "Unless the VA gets a massive amount of money (and) a set of new strong pro-veteran leaders, the situation will collapse" (Los Angeles Times, 4/18).

The report is available online.CBS' "Evening News" on Thursday reported on the study. The segment includes comments from Carissa Picard of Military Spouses for Changes, Col. Casper Jones and a soldier diagnosed with PTSD (Dozier, "Evening News," CBS, 4/18). Video of the segment and expanded CBS News coverage are available online. NBC's "Nightly News" on Thursday also reported on the study. The segment includes comments from Tanielian and Sutton (Miklaszewski, "Nightly News," NBC, 4/17). Video of the segment is available online.