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Wednesday, August 21, 2013

Post-Traumatic Stress Disorder and Other Mental Health Problems in the Military: Oversight Issues for Congress

Katherine Blakeley
Analyst in Foreign Affairs

Don J. Jansen
Analyst in Defense Health Care Policy

Military servicemembers suffering from post-traumatic stress disorder (PTSD), traumatic brain injury (TBI), and depression, as well as military suicides, continue to be a major concern of Congress. Numerous legislative provisions have been enacted over the past years to address these issues. Members will likely seek to offer legislation in the 113th Congress to address this complex set of issues. This report is intended to provide assistance in understanding the issues associated with psychological health in the active duty forces, potential congressional responses, and what questions may remain unanswered.

Key points in this report include the following:

• mental disorders such as PTSD are poorly understood and in most cases cannot be physically identified but, rather, must be diagnosed using symptoms reported by the servicemember;

• estimates of the prevalence of mental health conditions in any given population may be greatly affected by the methodology used;

• diagnoses of mental health conditions among active duty servicemembers have increased substantially relative to non-deployed servicemembers. This increase may be due to the psychological toll of exposure to conflict, but may also be due in part to increased and improved screening methods as well as Department of Defense (DOD) efforts to reduce the stigma associated with seeking mental health treatment that might dissuade some servicemembers from reporting mental health concerns or accessing care; and

• reliable evidence is lacking as to the quality of mental health care and counseling offered in DOD facilities. A 2012 Institute of Medicine (IOM) study recommended that DOD undertake efforts to measure the effectiveness of efforts to improve quality, such as training providers in evidence-based practice, that are not integrated into the system of mental health care offered in DOD treatment facilities.

Significant areas for potential congressional oversight activities regarding psychological health in the active duty forces include the following:

• research into the causes and physical manifestations of psychological health conditions, screening tools, and treatments;

• the effectiveness of screening and treatment efforts;

• servicemembers’ access to mental health care, including efforts to reduce the stigma of seeking mental health care, waiting times for care, staffing levels of mental health treatment professionals, mental health care available in remote or deployed settings, and care available to de-activated Reserve and Guard members;

• the quality of mental health care available to servicemembers, including the use of appropriate and effective treatments by qualified mental health treatment professionals;

• oversight of ongoing program evaluation efforts, including evaluation of the variety of suicide-prevention, stigma-reduction, and transition assistance programs within the services and DOD; and

• the costs of mental health care for active duty servicemembers, including present costs through the Defense Health Program, as well as the future costs of mental health care once servicemembers are no longer part of the active duty forces.

Date of Report: August 8, 2013
Number of Pages: 74
Order Number: R43175
Price: $29.95

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