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       The California Community Foundation sponsored a study by RAND to fill these information gaps for PTSD, major depression, and TBI. RAND assembled a team of over 30 experts in psychology, economics, public health, and related fields to review scientific research, survey service members and veterans, assess systems of care, and develop an econometric model to estimate costs. The study was the first of its kind to take a comprehensive view from a societal perspective.

       Research Questions What is the scope of mental health and cognitive conditions that troops face when returning from deployment to Afghanistan and Iraq? What are the costs of these conditions, including the costs of treatment and of lost productivity? What are the costs and potential savings associated with different levels of medical care? What existing programs meet the health-related needs of service members with PTSD, major depression, or TBI? What are the gaps in these programs and what steps can be taken to close them?

       In 2007, 18.5 percent of U.S. service members who had returned from Iraq or Afghanistan had PTSD or depression, and 19 percent had reported experiencing a TBI while deployed. There are significant short- and long-term cascading consequences associated with these disorders. The two-year post-deployment costs of PTSD and depression are significant, as high as $6.2 billion; however, providing high quality, evidence-based treatment to everyone with these conditions would save money or pay for itself within the same time frame. Roughly half of those who needed treatment for those conditions sought it, but only slightly more than half of those receiving it were getting even minimally adequate care. Service members reported barriers to seeking care including concerns about negative career repercussions. Recommendations Increase the cadre of providers who are certified to deliver evidence-based care, so that capacity is adequate for needs. Change policies to encourage more active-duty personnel and veterans to seek needed care. Deliver proven, evidence-based care to service members and veterans.

       The RAND study raised the profile of behavioral and cognitive health problems among returning veterans. In the days and weeks following release of the report, these problems were discussed by congressional committees, and in newspaper editorials and stories across the country. The RAND work was the only research cited in the White House’s Joining Forces Initiative, established in January 2011 to guide federal agency efforts to support military families. Within weeks of the release, DoD announced changes to its applications for security clearance to exempt service members from reporting that they had received combat- or family-related counseling from a mental health professional. RAND had reported that acknowledging such treatment had been perceived by service members as having negative career consequences. The Chairman of the Joint Chiefs of Staff called for screening for all returning military personnel, including face-to-face evaluations for PTSD. The findings galvanized citizens and policy makers, and led to large psychological and cognitive health projects funded by the DoD both at RAND and elsewhere. Ongoing projects consider Pentagon programs addressing suicide, family resilience, quality of care, program effectiveness, and other issues related to behavioral health.

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