Improving Treatment Outcomes for Veterans with Mental Health Conditions

Summary of testimony presented before the House Committee on Veterans Affairs, Subcommittee on Health on November 14, 2023.

Transcript

Congresswoman Julia Brownley

As our RAND witness points out in his testimony, up to 30% of patients drop out of evidence-based psychotherapy treatments, and more than half who do complete treatment still retain diagnosis of post-traumatic stress.

Rajeev Ramchand. Codirector, RAND Epstein Family Veterans Policy Research Institute, RAND Corporation

First, continued investment in research is critical. There currently are good treatments available for conditions like PTSD, but they do not work for everyone. There is a need to invest in research to develop new treatments. This includes adequate funding for the National Institutes of Health and research programs within VA and DOD. Federal investment is necessary because private funding for novel therapies for mental health conditions is waning. Congress can also make the process for conducting research on psychedelic compounds more efficient, relaxing the notoriously time-consuming, confusing, and expensive processes required to conduct research on Schedule I drugs would expedite research into psychedelic-assisted therapy and help get novel treatments to veterans more quickly.

Second, policy solutions are needed to address potential barriers to veterans’ abilities to access psychedelic treatments, if and when these treatments become available. The first potential barrier is cost. If and when available, MDMA-assisted therapy will not be cheap, especially in the early years. Veterans who can't afford MDMA-assisted therapy may try to access it in illegal markets where a dose is cheaper, but could include dangerous adulterants like methamphetamine.

A second access factor will be whether VA has the workforce and resources to provide MDMA-assisted therapies within its behavioral health infrastructure. VA would need to determine who should deliver this treatment and how to accommodate a more time and labor-intensive protocol while simultaneously meeting expectations to provide care to veterans in a timely manner.

The final issue related to access is quality. If VA providers deliver this care, VA must decide how closely to adhere to the FDA-approved protocol and how to monitor its own providers' adherence to it.