Not long ago, a veteran in crisis went to a Veterans Affairs (VA) medical facility only to learn that he couldn’t get immediate help. The result: within five hours of walking away from the health care facility, he killed himself.
While the Veterans Affairs medical system has some shining success stories across the nation, congressional representatives have heard about serious shortcomings that raise a warning flag.
Today, with veteran suicide rates officially at 22 per day, a number that is said to be approximately half of what the real rate might be because of undercounting, taking care of veterans in crisis is a point of emphasis that is not being met in the best way possible today.
“We expect better of the VA medical care system,” Rep. Mariannette Miller-Meeks (R-IA), chair of the House Veterans' Affairs Subcommittee on Health, said after a subcommittee hearing Tuesday where the panel heard testimony about a litany of situations, including the one she recounted above.
“We hold oversight because what’s occurring at the VA Medical Center and what is occurring in referrals for community care when veterans are in need … needs to be addressed and addressed rapidly,” Miller-Meeks said. “So we’ll continue to ask for both collaboration and verification, as we’ve said, but what you have learned today should, in fact, put you on notice and put you on record.”
These issues have far-reaching impact because, according to the U.S. Census Bureau as reported by Statista, the nation's veterans totaled approximately 16.5 million in 2021, and most of them were men over the age of 75.
In 2019, approximately 6.2% of veterans, or 1.3 million people, struggled with substance abuse, according to Addiction Help. Veterans are at a higher risk of experiencing mental health problems and substance addictions than civilians, and veterans who were injured or experienced trauma during service are at an even higher risk.
Two stark versions of the state of the VA health care system were painted at Tuesday's hearing. On one side, Dr. Tamara Campbell, executive director of the U.S. Department of Veterans Affairs, described how the VA governs how to ensure the best care for those in need; the flip side illustrated a system in disarray that fails to give those in crisis (with a focus on mental health and/or substance use disorder) timely help.
The hearing was split into two parts, one where the VA and other government entities were represented; the second featured an array of veterans’ supporters who testified about the travails a veteran in need faces.
The VA has had a department that is tasked with focusing on many aspects of mental health, from post traumatic stress disorder (PTSD) to substance use disorder (SUD) and beyond for decades. Campbell said approximately 140 people work in that department.
But Congressman Derrick Van Orden (R-WI) questioned the efficacy of the unit, asking why the rate of veteran suicide is not falling off since the department's inception. Indeed, he suggested the VA has been accused of undercounting veteran suicide because its metric doesn't include drug overdose deaths, a fact Campbell confirmed.
“So, is your office preventing suicide or not, or are we just spending money and hiring people so that they can get together, come to these committee meetings, submit reports, use metrics that can’t be defined?” he asked.
“I do believe we are moving the needle on this,” Campbell said. “We have a full public health approach where suicide prevention is concerned, and the field of mental health (psychology, psychiatry) has evolved over the past 30 to 40 years and as we continue to evolve we are learning new things, new methods, new evidence-based approaches that we can use.”
Van Orden then asked why the VA hasn’t followed the lead of programs, such as the Mighty Oaks Foundation, which have a track record of preventing veteran suicide.
The VA’s focus is on “evidence-based approaches” and it has not often looked to faith-based groups to copy their methods, though “We are certainly willing to sit down with them to see how we can partner with them,” Campbell said.
The veterans’ advocates charged that the VA is so entrenched in bureaucracy that it sometimes either can’t serve those in need or its workers don’t point veterans in the right direction when it comes to community care, a treatment option highlighted in the 2018 Mission Act.
Daniel Elkins, chief of staff of The Independence Fund, pointed out cases where the VA’s policies often tie the hands of providers, sometimes conflicting with other edicts. He mentioned the need for one VA facility to call five others to look for beds for residential treatment programs before referring a veteran to community care.
He also said his group has found cases where VA administrators or senior staff members sometimes overrule community care referrals, and other situations where staff members aren’t well-versed enough with the options to recommend them to veterans.
“We must ensure that all criteria for community care wait times, travel distance and access standards under Mission Act” are followed, Elkins said.
The VA Office of the Inspector General (OIG) has identified similar problems, finding “that VA faces significant challenges in meeting the needs of individual with substance use disorders,” Rep. Julia Brownley (D-CA), who also leads the Veteran Affairs Subcommittee on Health, said.
VA’s objective, as Campbell said, is that “Nothing is more important to VA than supporting the health and well-being of our veterans and their families.”
Julie Kroviak, principal deputy assistant inspector general at the VA, said the OIG, as a result of its recent assessment, made five recommendations – including one that addresses the need for VA staff to comply with community care referral requirements and another recommending a review of the facilities. The OIG will be checking back at the end of this month to see what progress the VA has made on its recommendations on how to streamline and better serve those in need, she said.
