By Shankar Vedantam
Washington Post Staff Writer
Thursday, May 11, 2006
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."