Despite spending billions of dollars a year to treat military service members and veterans with post-traumatic stress disorder, the government has little evidence that its efforts are working, according to a new report commissioned by Congress.
The report described PTSD care in the military health system as "ad hoc, incremental and crisis driven" and said the Department of Veterans Affairs had not hired mental health providers fast enough to keep pace with the rising demand.
The government spent $3 billion on PTSD treatments for veterans in 2012 and $294 million more for service members, according to the report.
But neither the Defense Department nor the VA have consistently collected data on how patients are faring or even what treatments they have received, making it impossible to assess the quality of care.
"Both departments lack a coordinated, consistent, well-developed, evidence-based system of treatment for PTSD," said Dr. Sandro Galea, a Columbia University epidemiologist who led the Institute of Medicine committee that produced the 301-page report.
Researchers estimate that between 7% and 20% of veterans of the recent wars have suffered from PTSD at some point.
As the stigma of the disorder has lifted, large numbers of veterans from earlier eras are also being diagnosed. They account for more than 75% of the roughly half a million VA patients receiving treatment for PTSD.
The VA has trained more than 6,000 mental health care providers in prolonged exposure therapy or cognitive processing therapy, two methods that have proved effective in clinical trials.
But the authors of the report noted that the VA was still not meeting its own requirement of offering those therapies to every veteran in need.
Both the VA and the Defense Department offer a wide range of other treatments and programs for the disorder, from medications to unproven alternatives such as yoga, acupuncture and relaxation exercises.
"There have been many well-intentioned programs done quickly," said Dr. Elspeth Ritchie, a former Army psychiatrist who served on the committee. "The critical importance of objectively measuring the effects of those programs has not been given the proper priority."
A Pentagon spokeswoman said that all branches of the military had already been working to solve that problem. Last fall, they began collecting data on symptom severity and treatment outcomes for PTSD as well as depression and anxiety, said Lt. Col. Cathy Wilkinson.
The VA is currently modifying its electronic medical record system to specify which type of PTSD treatment a patient is receiving. But those records will not report outcomes.