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The PTSD crisis ignored: Americans wounded at home

Lois Beckett | 2/7/2014, 6 a.m.

“The rates of PTSD we see are as high or higher than Iraq, Afghanistan or Vietnam veterans,” Ressler said. “We have a whole population who is traumatized.”

Post-traumatic stress can be a serious burden: It can take a toll on relationships and parenting, lead to family conflict and interfere with jobs. A national study of patients with traumatic injuries found that those who developed post-traumatic stress were less likely to have returned to work a year after their injuries.

For most people, untreated PTSD will not lead to violence. But “there’s a subgroup of people who are at risk, in the wrong place, at the wrong time, of reacting in a violent way or an aggressive way, that they might not have if they had had their PTSD treated,” Ressler said.

Research on military veterans has found that the symptom of “chronic hyperarousal” — the distorted sense of always being under extreme threat — can lead to increased aggression and violent behavior.

“Very minor threats can be experienced, by what the signals in your body tell you, as, ‘You’re in acute danger,’ ” said Sandra Bloom, a psychiatrist and former president of the International Society for Traumatic Stress Studies.

Hospital trauma centers, which work on the front lines of neighborhood violence, could help address the lack of treatment. Indeed, the American College of Surgeons, which sets standards for the care of patients with traumatic injuries, is set to recommend that trauma centers “evaluate, support and treat” patients for post-traumatic stress.

But it’s not a requirement, and few hospitals appear to be doing it.

ProPublica surveyed a top-level trauma center in each of the 22 cities with the nation’s highest homicide rates. Just one, the Spirit of Charity Trauma Center in New Orleans, currently screens all seriously injured patients for PTSD. At another, Detroit Receiving Hospital, psychologists talk with injured crime victims about PTSD.

Other hospitals have a patchwork of resources or none at all. At two hospitals, in Birmingham, Ala., and St. Louis, trauma center staff said they hope to institute routine PTSD screening by the end of the year.

Doctors in Baltimore, Newark, N.J., Memphis, Tenn., and Jackson, Miss., said they wanted to do more to address PTSD, but they do not have the money.

They said adding even small amounts to hospital budgets is a hard sell in a tough economic climate. That’s especially true at often-cash-strapped public hospitals.

In order to add a staff member to screen and follow up on PTSD, “Do I lay someone else off in another area?” asked Carnell Cooper, a trauma surgeon at Maryland Shock Trauma in Baltimore.

Many public hospitals rely on state Medicaid programs to cover treatment of low-income patients. But several surgeons across the country said they did not know of any way they could bill Medicaid for screenings.

The federal government often provides guidance to state Medicaid programs on best practices for patient care and how to fund them. But a spokeswoman for the Centers for Medicare and Medicaid Services said the agency has given states no guidance on whether or how hospitals could be reimbursed for PTSD screenings.