Mental health needs still unmet

Despite adding billions of dollars for mental health care to Department of Veterans Affairs budgets the last four years, and the hiring of 7,000 more mental health professionals at VA clinics and hospitals, many veterans with severe combat-related stress still face long waits to get the care they need.

And some VA facilities might be “gaming” appointment dates so they appear to comply with a rule that veterans with post-traumatic stress disorder, or PTSD, begin treatment within 14 days of seeking care.

Those were just two of many complaints leveled at VA officials who oversee the department’s burgeoning mental health care program during a hearing last week of the Senate Veterans Affairs Committee.

The most disturbing testimony came from Michelle Washington, coordinator of PTSD services and evidence-based psychotherapy at the VA medical center in Wilmington, Del. She said staff shortages are impacting patient care as needed therapy for severe PTSD cases gets delayed by weeks or months, and scheduled appointments are sacrificed to management’s higher goal of boosting new patient enrollment figures.

The evidence-based psychotherapy she uses for severe or complex PTSD cases, said Washington, involves 10 to 12 consecutive weekly sessions during which patients “re-experience” the trauma and address “erroneous beliefs” about the event so they “better process” trauma memory.

But scheduling patients for a series of weekly appointments “is very difficult at my facility,” Washington said. Patients wait as long as six weeks for their first appointment. While waiting, some patients lose their motivation for treatment while others see their PTSD worsen.

“Also, because scheduling clerks are under great pressure to bring new veterans in within 14 days, they may take one of my PTSD patient’s regular appointments for a new patient appointment, which hurts the effectiveness of my patient’s treatment,” said Washington.

The Wilmington center appears on paper to schedule appointments for PTSD patients within the mandated 14 days. But the first visit often will involve paperwork and patient history and no therapy, allowing statistical records to indicate treatment has begun.

She also described a “pervasive shortage of primary care providers” that results in patients being referred erroneously to mental health care for lack of an initial comprehensive care assessment to diagnosis properly conditions that require medical care and not a mental health provider.

John Roberts, executive vice president for mental health at the Wounded Warrior Project, urged VA to enhance mental health by using its authority to refer patients to civilian providers when VA resources don’t allow timely care, and by expanding peer support programs so that PTSD patients get mentoring and encouragement from veterans successfully treated.

AccordIng to a VA survey of frontline mental health care providers, 40 percent of providers said they could not schedule an appointment in their clinic within the VA-mandated 14-day window and 70 percent said they did not have adequate staff or space to deliver timely care.

Yet VA officials in July told Congress that 95 percent of veterans were getting appointments within the 14-day window.