The Legislative Response to PTSD in the United States (1989–2009): A Content Analysis

Abstract

Although knowledge about posttraumatic stress disorder (PTSD) has grown over the past 40 years, PTSD policy research is undeveloped. This gap in knowledge warrants attention because policy is among the most powerful tools to prevent and mitigate the effects of PTSD. This study provides a content analysis of all bills introduced in U.S. Congress that explicitly mentioned PTSD. All bills and bill sections mentioning PTSD were coded to create a legislative dataset. Bills that addressed traumatic stress, but did not mention PTSD, were also identified as a comparison group. One hundred sixty-one PTSD explicit bills containing 382 sections of legislative text were identified, as were 43 traumatic stress, non-PTSD bills containing 55 sections (the 2 categories were mutually exclusive). Compared to traumatic stress, non-PTSD sections, PTSD explicit sections were far more likely to target military populations (23.6% vs. 91.4%) and combat exposures (14.5% vs. 91.4%). PTSD, as a discrete diagnostic entity, has been largely defined as a problem unique to combat exposure and military populations in federal legislation. Research is needed to understand knowledge and perceptions of PTSD among policy makers and the public to inform science-based advocacy strategies that translate the full spectrum of PTSD research into policy.

Mapping “Trauma-Informed” Legislative Proposals in U.S. Congress

“…Although the volume of trauma-informed bills introduced in US Congress increased dramatically, only two of these bills (4.1%) became law—slightly less than the proportion of bills (9.3%) that became law in a mapping study of federal legislative proposals to address PTSD (Purtle, 2014). By identifying these two trauma-informed bills, however, our study raises empirical questions about their implementation, enforcement, and potential impacts.…”

“…It should also be noted that over one-quarter (29.6%) of trauma-informed sections were symbolic and did not include provisions that would have instrumental impacts on trauma survivors. This is more than twice the proportion of bill sections that were symbolic in the mapping study of federal legislative proposals to address PTSD (13.7%) (Purtle, 2014). This finding could reflect the fact that trauma-informed practice is a newer construct than PTSD and that these symbolic sections served to educate congresspersons about the notion of trauma-informed practice.…”

“…The boundaries of bill sections were delineated by the headings “Sec.” before and after the mentions trauma-informed practice. In this article, bills that included trauma-informed language are referred to as “trauma-informed bills” and bill sections that included trauma-informed language referred to as “trauma-informed sections.” Preliminary coding categories and sub-categories were established a priori based on an earlier policy mapping study of federal legislative proposals to address post-traumatic stress disorder (PTSD) (Purtle, 2014) and scholarship about trauma-informed policy (Ardino, 2014; Bloom, 2016; Bowen & Murshid, 2016; Fairbank & Gerrity, 2007; Gerrity, 2007; ISTSS, 2010; Shern et al, 2016; Shonkoff & Fisher, 2013). …”

“…By assessing trends in the volume of policy proposals to address an issue, mapping studies can provide indication of changes in the amount of attention an issue is receiving from policymakers (Tremper et al, 2010; Wagenaar, Erickson, Harwood, & O’Malley, 2006). Mapping studies are frequently conducted for policies related to physical health (e.g., air quality and food safety), but are underutilized in the field of mental health (Peck & Scheffler, 2002; Purtle, 2014; Rowan, Duckett, & Wang, 2015). For example, The Policy Surveillance Program at Temple University conducts ongoing mapping studies for 58 health-related policies and only one is focused on mental health (i.e., involuntary commitment laws).…”

Advancing a national cradle-to-grave-to-cradle public health agenda

“…As he has demonstrated in his research, at the Congressional level most attention, where it exists at all, has been directed toward combat veterans and relatively little has been directed toward civilian survivors (Purtle, 2014(Purtle, , 2016. A policy typology that differentially defines trauma informed, trauma responsive, and trauma specific may help to define a typology of trauma policies as well.…”