VA Mental Health Care – Ensuring Timely Access to High-Quality Care

(March 20, 2013) –It is now 10 years since the United States went to war in Iraq and the war in Afghanistan before that. The cost of these wars has been very high. Not just in tragic loss of life, not just in terms of those who came home without legs, arms or eyesight – very visible wounds – but in what is called the “invisible wounds” of war – Post Traumatic Stress Disorder, Traumatic Brain Injury, and all of the symptoms associated with these illnesses. Further, and tragically, up to 22 veterans commit suicide each day, that’s more than 8,000 veteran deaths by suicide each year. Suicide is a very serious problem for our nation as a whole. It is a major tragedy for the veterans’ community – and it is something that must be addressed aggressively.

Mental Health

Ensuring timely access to high-quality mental health care is critical for our veterans and their loved ones. And that’s what we are going to discuss today with our excellent panels. As a nation, our goal must be to ensure that veterans get the best mental health care possible, and that they get it in a timely, non-bureaucratic way

I want to commend VA for its work in this area. The Department has made great strides in providing mental health care to veterans. In fact, VA is leading the field on PTSD research. But much, much more must be done.

Addressing the mental health needs of our veterans requires a three pronged approach of timeliness, quality and appropriate care.

Timeliness

We know that our Veterans who need mental health services need them quickly. Today, all first-time patients referred to or requesting mental health care services are required to receive an initial evaluation within 24 hours and a comprehensive evaluation within 14 days. In April of last year, the Office of the Inspector General found that VHA was not meeting these benchmarks. Some veterans were waiting as many as 60 days for an evaluation. This was absolutely unacceptable and deeply troubling.

A year after those negative findings, I want to commend VA for the strides they have made in implementing recommendations from the IG report. People are no longer waiting, and veterans are getting an evaluation in 24 hours.

One thing that I am very concerned about – both in the VA and in our health care system in general – is a shortage of mental health providers. These long wait times that I mentioned were partially caused by staffing shortages. I am pleased that Secretary Shinseki has implemented the executive order to hire 1,600 new mental health clinicians. I understand that as of March 13th, VA has hired more than 3,000 mental health professionals and administrative support, including more than 1,100 of these new mental health clinicians. This is good progress toward VA’s goal.

However, I am concerned that VA has hired only 47 clinicians in the last two months. I understand the challenges here: VA must ensure they are hiring high-quality clinicians and there are certain parts of the country that are harder hit by mental health shortages, but that is no excuse. VA must step up the pace of hiring if it intends to meet its goal of 1,600 new clinicians by the end of June of this year. In order to meet this goal, VA will need to hire almost 500 clinicians in the next two months. Frankly, I don’t see how this is possible, and I want to know what the VA is going to do about it.

Quality

Just as it is critical that VA clinicians be available to see patients, they must also be properly trained to consistently deliver high-quality care. VA has made important steps in this area.

VA clinicians are now trained in evidence-based therapies such as Cognitive Behavioral Therapy and Prolonged Exposure Therapy.

While VA clinicians are trained in these therapies, VA must do a better job tracking utilization so we may ensure that what these clinicians are trained to do is being put into practice.

Appropriate Care

Access to timely and high quality care only matter if the care is delivered to veterans in the appropriate way. VA must continue to provide care in a variety of settings to meet the needs of each veteran. Medical Centers, Community-Based Outpatient Clinics, Vet Centers and Telehealth services each play important roles in appropriate care delivery.

• VA Medical Centers are equipped to treat the most severe cases conditions, such as PTSD. They are also critical in addressing the mental health care needs of patients admitted to the hospital for physical injuries.

• Vet Centers provide a safe, welcoming, home-like environment for veterans to receive care both one-on-one and in group settings.

• Additionally, Community-Based Outpatient Clinics, or CBOCs, offer mental health care services that are often closer to veterans’ homes. In certain situations, CBOCs use telemedicine to link veterans to clinicians at VA Medical Centers.

It is critical that VA provide these various options of care. We must ensure not only that these options remain available but veterans know about them.

Prevention

While VA has made tremendous strides in improving mental health care to our veterans, we must do more to ensure better prevention for today’s service members, the veterans of tomorrow. The Army – which has sustained the highest rates of suicide among the services in recent years – has addressed this issue head-on.

Based in large part on the efforts of this Committee, the Army Task Force on Behavioral Health recently completed a comprehensive review of behavioral health care. The report provided multiple recommendations for improving mental health care, including:

• positioning behavioral health experts at both the command and installation levels to provide better consultation, guidance, and care coordination;

• ensuring each installation appoints a Director of Psychological Health; and

• Maximizing tele-behavioral health at remote locations.

I look forward to hearing from our Army witness about these efforts and any others to improve soldier-readiness and resiliency.

It is my sincere hope that the Department of Defense as a whole will benefit from the Army’s work and adopt these recommendations. Such efforts are critical to ensure not only a healthy military force but also a healthy veteran population in the years to come.

A Community of Care

While we often think of the military and VA as providers of mental health care for our service members and veterans, community organizations like the ones that will testify here today play a key role in helping veterans access the care they need. These organizations can partner with VA to identify veterans in need of care, work with veterans to help them prepare for care and provide direct care to veterans.

• The National Alliance for Mental Illness has created a Veteran and Military Council to address specific mental health needs of veterans.

• Give an Hour, a non-profit organization, provides free mental health services to veterans and their families.

• Team Rubicon organizes veterans to contribute to communities in the wake of natural disasters.

These organizations do not shy away from the worst consequence of serious mental illness – suicide. In my home state, the Vermont Veterans Outreach Program, operated by the Vermont Guard, has intervened to prevent suicides from occurring. I am tremendously proud of their work.

Other organizations, like the Tragedy Assistance Program for Survivors help family members cope with the heartbreaking loss of a loved one to suicide.

This is a tremendously difficult issue with no single answer. Our goal today is to understand what works, what needs improvement and where we go from here.

Mental health is just one facet of a veteran’s life but one that has repercussions for physical health; employment; education; and housing.

When we work to provide what is necessary to help improve a veteran’s mental health, we improve the overall life of the veteran. Each department and organization represented here today plays an important role in this. And I thank you all for being here today.

It is up to all of us to ensure service members are prepared for the difficulties of war, veterans receive timely access to care and not one more veteran or service member commits suicide.

I commend all of you for your efforts and look forward to your testimony.