Volume 2, February 2009
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Public concern is high over the wellbeing of the approximate 1.64 million US troops deployed as part of Operation Enduring Freedom (OEF; Afghanistan) and Operation Iraqi Freedom (OIF; Iraq) since 2001. Never before has the pace of deployment for America’s armed forces been higher, the length of deployment longer, redeployment more common, and breaks between deployments so infrequent. And although medical and technological advances have brought casualty rates of killed or wounded to the lowest in history, they do not necessarily prevent behavioral health wounds among our troops.
The Department of Defense (DoD) and Veterans Affairs (VA) have begun to study how behavioral health issues are handled. They are working to identify the scope of the problem, and changes in policy are already occurring based on some of the preliminary findings.
According to the 2008 Center for Military Research RAND Report, of the 1.64 million troops that have been deployed, approximately 300,000 currently suffer from post traumatic stress disorder (PTSD) or major depression. The report states that only about half (53 percent) sought help from a physician or mental health provider in the past year.
A survey of more than 1,900 servicemen and women identified many barriers that prevent treatment for behavioral health issues. For those surveyed, concerns around seeking treatment included:
For PTSD and major depression, the RAND study used a microsimulation model to project health care and productivity costs within the first two years after a service member returns home.
Results showed two-year costs associated with PTSD are approximately $5,904 to $10,298, while costs for major depression are $15,461 to $25,757. The microsimulation was also used to predict health care and productivity costs for the entire population deployed since 2001. These costs were estimated at between $4.0 and $6.2 billion over two years.
Co-morbid PTSD and major depression costs were approximated at $12,427 to $16,884. The model also revealed that 55 to 95 percent of total cost can be attributed to lowered productivity. The report notes that it is likely that the actual figures would be much higher if the current or potential costs stemming from substance abuse, domestic violence, homelessness, or family strain were included in the study.
The study estimated that evidence-based treatment for PTSD and major depression would pay for itself within two years, resulting in $1.7 billion in savings from increased productivity and lowered rates of suicide. The good news is that efforts to identify and deploy effective sustainable treatment solutions are high priority and are receiving special attention.
Recommendations made in the RAND report to the DoD and VA to deploy adequate and effective behavioral health care to service members include:
Most of the troops coming home from the war are young and present as healthy, without necessarily disclosing internal pain and suffering. Treating the one-third of troops returning home from Afghanistan and Iraq affected by PTSD or depression is a national issue and will require a systematic shift not only within the DoD and VA, but also across the entire US health care system.
Once home, many will be employed outside of the military. At that point, the health care and productivity burdens will be passed on to employers, health plans, or the public sector. It is in the best interest of the country at large to dedicate sufficient resources to ensure that the post-deployment adjustment and recovery of our troops is both successful and complete.
“We currently have a window of opportunity to assist returning veterans,” said Dr. Lisa Najavits, Professor of Psychiatry at Boston University School of Medicine. “Some service members and their families are suffering from PTSD, depression, and other psychological problems. The good news is that major efforts are underway to prevent the long-term course of these disorders that so often occurred in earlier war cohorts. With rapid and proper care, these problems are typically highly treatable.”
Dr. Najavits notes that in this current era there is much more awareness and compassion for how these problems are affecting our troops and adds, “The men and women serving this country deserve the very best care possible on their return.”