More than 70 different drugs are being prescribed to veterans suffering from post-traumatic stress disorder (PTSD) as part of an "ad hoc" treatment system, a mental health expert has told the Royal Commission into Defence and Veteran Suicide.
Key points:
- Psychiatrist Andrew Khoo says there is no clear evidence base for prescribing drugs to treat PTSD
- He says many soldier and veteran deaths could have been the result of prescribed drug use
- Dr Khoo says a US study found death from drug misuse was more common among veterans than suicide
Consultant psychiatrist Dr Andrew Khoo also expressed concern that some veterans' deaths might have been wrongly classified as suicide when they were caused by accidental self-poisoning with prescription drugs.
The revelations were raised on day three of the royal commission's sitting in Brisbane.
Dr Khoo told the commission PTSD was complex, chronic and difficult to treat, caused problems in relationships and families, and rendered people unable to work.
He said this bled "into every aspect of life".
Dr Khoo, who is also a member of the Veterans Affairs Clinical Reference Group, said even the best treatments were leaving "quite a large proportion of people still unwell".
He detailed how he once tried to write down a list of all the drugs he commonly saw prescribed to the PTSD sufferers who came to his program for help.
"I stopped when I got to 70 drugs that are regularly prescribed for this one condition," he said.
"It is not based on any kind of evidence base. It just tends to go by what people think works. What an individual prescriber thinks works with these patients."
Dr Khoo said there was no gold standard pharmacological treatment for PTSD because everyone tended to develop their own ideas about what worked in PTSD.
He said antipsychotics were used liberally in PTSD in an attempt to improve people's sleep and decrease nightmares.
Dr Khoo said there needs to be a more evidence-based approach in relation to prescribing, and that a prescribing algorithm did not exist for PTSD.
He said of the 2,000 people who had been through his programs only about 10 to 15 per cent were not taking any drugs.
He also raised concerns about the potential for veterans to die as a result of drugs they had been prescribed.
Dr Khoo said a US veterans administration study found the rate of accidental fatal self-poisoning due to inappropriate prescribing and polypharmacy was greater than the rate of veteran suicide.
He said the study raised concerns for the royal commission about whether individuals who accidentally died from self-poisoning had instead been incorrectly listed as suicides.
"It may not have been a suicide attempt but rather just an outcome of not following these increasing medication regimes that these patients are prescribed and usually they have got multiple prescribers," he said.
Pension applications take up to two years
The commission also heard evidence from clinical psychologist Dr Katelyn Kerr and former interim commissioner for defence and veteran suicide prevention Dr Bernadette Boss.
Dr Boss queried the length of time being taken to process pension applications and how she was unable to access key data such as the National Coronial Information System to compile a report.
Dr Kerr also spoke at length about PTSD, its treatment and how psychologists and psychiatrists were less likely to treat Defence members or Department of Veterans' Affairs (DVA) clients.
Dr Kerr said another longstanding issue involved the lower compensation psychologists and psychiatrists received for DVA clients and Defence members, compared with other patients.
"Recently, the fees have improved but unless you work in the field already you wouldn't know that," she said.
Earlier in the hearing, Dr Boss spoke at length about the issues associated with her Independent Review of Past Defence and Veteran Suicides.
Dr Boss revealed that in compiling her report she was unable to gain access to key information like the National Coronial Information System (NCIS) to cross-reference its data with Defence.
She said access might have allowed her to find unknown veteran suicides.
Dr Boss also highlighted the time being taken for veterans to process pension claims which involved three government acts and could take up to two years.
"The end user shouldn't be going back and forward against each act," she said.
"There is a psychological cost and people who are not well, find it incredibly difficult to deal with fairly straightforward administration, let alone having to go back and forwards trying to get their head around which act they are supposed to be dealing with and why."
The royal commission's Brisbane hearings will continue until December 10.
More sessions will take place in Sydney next February and March, followed by hearings in Wagga Wagga, Townsville and Canberra.
An interim report is due next August and a final report by June 15, 2023.
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2021-11-30 09:06:17Z
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