What can Ohio do to fight PTSD?
If you are interested in the world of public health, you may have heard the growing conversation around adverse childhood experiences (ACEs)—traumatic events in childhood that have health and economic impacts that ripple into adulthood.
According to the Health Policy Institute of Ohio nearly two-thirds of Ohio adults reported exposure to ACEs in 2015. This included over half the population reporting emotional abuse, 41% reporting substance abuse in their household as a child, and over a third reporting experiencing divorce.
Ideally, we can work to prevent adverse childhood experiences from happening. But even going as far as to half these numbers would still leave millions of Ohioans dealing with the traumatic effects of abuse and other problems stemming from childhood.
On top of the human cost to these individuals, this means higher costs for health care to treat health problems stemming from this trauma and lower labor market earnings due to the effects of trauma on productivity. Trauma is bad for well-being, health, and the economy.
Luckily, we have a tool for ameliorating the impacts of trauma for people experiencing it that has decades of experimental validation: cognitive behavioral therapy (CBT). CBT is a form of psychological treatment that attempts to change thinking patterns through strategies like facing fears, roleplaying to prepare for difficult interactions, and learning to calm the mind and relax the body.
Cognitive behavioral therapy is not only thoroughly supported by experimental research, it also has been found to have large economic benefits.
The Washington Institute for Public Policy (WSIPP) estimates that for every dollar spent on cognitive behavioral therapy for adults experiencing post-traumatic stress disorder, $89 are generated in public benefit in the form of higher labor market earnings, lower health care costs, and reduced chance of death associated with depression. $49 of those $89 are recouped by taxpayers, mainly through new taxes generated from higher labor market earnings.
So what can we do to encourage the use of CBT by people who need it? Some good examples of what states can do come from Richard Reeves of the Brookings Institution.
One suggestion by Reeves is to increase mental health screenings to help identify individual need for cognitive behavioral therapy. This is a recommendation from the U.S. Preventative Services Task Force and has been shown to be effective at improving take-up of treatment. Reeves suggests universal screenings in schools, colleges, and clinical settings.
Another suggestion from Reeves is to make CBT free for patients. WSIPP estimates that a dollar invested in CBT leads to $49 in savings for taxpayers and $89 in total social benefits, making the economic case for covering CBT for patients strong. Reeves suggests CBT can be provided for free in public schools and college and for people serving in civilian or military services corps. He also suggests allowing for Medicare and Medicaid to cover CBT first, accommodating for teletherapy, and expanding community health centers.
A lot has been said about a growing mental health crisis, especially in industrial states like Ohio that have become the center of the conversation around deaths of despair. Encouraging use of one of the best tools we have to fight trauma would improve lives, health, and the state’s economy.
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