Report: Pentagon not providing adequate care to troops at risk of suicide
By NIKKI WENTLING | STARS AND STRIPES Published: August 7, 2017
WASHINGTON – Defense Department health care providers do a good job of screening for suicide risk, but they fail to provide critical and effective follow-up treatment to servicemembers identified as suicidal, according to a Rand Corp. report released Monday.
Rand researchers found appropriate follow-up care was given to only 30 percent of servicemembers with depression and 54 percent of servicemembers with post-traumatic stress disorder who were at risk of suicide. The rest did not receive follow-up care or got medication and psychotherapy that has not been proven to help.
The report is based on observations of nearly 39,000 servicemembers with diagnosed PTSD or depression over a one-year period. It’s one of the largest evaluations of military mental health care, said Kimberly Hepner, a behavioral scientist and the lead researcher.
“The military health system did quite well in screening for suicide risk,” Hepner said. “Where we found they could do better was how the providers responded to servicemembers with suicide risk identified.”
The Pentagon asked Rand for an independent report on the care it provides to servicemembers with PTSD and depression.
It’s difficult to know how many active-duty servicemembers suffer from PTSD or depression, Hepner said. The report cites between 4 and 20 percent of the more than 2.6 million people who deployed to Afghanistan or Iraq during Operation Enduring Freedom or Operation Iraqi Freedom.
The Department of Veterans Affairs analyzed millions of veterans’ records and reported last year an average of 20 veterans died from suicide each day in 2014. While veterans made up about 8.5 percent of the U.S. population in 2014, they accounted for 18 percent of suicides.
Capt. Mike Colston, a psychiatrist and director of Mental Health Programs for the Office of Health Affairs, said the Military Health System has grown exponentially since 9/11, in numbers of providers and patients. Pentagon officials first asked for the review in 2012, he said.
“You don’t want to engage an intervention without measuring it,” Colston said. “They thought, ‘Let’s get a real nuts-and-bolts measurement of how we’re doing.’”
Rand researchers made several recommendations for the Pentagon to improve how they treat veterans with PTSD and depression who are at risk of suicide, including better therapy. Because of the number and type of medications, researchers also suggested the Pentagon more closely monitor what’s prescribed.
Less than half of servicemembers – 45 percent – who had PTSD and went through psychotherapy received evidence-based therapy proven to work. A third of the PTSD patients at risk of suicide filled prescriptions for benzodiazepines, which are also not proven effective, Hepner said.
One study published in the Journal of Psychiatric Practice in 2015 found the class of drugs, which includes Xanax and Valium, could prolong or worsen PTSD.
“Those are meds used to treat sleep apnea and anxiety, but actually have not been helpful in treatment of PTSD,” Hepner said. “The clinical practice guidelines suggest benzos could be potentially harmful for patients with PTSD.”
Some servicemembers in the study – 45 percent with PTSD and 32 percent with depression – received four or more types of medication, the report states. About half of PTSD and depression patients filled prescriptions for opioids.
Colston said the Military Health System wants to get servicemembers evidence-based interventions.
Pentagon health care providers need to talk with patients at risk of suicide about ways to limit their access to firearms, at least temporarily, Hepner said. According to the VA, 67 percent of all veteran suicides were by firearms.
The report also highlighted what the Pentagon is doing right. Besides screening well for risk of suicide, Pentagon health care providers also screened more than 90 percent of patients for alcohol and substance use. They also had timely follow-ups with servicemembers discharged from psychiatric inpatient care.
Hepner recommended the Pentagon be more transparent in reporting what’s going right, and wrong, in the mental health care it provides.
“It’s the only way we know how to make improvements and where to focus those improvement efforts,” she said.
Kristofer Goldsmith, an Iraq veteran who was discharged for misconduct after a suicide attempt, thinks the only way the Pentagon will improve is if Congress holds it accountable.
“The primary issue I see is that they look at mental health care as a box-checking exercise,” Goldsmith said. “They achieve the bare minimum and leave it there.”
Goldsmith also referenced a Government Accountability Report from May that found more than 13,000 servicemembers separated from the military for misconduct from 2011 through 2015 suffered from PTSD, traumatic brain injury or another disorder. Because of their discharge status, they were prevented from receiving VA treatment.
Goldsmith works for Vietnam Veterans of America, which issued a statement Monday calling the reports “infuriating.”
“This is an issue of government accountability,” he said. “The government is responsible for caring for veterans to make sure they get the care they need in order to recover from war, and the DOD has been failing.”
Now that the Military Health System has more data, Colston said, officials will “drill down on what clinical interventions are best and what’s working best for our soldiers.”
“Day one is today,” Colston said. “In an organization that’s always striving to improve every day, we want to get a plan to work on to better the system.”