Today I am blogging because I am angry. Like many Americans, I am saddened by the deaths of twelve innocent people in Washington DC this week. My emotions have been difficult to reconcile over the last 48 hours. Often, blogging can be therapeutic for me–today this is particularly true. Typically, my musings are less than 750 words in length–please forgive me but today I may have to go a bit longer…
The tragic events that occurred at the Naval Shipyard in Washington, DC on Monday have forced all of us to reflect and many of us have begun asking very specific questions: why did this happen? how could this happen? and, most importantly, could this have been prevented? As details have emerged, it has become apparent that the alleged gunman Aaron Alexis was suffering from significant mental illness. The reports of his symptoms suggest psychotic features such as those seen in patients with schizophrenia. As the investigation continues, it appears that the gunman was a veteran (navy reservist) and had sought mental health counselling and care from the VA hospital system. Unfortunately, the “system” failed him—failed those who were killed in the Naval Shipyard shooting– and ultimately has failed all of us. Our veterans deserve better. The VA healthcare system is a proud institution with a rapidly increasing number of patients as the wars of the last 10 years continue to produce ailing servicemen and women in need of care.
Mental health care in the VA system has been identified as a major weakness by those in the VA administrative offices in Washington DC as early as the end of the Iraqi war. As reported on National Public Radio (NPR) in 2012, the VA has not been keeping up with mental health demands. In response to the increasing number of veterans entering the mental health system, the inspector general made it a priority to improve mental health services and decrease wait times for veterans requesting help. In the last five years, the number of veterans requesting mental health services has increased by 33%. In response, the VA appropriately approved increased funding and beefed up standards for patient evaluation and management. However, it has become apparent that the ways in which the VA measures itself against a “standard” is rather dysfunctional.
In a hearing in Atlanta in July, 2011, Senator Patty Murray, Chair of the Senate Veteran’s Affiairs Committee, questioned the way in which the VA has been handling mental health care claims. The Inspector general issued a report and admitted before the Congressional Committee that the VA had skewed the statistics in order to make wait times appear shorter than they really were.
In an opening statement, Senator Murray states:
“In the face of thousands of veterans committing suicide every year, and many more struggling to deal with various mental health issues, it is critically important that we do everything we can to make mental health care more accessible, timely, and impactful. Any veteran who needs mental health services must be able to get that care rapidly, and as close to home as possible”.
As I mentioned above, during the hearing data was presented that seemed to indicate that most patients were receiving timely mental health care and referrals–the standard is that any patient requesting mental health services is contacted within 24 hours and an appointment is scheduled within 14 days. However, upon closer inspection, it was determined that the way in which the VA tracked this data was flawed. They only counted the time until an appointment was scheduled. Real data from veterans in mental health referral situations shows that the average wait for mental health services in the VA system is actually 50 days. In some centers (Seattle, for instance) the average wait is nearly 80 days! Mental health requests will continue to increase as more brave soldiers return from battle. Those who have served must be afforded with easily accessible, timely healthcare. Certainly, in the case of naval shipyard shooting suspect Aaron Alexis, better access to more comprehensive mental health care may have made a difference and this week’s tragedy could have been averted.
Senator Murray, after the Atlanta hearings in 2011, issued a summary statement that we should take notice of again today:
“This report confirms what we have long been hearing, that our veterans are waiting far too long to get the mental health care they so desperately need. It is deeply disturbing and demands action from the VA. This report shows the huge gulf between the time VA says it takes to get veterans mental health care and the reality of how long it actually takes veterans to get seen at facilities across the country…this report clearly shows that the VA is failing to meet their own mandates for timeliness. Clearly the VA scheduling system needs a major overhaul. The VA also needs to get serious about hiring new mental health professionals in every corner of the country.”
The Senator goes on to say “…the VA is failing many of those who have been brave enough to seek care. It is hard enough to get veterans into the VA system to receive mental health care. Once a veteran takes the step to reach out for help we need to knock down every potential barrier to care”
It is clear that we must do more. Large agencies such as the VA must eliminate the bundles of red tape that those seeking mental health evaluation and assistance must navigate. Every single day there are multiple suicides among veterans. Although money has been allocated for hiring new mental health professionals, a report issued as recently as February 2013 indicated that although roughly 1900 new mental health professional positions have been created, they are not yet filled. In fact, other previously approved vacant positions have yet to be backfilled. Our veterans continue to suffer.
When are we going to get serious about providing timely access to mental health services? Now, more than ever, we have been given a solemn wake up call. Shall we wait for another mass shooting rampage before we seriously attack the problem? Do we continue to tolerate those that manipulate data to meet predefined metrics or do we say ENOUGH! We need action NOW to prevent future tragedies. The VA system was created to SERVE those who have SERVED. It is time to live up to that lofty charge and provide prompt mental health care services to those who need it. Hopefully, with time, those who are grieving losses at the Naval shipyard will heal–lets honor the memory of the fallen by working to provide better mental health services in the US today.
Dr. Kevin Campbell, MD 