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Sergeant Major of the Army Recounts How He Overcame PTSD: IoM Report Calls for Annual Screening by DoD

by U.S. Medicine

August 6, 2012

By Sandra Basu

WASHINGTON —Sgt. Maj. of the Army Raymond Chandler III said he was faced with his “own mortality” in Iraq in 2004, when a rocket blew up in the room where he was.

At first, Chandler recounted, he was ashamed of the post-traumatic stress disorder (PTSD) symptoms that followed the attack. But then, “I spent about two years in almost weekly behavioral healthcare counseling in Fort Bliss, TX, and that care by those committed individuals and by the folks I worked with made a significant change in my life.”

Chandler’s keynote address on the third annual National Post-Traumatic Stress Disorder Awareness Day in late June underscored that PTSD can affect anyone and does not necessarily damage military-career prospects.

The commemoration, marked this year by a ceremony on Capitol Hill, was created by a congressional resolution that calls for designating June 27 to raise public awareness about issues related to PTSD and reduce its associated stigma.

Sgt. Maj. of the Army Raymond Chandler III spoke about his experience with PTSD at an event held in commemortaion of National Post-Traumatic Stress Disorder Awareness Day.

“Military medicine and the Department of Defense must remain prepared to assist our men and women. We have the collective responsibility to raise national awareness regarding post-traumatic stress. We know, with the right treatment, most will go on to live productive and fulfilling lives,” Army Surgeon General Lt. Gen. Patricia Horoho, RN, said at the event organized by the Code of Support Foundation and Honor for All.

At the event, military leaders urged troops to seek out care and, as has become more common in recent years, gave examples of how they also have struggled.

Chandler’s positive treatment experience was not unusual, according to Air Force Surgeon Lt. Gen. Charles B. Green, MD, who said that, “contrary to popular understanding, PTSD is treatable, and over 75% return to full duty and normal healthy lives.”

IoM Report

A few weeks after the event, a congressionally mandated report from the Institute of Medicine called for DoD to annually screen servicemembers for PTSD, as is now done at the VA.

The IoM report, which called on both DoD and VA to improve timely access to evidence-based care for PTSD sufferers, noted that, of U.S. troops screening positive for PTSD after deployment to Iraq and/or Afghanistan, about 40% percent have received a referral for additional evaluation or treatment. Of those referred, according to the report, only 65% actually receive treatment.

In addition to broadening patients’ access to care, DOD and VA should support better research on optimal PTSD treatments and improve tracking of outcomes. Included in that, report authors wrote, should be rigorous evaluation of complementary and alternative therapies.

Sergeant Major of the Army Recounts How He Overcame PTSD Stigma Subhead: IoM Report Calls for Annual Screening by DoD

“DOD and VA offer many programs for PTSD, but treatment isn’t reaching everyone who needs it, and the departments aren’t tracking which treatments are being used or evaluating how well they work in the long term,” said committee chair Sandro Galea, professor and chair of the department of epidemiology, Mailman School of Public Health, Columbia University, New York City. “In addition, DOD has no information on the effectiveness of its programs to prevent PTSD.”

The report, which concludes the first phase of a study of DOD and VA programs to prevent, identify, and treat PTSD, did not measure the effectiveness of the programs. The committee said it did not have sufficient data to do that but hoped to refine its findings and recommendations with additional data in the second phase of the study.

Committee members did note, however, that despite efforts to remove barriers to care, stumbling blocks remain, including concerns that getting help will adversely affect servicemembers’ military careers; the need to travel long distances to a mental-health provider; and the inability of  patients to take time off from their duties or work to get treatment.

In addition, healthcare providers may lack training, time or be in a less than optimal location for providing help, such as a war zone. The report also cited organizational barriers such as limited treatment opportunities in combat zones, restrictions on when and where medications for PTSD can be used, and logistical difficulties in getting troops or veterans to appointments.

Commending DOD and VA for jointly developing a clinical practice guideline for care of PTSD, the committee said it is not clear, however, how frequently healthcare providers are adhering to the guidelines.

More Mental Health Professionals.

In a commentary published in the San Antonio Express-News for National Post-Traumatic Stress Disorder Awareness Day, Secretary of Defense Leon Panetta wrote that, as a result of the 35% increase in mental health professionals in military hospitals and clinics during the past three years, the number of PTSD cases diagnosed increased by more than 25%, even as the total number of deployed troops decreased.

Also in June, two new $11 million National Intrepid Centers of Excellence satellite centers broke ground at Fort Belvoir and Camp LeJeune for troops with TBI and PTSD.

The two new centers are the first of nine such centers that will be funded and built by the Intrepid Fallen Heroes Fund and will be located at military bases and medical centers around the country to provide care for troops with TBI and PTSD. Each of the new NICoE Satellite Centers is set to be completed and gifted to DoD within approximately three years, according to the Intrepid Fallen Heroes Fund.

Panetta said the centers “will help complement the National Intrepid Center of Excellence in Bethesda and provide cutting-edge evaluations, treatment planning, research and education for servicemembers and for their families.”

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