Warrior Wellness Act (HR 6712, 115th Congress)

The Policy

Synopsis

The Warrior Wellness Act (HR 6712; 115th Congress) seeks to address certain aspects of mental healthcare within the Department of Defense (DOD). As such, the Act has two main goals.

The first goal is to attempt to solve the mental health provider shortage at the Department of Defense (DOD). The Act addresses this by charging the DOD submit a report within 180 days of the passage of the Act that describes and explains the mental health provider shortage and its effect on members of the Armed Forces. Additionally, this report is mandated to develop a strategy to increase the number of mental health providers at the DOD.

The second goal is to study the medication prescribing practices for treating post-traumatic stress disorder (PTSD). This is done by directing the DOD to submit a report within 180 days of the passage of the Act to Congress about the military’s prescription medication practices for post-traumatic stress disorder (PTSD) that were inconsistent with those promulgated by the DOD and the Veterans Health Administration. Based on this report, the Army, the Navy, and the Air Force are then mandated to develop a medication monitoring program that includes periodic reviews, regular reports, and internal procedures to address the inconsistent practices of prescribing medication for PTSD.

Context

While mental health providers at the DOD have increased in recent years, according to an April 2016 Government Accountability Office (GAO) report on mental health care at the DOD, there is still a shortage of these providers. Additionally, for service men and women seeking treatment for PTSD, the DOD and Department of Veterans Affairs (VA) have developed clinical practice guidelines, but a January 2016 GAO report found that the DOD delegates monitoring prescribing practices to individual branches of the military and the Army does not regularly monitor these practices. 

The Science

Science Synopsis

The first part of this bill aims to increase the number of mental health providers at the DOD. The need for robust mental health services within the DOD is clear; a 2014 study found that rates of certain mental disorders are much more prevalent in the military than in civilians. Relative to civilians, military rates of major depressive disorder was found to be five times higher, intermittent explosive disorder was found to be six times higher, and PTSD was found to be fifteen times higher. 

The second part of the bill aims to address the inconsistencies between the military and the VA/DOD clinical practice guidelines for prescribing medication in treating PTSD.  While the bill does not explicitly state which inconsistencies in prescribing practices it addresses, one prominent example is the use of benzodiazepines to treat PTSD. The VA/DOD clinical practice guidelines argue strongly against using benzodiazepines to treat PTSD because of lack of evidence for their effectiveness and potential significant adverse effects. Despite this warning, approximately 30% of VA patients were treated for PTSD with benzodiazepines in 2012. This is remarkably different from the clinical practice guidelines, which recommend trauma-focused psychotherapy or certain selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs) if psychotherapy does not work or the patient does not want it.  These drugs have stronger support for treating PTSD and the benefits generally outweigh the harms.

Scientific Assumptions

  • The VA/DOD clinical practice guidelines for prescribing medications for PTSD are better than what the military would use without these guidelines (Section 3(a)(2)(C)): The clinical practice guidelines are well researched and supported by evidence in the literature while it is unclear what the military would do on its own since it does not regularly monitor its practices.
  • Mental health providers furnish effective treatment for mental illnesses (Section 2(4)): The link between receiving treatment from a mental health provider and recovering or improving has been well researched and almost all researchers are in agreement of the link between the two.

The Debate

Scientific Controversies / Uncertainties

While benzodiazepines are used occasionally to treat PTSD, almost all scientific studies that have examined the relationship between benzodiazepines and PTSD have determined that they are an ineffective treatment.

Endorsements & Opposition

  • Representative Salud Carbajal (D-CA), press release, September 6, 2018: “Far too many of our service men and women are returning home with untreated symptoms of depression, substance abuse, and other mental health conditions related to their service. This legislation is critical to equipping the VA with the information and tools they need to take on this epidemic and help provide our veterans with the support they deserve.”
  • Representative Lloyd Smucker (R-PA), press release, September 6, 2018: “Some of the greatest wounds inflicted upon our brave service men and women are unseen.  We should be doing everything we can to treat these wounds as we would any other. Ensuring our troops have access to high-quality mental health services and are properly evaluated and treated is critical to their safety, the safety of their fellow soldiers, and the effectiveness of our national defense.”