Monday, September 17, 2007

VA Inconsistent in Delivery of Mental Health Services

Two internal annual VA reports that have been obtained by McClatchy Newspapers reveal that in some parts of the country mental health services are not getting the resources they need, and in several areas, they are failing to meet the VA's own goals. The reports used to be readily available to the public, but in the last year, the VA has removed them from its Web site. McClatchy obtained the reports for FY 2006 via a Freedom of Information Act request.

In fiscal year 2006, the reports show, some of the VA's specialized PTSD units spent a fraction of what the average unit did. Five medical centers — in California, Iowa, Louisiana, Tennessee and Wisconsin — spent about $100,000 on their PTSD clinical teams, less than one-fifth the national average.

The documents also show that while the VA's treatment for PTSD is generally effective, nearly a third of the agency's inpatient and other intensive PTSD units failed to meet at least one of the quality goals monitored by a VA health-research organization. The VA medical center in Lexington, Ky., failed to meet four of six quality goals, according to the internal reports.

An official at the VA dismissed the findings and played down the significance, insisting that Veterans are receiving adequate care. He insisted that the spending disparity is not as extreme as the numbers make it sound, and besides that, they are working to improve resource allocation for mental health services anyway. Spending varies widely among the units, however, from more than $2,000 per treated veteran in centers in The Bronx, N.Y., and Boise, Idaho, to about $300 per treated veteran in Augusta, Ga., and about $200 in Palo Alto, Calif., one of the reports says.

The VA is bracing for an onslaught of veterans returning from Iraq and Afghanistan experiencing PTSD, and at a time when the department is under scrutiny for shortfalls in staffing and funding for mental health units. The VA insists that they deliver high-quality care and that when comparisons are made across facilities in the system, the results are uniformly positive.

The data shows that the number of veterans who utilize the VA's specialized outpatient PTSD services is growing much faster than the number of appointments the VA is providing. The reports reveal that the number of veterans treated grew by more than 4% from 2005 to 2006, while the number of appointments scheduled grew by only 1%. This translates to veterans receiving fewer visits.

"It is the task of thoughtful planning, performance assessment and clinical care to assure that, as VA passes through a period of major change during the years to come, the treatment provided to veterans with PTSD is equitably distributed, accessible, effective and efficient," the report concludes.

Paul Sullivan, a former VA official who works for the advocacy group Veterans for Common Sense, said the numbers indicated that the VA wasn't prepared to treat the number of soldiers who were coming home with PTSD.

"If the ominous trend continues or if all our Iraq soldiers return home quickly, VA's crisis may deteriorate into a full-blown catastrophe," he said.

The influx of veterans returning from Iraq and Afghanistan needing services is already taking its toll as the agency struggles to meet demands for care. Depending on the severity of symptoms, the services provided by the VA range from inpatient intensive therapy to outpatient group therapy. Services available are split between general mental health services and individual counseling to specialized, largely group therapy programs, that deal with specific focused issues and symptoms (i.e. PTSD.) "The availability of specialized PTSD programs is an important indicator of the quality of health care provided by VA," it says.

The VA health system consists of 153 medical centers, 103 of which have special PTSD clinical units, but only 40 have specialized inpatient units for the treatment of PTSD.

Assessing the efficacy of PTSD treatment is subjective rather than objective, but by and large, programs can be evaluated for effectiveness by tracking the symptoms of veterans receiving the services. Are they abusing drugs or alcohol ('self medicating')? Are they able to hold a job? What are their work habits? Is the veteran coming into contact with law enforcement as a result of their behaviors? Are there instances of domestic violence? Other episodes of violence?

Overall, the results show, the VA offers effective treatment for PTSD, with most beneficiaries of treatment reporting that they experience a decrease of symptoms.

The VA is managing to keep it together for now, but there is only so much belt tightening and streamlining that can be done. There are only so many hours in the day and a finite number of appointments can be made. The time is long since past to fully fund the VA, and provide the care to our returning Soldiers, Sailors, Airmen and Marines that is part of the bargain when they agree to serve. They have lived up to their end of the bargain. It is time for American society to reciprocate.