Abstract
About 7 percent of the adult population (or 18 million people) in the US are veterans. More than two-thirds of that community are wartime veterans with service in Korea, Vietnam, the Gulf, and after 9/11.
Each year, the number of veterans grows as demands for global aid and commands to stage war increase. As it does, its younger generation (aged 19 to 49) experiences the highest rates of serious mental illness and substance use, affecting about one in six (16 percent, or 3 million) after their service.
SAMHSA data shows these veterans have the fastest-growing rates of serious mental illness, substance use disorder, and suicidal thoughts, plans, or attempts. And the climb of co-occurring mental illness and substance use disorders is clear-alongside pressure for more effective, better-structured treatment.
When you consider SAMHSA's latest published data shows actual suicide attempts among veterans 18 to 25 growing 620 percent since 2008-the deficit of care is the definition of dire (even excluding the high rate of our young veterans who think about and plan to end their lives).
At the same time, veterans serving after 9/11 have kept the highest rates of substance use disorder among all veterans: one in eight (12.7 percent). SAMHSA suggests high rates of addiction and mental illness stem, in part, from lasting exposure to trauma like combat, physical injury, sexual abuse, service stress, and witnessing death among others.
Because risk of suicide and substance use disorders "co-occur" with serious mental illness (like significant increases in major depression for veterans aged 26 to 49), care providers must find new ways to relieve this population through the most effective measures known.
We need doctors who are like artists, bringing together every element and technique for full recovery
Responding to historic gaps, one of the longest operating treatment centers in South Florida, The Recovery Team, announced its Haven for Heroes program last year to bring personal, integrated, evidence-based care directly to veterans, first responders, and affected families. Chief Medical Officer, Dr. Ignatov spoke about his reason for implementing the very latest treatment technologies to uplift the patients he serves.
"After years practicing as a general psychiatrist, I shifted to addiction medicine 15 years ago because I saw the results I could bring to those who need it most...It can be a high-tech and exciting field if you care about rapid relief."
In the national centers he medically oversees for Haven Health Management, Ignatov is introducing ketamine-assisted treatment for dual diagnosis and Deep Transcranial Magnetic Stimulation (Deep TMS™) developed by Brains Way for treatment-resistant conditions.
"Not many 'first-line' options satisfy patients with their speed," Ignatov explained, "They don't stick with antidepressants. Psychotherapy can take years, and they can both be demanding for patients to access. Ketamine and Deep TMS, however, can offer help quickly, even when other attempts at relief have failed."
Ketamine and TMS pair well with other, personalized therapies in fully supported residential programs.
Ketamine treatments and Deep TMS™ are both cleared by the FDA for treatment-resistant depression, a condition young veterans face more and more. But few mental health and substance abuse treatment centers in Florida (or beyond) have given them a secure place in treatment.
With Ignatov's guidance, Haven Health Management's centers have challenged themselves to deliver the best, new treatments within a safe infrastructure. "Ketamine and TMS pair with other, personalized therapies in fully supported residential programs."
"Everyone's excited about these 'new wave' treatments," Ignatov explains, "because TMS and ketamine supervised by a doctor can really lift severe, chronic suicidal ideation in depression. Off-label uses for both in PTSD, pain, and cravings are also promising."
"With TMS, we've seen fast, effective, painless treatment for veterans with trauma, addiction, and 'co-morbid' conditions-which, I think, would surprise people who imagine addiction medicine as a painful, slow process."
While he supports the results of ketamine and TMS, Dr. Ignatov also gives a warning to patients seeking treatment with psychedelics and "new wave” technology: “TMS and ketamine are very helpful for our patients, and it's wonderful to help people who have never seen results before, but you must be careful choosing providers.”
"You have to be supervised by a psychiatrist or clinician who knows mental health. Anesthesiologists usually administer ketamine, but they aren't trained to ensure a patient's mental safety," Ignatov said. "No single treatment we've discovered is safe for everyone, so you have to be screened, tracked, and assessed-even for non-invasive TMS."
He explained the importance of having the right medical system and space for these newer, impressive treatments. "The rate of relief from symptoms can be up to 80 percent in some literature. But you need to match your mode to the patient in front of you and offer a controlled environment. It's not about being better because the center has a pool, it's about bringing everything together and taking every precaution."
Ignatov explained how centers under his policies protect patients. "We use advanced software to measure results, ensure continuity, and monitor response. These systems offer a high degree of certainty and solid documentation...Results are better in residence as well where patients can access every one of our programs and safeguards."
You can have a breakthrough-not after six years or six months-but after six days.
Emphasizing the vulnerability of at-risk veterans, Ignatov turned to his vision as treatment technologies improve and national providers implement. "People are starting to see the connection of mind, body, and soul-if you like. Before, providers and patients needed more time, more money, and more blind commitment to even try getting better...But, breakthroughs are coming."
Using his standard twice-weekly ketamine treatments as an example, "you can have a breakthrough-not after six years or six months-but after six days. It’s very exciting for holistic medicine with so many applications.”
“If there's a limitation for these technologies, it's that few doctors are willing to lead in this area...they resist new methods. They stick to slower, more difficult, and narrow treatments because they know them. We need more doctors willing to learn and embrace. We need doctors who are like artists, bringing together every element and technique for full recovery.”
—Devn Ratz writes from West Palm Beach. As someone in recovery, he seeks to change how we think about mental illness and total wellness through words with heart.
