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Innovation in Veteran posttraumatic care requires collaboration

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Of the many adaptations American leaders and healers have been forced to embrace during the COVID-19 pandemic, left behind as an unintended casualty has been the critical work to advance mental health care for more than 2 million Veterans fighting daily against Post Traumatic Stress Disorder and Injury (PTSD/I).

Left untreated, PTSD/I can be debilitating, leading to a decline in quality of life and causing significant medical, mental health, interpersonal and social impairment. More threatening though, it has a strong link to suicide, with the lack of effective treatment now seen as a major contributing factor.

Before National PTSD Awareness Month in June ends, U.S. Department of Veterans Affairs statistics reveal that roughly 600 Veterans will die by suicide. The cost of status quo for our Veterans, their loved ones and our nation is unacceptable and unnecessary.

Just as our troops realize that we’re stronger and more successful when we sync our efforts and function as a team, medicine needs to transition to the same mindset; it needs to collaborate as members of a mission-driven care team to provide effective healing for those with trauma.

A great irony in medicine is that as systems evolve to allow for more coordination of care, consumers often voice frustration that their treatment is increasingly fragmented. Health care systems often tout the value of team-based care, but in many cases, meaningful, active collaboration between health care providers is the exception to the rule.

Empowering Veterans with the most effective care, a new model for addressing trauma fuses expertise and strategically sequenced skills of providers. To illustrate the value of this model, Americans should look to a potentially game-changing treatment that teams a biological intervention called Stellate Ganglion Block (SGB) with high quality psychological care, and ease of access through common-sense legislation.

In traditional settings of trauma-focused care, patients engage with a therapist to address deep-seated psychological scars. When patients are struggling with acute trauma symptoms, they’re overrun with adrenaline, and unable to calm down. In this state of mind, they’re not prepared to receive and integrate psychological insights. Living in a state of “chronic threat response,” these patients function in “survival mode,” where decisions are made in a “fight-or-flight” context. We know that this exaggerated hyperarousal is predictive of poor response to standard PTSD treatments.

In use since the 1920s for a variety of conditions, SGB is an injection of a local anesthetic adjacent to a cluster of nerves in the neck, just above the collarbone. When used for trauma symptoms, SGB appears to reset the fight-or-flight system. Used successfully for more than 10 years on thousands of patients to treat post-traumatic stress symptoms with a success rate between 70-80 percent, positive effects can last from six months to many years when paired with effective psychological interventions.

Since 2014, research studies have shown consistently that SGB can reduce PTSD symptoms by 50 percent and is particularly helpful in improving symptoms of irritability, surges of anger, difficulty concentrating, and trouble falling or staying asleep.  Most recently, a randomized clinical trial published in JAMA Psychiatry demonstrated twice the effect of SGB as compared to a placebo injection.  The large magnitude of effect and high success rates of SGB are simply too compelling to ignore, especially when standard PTSD therapies demonstrate disappointing results and weak effect sizes.  It’s not just time to get the word out, it’s time to take action.

The Center for Compassionate Innovation within the VA describes SGB as a “safe and ethical” PTSD/I treatment option. A handful of pioneering physicians in approximately 11 clinics within the VA have begun to offer this procedure. The adoption of SGB as a treatment option across the VA would change – and potentially save – the lives of countless Veterans.

Now, Congress must act. H.R. 5648, the Treatment and Relief through Emerging and Accessible Therapy for (TREAT) PTSD Act, would require the VA to provide SGB therapy as a front-line treatment for Veterans diagnosed with PTSD. Congress must consider this bill swiftly and in bipartisan fashion.

Effective healing requires us to practice collaboratively. Innovation is critical, especially now when trauma, secondary to our global health crisis, is rampant. Mental health care that fuses expertise of those providing psychological and biological interventions like Stellate Ganglion Block hold game-changing promise for relief from suffering. Those who suffer from trauma deserve the best care we can provide – care that is practical, effective, and informed by modern neuroscience. Our Veterans are counting on us to be like them – team up and find a better way.

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