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commentary

(The RAND Blog)

June 23, 2017

Raising Awareness of the Need for Collaborative Care to Treat PTSD

Photo by PeopleImages/Getty Images

by Lisa S. Meredith

National PTSD Awareness Day marks its seventh birthday on June 27, established by Congress to increase public understanding of a disabling condition so prevalent that post-traumatic stress disorder is commonly known by its four-letter acronym—PTSD.

PTSD affects nearly 8 percent of American adults, equivalent to more than 21 million people.

PTSD affects nearly 8 percent of American adults, equivalent to more than 21 million people. It may be a consequence of having witnessed or directly experienced a frightening event. Symptoms include re-experiencing the traumatic event through flashbacks and nightmares, avoiding situations that serve as reminders of the event, feeling numbness, and being hyper-aroused or overly vigilant regarding anticipating another event.

People from all walks of life may have PTSD, not just service members and veterans who are at-risk from combat exposure. Civilians who experience trauma in the form of community violence and interpersonal violence are at risk as well. Immigrants and refugees may experience PTSD as a result of political violence in their home countries or because of discrimination or hate crimes in the U.S.

People from all walks of life may have PTSD, not just service members and veterans who are at-risk from combat exposure.

Raising awareness of PTSD should include highlighting the need for access to evidence-based treatments for the disorder—in other words, treatments that have been shown to work. Although effective treatments exist, such as medication and talk therapy, research has shown that half of those suffering from the disorder go unnoticed and untreated.

Many barriers hinder access to effective care despite public education campaigns, the dissemination of clinical practice guidelines, and attempts by health care systems to expand mental health care. Psychotherapy for PTSD may be difficult for many to access because of limited insurance coverage for specialty care. Medications that have been proven to work clinically are also widely available but may not be sufficient without supportive counseling. Many suffering from PTSD also need to have their non-medical challenges dealt with—such as housing and nutrition needs.

Collaborative care models in which providers work together are likely to reach more patients.

Collaborative care models are one evidence-based approach for integrating physical and behavioral health services that can be implemented within a primary care-based medical setting. These models typically integrate care from primary care providers, care managers, and psychiatric consultants who work together to address all of a patient's health needs. Because many patients receive their care solely from a medical clinic, collaborative care models in which medical providers, behavioral health providers, and social service providers work together to treat PTSD are likely to reach more patients.

A systematic review of 79 randomized controlled trials of collaborative care for depression and anxiety conducted by the nonprofit, independent Cochrane organization found collaborative care to be effective. However, only four such trials of collaborative care for PTSD have been carried out recently (between 2008 and 2016). These include

The overall findings were mixed with only two of the four studies—the RAND research on active-duty military and the VHA study on telemedicine-based collaborative care—showing positive effects of collaborative care for PTSD. One reason for the discrepant findings was that all patients in the two studies that reported positive findings received the collaborative care intervention while between 11.5 percent to 27 percent of patients in the other two studies could not be reached by care managers and did not receive the intervention as intended. Taken together, the findings from these studies are inconclusive but still suggest more work is needed to improve and adapt models of care for PTSD—solutions that can be adopted by health care providers to engage patients in treatment. The findings also suggest a need for strategies that would address low-cost and efficient interventions that would be practical and feasible in primary care settings. And if the American Health Care Act were to pass, the availability of such PTSD treatment strategies in primary care may become even more critical because mental health coverage for more than 30 million people may no longer be in place.


Lisa S. Meredith, is a senior behavioral scientist at the nonprofit, nonpartisan RAND Corporation and has published widely on the topic of PTSD.

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