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Study finds that VA treats PTSD better than the private sector

 
Vietnam veteran John Paul, who has been receiving treatment since 1991, still attends PTSD therapy programs regularly.
Vietnam veteran John Paul, who has been receiving treatment since 1991, still attends PTSD therapy programs regularly.
Published May 31, 2016

SEMINOLE — On May 10, 1967, U.S. Marine Corps infantryman John Paul was seriously wounded during a battle in South Vietnam's A Shau Valley near the North Vietnamese border.

"When I got hit, I was standing up,'' Paul, 67, recalled during a recent interview. "I was shot twice in the abdomen and left hip. … I thought I bought the farm."

He spent six months in a series of hospitals, and when he was discharged from the Marines, his limp was not his only reminder of his brush with death.

"I was a mess for years," he said, adding that he drank heavily to medicate the mixed feelings he had about the war.

In 1991, he started getting help for post-traumatic stress disorder, or PTSD, at the C.W. Bill Young VA Medical Center at Bay Pines. A recent study published online in a journal produced by the American Psychiatric Association indicates he made a good choice.

The study found that the VA is up to 30 percent better at providing medication to veteran patients than the private sector is for its patients. That was largely due to the VA's ability to provide a one-stop shop for timely medication to patients with appropriate followup care, such as therapy and blood-level checks, to ensure proper medication dosages. Patients in the private sector also have other hurdles like insurance programs that don't cover certain mental health care costs, such as medication associated with mental health disorders.

The study was approved by Congress and funded by the VA. According to one of the primary authors, it compared data from veterans and patients in the private sector who were being treated for five mental health disorders: schizophrenia, bipolar disorder, PTSD, major depression and substance abuse disorders.

Dr. Alfonso Carreno, chief of mental health and behavioral sciences at the C.W. Bill Young campus, explained that study findings are partly explained by the fact that the private sector is driven by profits, whereas the VA is not.

"In for-profit systems, you have to minimize the costs," said Carreno, whose own brother suffered from a mental health disorder and committed suicide. "Sometimes under those systems, they may say or suggest to providers, physicians and others, 'Only medically necessary testing, please, or in life or death, if you really need it,' even though these tests are recommended by the American Psychiatric Association, or the American Diabetic Association."

The Bay Pines facility is able to see 100 percent of its first-time mental health patient referrals within 30 days, Carreno said. Various specialized mental health programs treated 21,067 unique patients in fiscal year 2015, he said.

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Dr. Katherine Watkins, a primary author of the study at the RAND Corp., said the study compared more than 830,000 veterans against 545,000 nonveterans.

Watkins said that the VA was allowed to review the study before it was published, but that "it was only to check for potential errors in execution. All of the conclusions and interpretations are from the authors of the study," she said. And all RAND studies, she said, are scrutinized by "at least two external reviewers."

She said many veterans who suffer from various psychological conditions are especially vulnerable, making them more prone to homelessness or drug and alcohol addiction.

"It's generally harder to take care of people who are sicker and more economically disadvantaged," Watkins said by telephone from Santa Monica, Calif. "So it's harder to take care of that population. … It either points to how good of a job the VA is doing or how bad of a job the private sector is doing."

Carreno said Paul, the veteran, is in a good position. He still receives medication and is monitored as necessary for it, but is not involved in psychotherapy anymore.

"John Paul is an example of a Vietnam veteran who is productive and happy and who gives back to others," Carreno said. "If the goal of treatment is to help people learn to deal with life after trauma, then I think he's a great example of that. This is what I call 'cure' — namely having a person regain functionality, quality of life, enjoyment and ability to give back to others."

Paul lives at home with his wife; his three daughters are grown. He regularly attends his PTSD therapy programs every week, sees a psychiatrist every two to three months and even leads two peer-to-peer groups for Vietnam War veterans.

But he said he still gets squeamish in crowds and doesn't do well with loud noises. He said he had gall bladder surgery in 2015, and when he came out of the anesthesia, he thought he was back in Vietnam.

"It took me 15 minutes to realize where I was," he said. "There's no real cure for PTSD. Recovery is an ongoing process. To be successful, you need to stay on top of everything. Believe me, if there was a cure for this, I'd take it in a heartbeat."