Defense, VA urged to spend more on mental health, brain injury treatments

In a congressional briefing on Monday, RAND Corp. called on the Defense and the Veterans Affairs departments to lead a nationwide effort to care for the growing number of Iraq and Afghanistan veterans and soldiers suffering from post-traumatic stress disorder and traumatic brain injury. A little more than half of all returning service members seeking care for PTSD or depression are receiving minimally adequate care, RAND reported.

Promoting a nationwide effort might be a matter of dollars and sense, RAND concluded in a recent study, which noted that if the government invested in treatment for at least 50 percent of soldiers suffering from PTSD it would see an overall cost savings.

"If we can get 100 percent of those in need into effective evidence-based care the costs come down even further," said Terri Tanielian, co-director of RAND's Center for Military Health Policy Research. "These savings come from increases in productivity and lower rates of attempted suicide."

Effective care has not yet reached all treatment settings, said Tanielian, but the estimated cost to care for mild traumatic brain injury averaged $30,000 per patient while moderate to severe cases cost $350,000. Many vets are released from service without a brain injury diagnosis and are being treated by private doctors, according to the report, making it difficult to calculate the overall cost of such cases. Citing 2,700 documented cases at the Defense Department, Tanielian said the government has spent $770 million to treat traumatic brain injury in the first half of 2007.

If all soldiers needing care for PTSD and depression received proper treatment, costs could be reduced by $1.7 billion, or $1,063 per veteran, she added.

RAND reported that of the 1.64 million troops deployed to Afghanistan or Iraq, an estimated 300,000 suffer from PTSD or depression and 330,000, have experienced mild, moderate or severe brain injuries. Tanielian said most of those soldiers likely have the mild form -- a concussion -- but 60 percent of those afflicted with brain injuries have not been evaluated by doctors.

"So what's unknown is the current level of need in this population. And it is that unknown that could hurt those exposed to TBI that is the most concern," she said, adding that the high volume of cases report in the RAND was "in the ballpark" of an Army surgeon general report released in 2007.

Ten percent to 20 percent of soldiers returning from combat in Iraq and Afghanistan suffered from mild TBI, said the Army surgeon general's Traumatic Brain Injury Task Force report , which like PTSD "may produce similar symptoms, such as sleep problems, memory problems, confusion and irritability."

"Our findings demonstrate that, like our civilian counterparts, the Army has a good handle on treatment of moderate to severe TBI, but is challenged to understand, diagnose and treat military personnel who suffer with mild TBI," said task force chairman Brig. Gen. Donald Bradshaw, commander of the Army's Southeast Regional Medical Command.

RAND's 500-page study, which surveyed 1,965 recently returned soldiers, estimated that 30 percent of all deployable service members have experienced PTSD, depression or TBI. Founded after World War II, RAND has been a key think tank advising the military services for 60 years.

Calling for a nationwide effort to care for traumatized soldiers, Tanielian said the military should rapidly expand the number of health care providers and make them accessible anywhere in the country, encourage soldiers to seek treatment, and invest in research to better understand what wounded soldiers need after leaving active duty.

"We need to make sure that changes in this policy are directed not just at the DoD and VA, but make this a national priority and an issue across America," she said.