By Shankar Vedantam
Washington Post Staff Writer
Saturday, May 13, 2006
The Pentagon's top medical officer yesterday contested the conclusions of a Government Accountability Office report that questioned whether service members returning from Iraq and Afghanistan are getting appropriate mental health care.
Although the report said only 22 percent of service members identified as at risk for post-traumatic stress disorder (PTSD) on a post-deployment questionnaire were referred for a mental health examination, that did not account for troops who were referred to primary care physicians or other treatment providers for mental health care, said William Winkenwerder Jr., assistant secretary of defense for health affairs.
"Many people are referred and were referred in this process not to a mental health professional but to a primary care professional, their doctor," said Winkenwerder in an interview. "They were referred to group counseling sessions, or a [confidential counseling] service or a chaplain.
"The fact that 22 percent were referred to a psychiatrist or a psychologist is not an indication the [others] did not get the support or help they needed," he said.
The issue of PTSD care in the military has become the subject of controversy. Democrats and several veterans groups have charged the administration with short-changing returning service members who are in distress, but the Pentagon has insisted that the quality of care being provided is historically unparalleled.
The Pentagon could not make a knowledgeable official available to comment on the GAO report Wednesday evening after The Washington Post obtained a draft. The final report, with the Pentagon's official response, was made public Thursday.
That response broadly concurred with the report's conclusions and recommendations -- including a call for better explanations of why some service members who were found to be at risk, but not others, were referred to mental health professionals. But the Pentagon said it disagreed with the GAO's contention that "reasonable assurance is not available to support that [Iraq and Afghanistan] service members receive referrals when needed."
"Many of these people got help," Winkenwerder said. "Probably most. We don't know the exact number, and neither does the GAO."
Winkenwerder also rejected charges that cost concerns were prompting the Pentagon to diagnose fewer people or to limit treatment.
Rather, he said in his official response, clinicians at the Pentagon were being cautious about pathologizing what may be transient emotional problems among service members who have finished their service, because the questionnaires are often administered while troops are still in the theater of operation.
"To label those symptoms as denoting a disorder may not be appropriate at this time," he noted.
Michael E. Kilpatrick, deputy director of deployment health support, said the Pentagon is evaluating troops three to six months after deployment to get a better sense of how they were faring on various measures of physical and mental health.