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Friday, February 09, 2007

McClatchy Digs Deep into VA PTSD Care Records

An impressive and significant investigation measuring the performance of the Veterans Administration in delivering required mental health care services to returning veterans arrived today. Chris Adams of McClatchy Newspapers sifted through 200 million VA records, including all appointments from 2005; examined a wide variety of VA documents, including those publicly available and those obtained through Freedom of Information Action requests; and interviewed veterans, military family members and mental health experts. The results are not pretty.

Click on 'Article Link' below tags for more...

In the interest of public education, I will quote from the piece extensively:

The VA's mental health experts started pushing for specialized PTSD programs in all medical centers in the 1980s. Top VA officials agreed "in concept" that it would be a good idea. But in 2005 and 2006, despite telling Congress that it was setting aside an additional $300 million for expanding mental health services, such as PTSD programs, the VA didn't get around to spending $54 million of that, according to the Government Accountability Office.

At medical centers with no specialized PTSD teams, veterans still get PTSD treatment, but not from the specialists whom the VA considers to be most essential.

In all, only 27 percent of veterans receiving PTSD care received it in one of the VA's specialized programs, VA data show. And that varies widely: In the region that includes Wisconsin, 13 percent of veterans with PTSD got care from specialized teams. In Ohio, 45 percent did.

The amount of specialized care came up at a Senate committee last February, in which VA Secretary Nicholson assured lawmakers that PTSD funding wasn't a problem. "We're certainly getting the resources" to deal with the issue, he testified. "In every one of our 154 major medical centers, we have a certified expert on PTSD."

But that doesn't come close to meeting the goals of the VA's own committee of PTSD experts, which for years had urged a full PTSD clinical team in every VA medical center - not just an expert. By 2006, there were full PTSD clinical teams in 104 of 163 medical centers; in the past, the department's inspector general has questioned whether people are really working in some of those units.

In the same month as Nicholson's testimony, the VA's PTSD expert panel sounded a different note from the secretary's. "Just having a team or a PTSD expert does not solve the problem," the committee concluded. It added: "Specialized PTSD programs are not ready to meet the ongoing needs of veterans of past deployments while also reaching out to new combat veterans."

A few conclusions:
- Despite a decade-long effort to treat veterans at all VA locations, nearly 100 local VA clinics provided virtually no mental health care in 2005. Beyond that, the intensity of treatment has worsened. Today, the average veteran with psychiatric troubles gets about one-third fewer visits with specialists than he would have received a decade ago.

- Mental health care is wildly inconsistent from state to state. In some places, veterans get individual psychotherapy sessions. In others, they meet mostly for group therapy. Some veterans are cared for by psychiatrists; others see social workers. And in some of its medical centers, the VA spends as much as $2,000 for outpatient psychiatric treatment for each veteran; in others, the outlay is only $500.

- The lack of adequate psychiatric care strikes hard in the western and rural states that have supplied a disproportionate share of the soldiers in the wars in Iraq and Afghanistan - often because of their large contingents of National Guard and Army Reserve troops. More often than not, mental health services in those states rank near the bottom in a key VA measure of access. Montana, for example, ranks fourth in sending troops to war, but last in the percentage of VA visits provided in 2005 for mental health care.

Moreover, the return of so many veterans from Iraq and Afghanistan is squeezing the VA's ability to treat yesterday's soldiers from Vietnam, Korea and World War II. And the competition for attention has intensified as the vivid sights of urban warfare in Iraq trigger new PTSD symptoms in older veterans.

"We can't do both jobs at once within current resources," a committee of VA experts wrote in a 2006 report, saying it was concerned about the absence of specialized PTSD care in many areas and the decline in the number of PTSD visits veterans receive.

- Some veterans get in for visits far more than others. The average number of visits per veteran with PTSD ranged from 22 in the Hudson Valley, N.Y., medical center and clinics to a low of 3.1 in Fargo, N.D. The national average was 8.1.

- Some VA medical centers spend far more on mental health care than others. In Connecticut, it was an average of $2,317 for each veteran's outpatient psychiatric care. In Saginaw, Mich., it was $468.

- Some veterans get in quickly. Others wait. At the Loma Linda, Calif., VA network, only 39 percent of new mental health patients were able to get appointments within 30 days, the VA's standard. In other networks, 90 percent or more did.

- Once they're in the door, some veterans get visits of 75 to 80 minutes, while others get 20- to 30-minute appointments, the shortest psychotherapy appointments listed in the system. Of all the individual sessions for veterans with PTSD, those in the Amarillo, Texas, network got the shortest possible visits 87 percent of the time, while those in Butler, Pa., were given those short visits 6 percent of the time.

The VA's mental health system is nonexistent for many veterans it's supposed to serve. One key measure is the number of veterans with mental illnesses who get all their treatment outside the VA mental health system - that is, typically from the VA's general primary care doctors. Nationwide, 22 percent of veterans got all of their mental health care outside the mental health system.

But there was a big range: In Beckley, W.Va., 10 percent got their care that way. In Montana, 52 percent did, data from 2005 show.

A thank you to McClatchy for providing us with this important information.

See the accompanying photos, and the read the full piece to learn of two troops who slipped through the VA healthcare cracks after returning from their Middle East deployments, Timothy Bowman, who killed himself on Thanksgiving Day 2005, and Joshua Omvig who followed in his footsteps a month later.

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