Care for Your Mind acknowledges and appreciates the collaboration of the National Network of Depression Centers in developing this series.
Sanjai Rao, M.D., VA Medical Center, San Diego
In my previous post, I addressed the challenging state of mental health care for our nation’s returning veterans and their increased risk of suicide. It’s crucial that we step up and ensure that mental health care is available to all former servicemen and women who need it. Now, I propose some possible solutions.
First, a disclaimer: although I work for the VA, I am writing this post as a private citizen, not a VA employee. The views expressed here are entirely my own and not in any way meant to be reflective of those of VA leadership.
Expanding the VA
In order to ensure the best possible outcomes for veterans in need, the VA needs to grow. With more resources, we can hire and train more mental health professionals, and therefore treat more patients. As I discussed earlier, the VA is by far the best place for veterans to get state-of-the art, evidence-based mental health care, but the VA system doesn’t have the capacity to treat everyone as quickly as they need. We do the best we can with what we have, but ultimately Congress regulates our size and budget. It’s up to our elected officials to provide the funding we need to increase our capacity.
At this point, you might be wondering whether the public can trust the VA to use additional resources efficiently. After all, wasn’t the VA involved in a “scandal” where patients waited for extraordinarily long times to get care? Yes, there were reports of this happening in some VA facilities, but in part I see it as a reflection of the difficulty of caring for an expanding pool of veterans without a corresponding increase in resources.
The VA has come a long way in addressing the negative stigma and lack of awareness surrounding veterans’ mental health needs, but encouraging veterans to seek care creates frustration and additional suffering if we don’t have the capacity to treat them in a timely manner.
Thankfully, this does appear to be changing. At the San Diego VA, we have been working to fill vacancies and hire new mental health staff, and I hope and assume that this is true across the country.
The Barriers of Bureaucracy
As with many large organizations, the VA can also sometimes be weighed down by its own bureaucracy. As a clinician, I spend a significant amount of time on tasks and requirements that don’t always improve patient care.
Here’s one small example of the larger problem: every patient at the VA is mandated to be regularly screened for depression, substance abuse, PTSD, and a number of other issues. However, when a patient’s case is severe enough that they need to be admitted to our psychiatric unit, they go through a comprehensive evaluation that is significantly more thorough than these screens.
Despite its magnitude, that intake process does not satisfy the requirements for the individual screens. So, as doctors we’re forced to duplicate efforts with many of these patients, and re-screen them despite the fact that they’ve already received a comprehensive exam. Clearly, regular screening for serious mental health issues is a laudable goal, but with rational changes in these kinds of procedures, we could gain back a lot of time and use it to treat more veterans.
Beyond the VA: How the Community Plays a Role
The VA isn’t the only player when it comes to providing care. An expansion of community resources is another important element for returning veterans. Too often, they feel abandoned or isolated, and while medical care is key, veterans also need social support — recreation, group activities, and opportunities to forge friendships. There aren’t enough places that these men and women can go and feel like they have worth outside of their status as a veteran.
The VA, which doesn’t generally fund outside or community programs directly, will pay for certain types of outside care when a veteran has substance abuse issues (recovery homes, sober living, etc.). In addition, referral to a community program is available on a case-by-case basis if the mental health team recommends it and the administration agrees. Aside from the VA’s efforts and funding, it would be a great benefit for communities to have more organizations and advocacy groups stepping up to offer support and care to veterans in need.
How You Can Help
Whether you’re the parent, spouse, child, friend, or colleague of a veteran who’s struggling, there are many ways you can provide support. You can offer understanding, patience, and awareness about mental health issues. You can help the person you care for see that they’re not alone and urge them to seek professional care. The Veterans Crisis Line is available 24 hours a day, seven days a week, and is staffed with qualified VA responders. Veterans and their loved ones can reach the line anonymously at 1-800-273-8255 (press 1), access it online, or send a text message to 838255.
If you’re an employer, please consider giving a veteran a chance. These men and women have unique experiences and backgrounds, and they’ve acquired valuable skills that can be extremely useful in the professional world.
Above all, as advocates for veterans, we must ask elected officials to increase funding to the VA. Please contact your representatives and senators, and tell them to stand up for our at-risk servicemen and women.
If we work together to expand access and increase resources, we can improve the state of care in this country and provide treatment for every single veteran who needs it. They deserve nothing less.
- Which of Dr. Rao’s suggestions do you think can be achieved? Why?
- What organizations or groups are available in your community to support Veterans in need of mental health care and support?
- What will you do to support increasing the capacity of the VA to provide mental health care to Veterans?
Dr. Rao received his medical degree from the University of California, San Diego, and is board certified in general psychiatry and psychosomatic medicine. His primary clinical role is inpatient attending psychiatrist at the VA Medical Center in San Diego. Dr. Rao currently serves as both an Associate Training Director and the Site Director at the VA Medical Center for the UCSD Psychiatry Residency and Co-Chair of the NNDC’s Military, Veterans and Families task group. Dr. Rao coordinates large parts of the residency curriculum, and has received a number of teaching awards based on his clinical and academic work. His current research activities include serving as the San Diego Site Investigator for VAST-D, a multi-site VA Cooperative study on treatment of depression in patients who have failed at least one antidepressant. He has also conducted research on improving the assessment and treatment of depression and delirium in the palliative care setting. Dr. Rao has published in several areas, including depression and delirium in palliative care, anxious depression, side effects of antipsychotic medications, and residency training.