Thomas J. Berger
Ph.D., Executive Director of the Veterans Health Council for Vietnam Veterans of America
CFYM continues our series examining the state of mental health care provided in VA hospitals and centers. In today’s post Tom Berger, Executive Director of the Veterans Health Council for Vietnam Veterans of America examines whether or not the VA is meeting its own policies outlining how long a vet should wait to receive a mental health evaluation.
First, we must recognize that the Veterans Health Administration (VA) has made some significant progress in its efforts to improve the quality of mental health care for America’s veterans. For example, although not all mental health clinical staff has yet been trained, VA should be commended for its system-wide adoption (finally) of evidence-based cognitive behavioral treatment modalities for PTSD. In addition, the development of various web-based program applications and social media mental health outreach campaigns reflect a much better effort to reach America’s veterans. But while these efforts are laudable, there are reasons to believe they have not gone far enough, especially when accessing the VA mental health diagnoses and treatment programs.
As far back as April 2012, an Inspector General (IG)’s report concluded that the VA does not have a reliable or accurate method of determining whether they are providing veterans timely access to mental health care services and that the VA is unable to make informed decisions on how to improve the provision of mental health care to veteran patients due to the lack of meaningful access data. This is absolutely unacceptable
Does internal reporting tell the full story?
VA policy requires that all first-time patients requesting mental health services receive an initial evaluation within 24 hours, and a comprehensive diagnostic appointment within two weeks. For years now, VA officials have claimed that 95 percent of its new patients were seen in that time frame. But a 2013 IG report called those calculations confused and inaccurate. By IG researchers’ count, fewer than half of those patients were seen within the 14-day requirement. The average wait for a full evaluation among the rest was 50 days.
The report also sharply criticized VA staffers for not following proper scheduling procedures, further confusing the data collection. For new patients, scheduling clerks frequently stated they used the next available appointment slot as the desired appointment date for new patients, thereby showing deceptively short wait times. For established patients, medical providers scheduled return appointments based on known availability, rather than the patient’s clinical need. The report found that the VA’s system for measuring waiting times for evaluations “had no real value” because it measured how long it took the department to conduct the evaluation, not how long the patient waited to receive it. As a result, the report said, even if a patient waited weeks for an appointment, the VA could say there was zero waiting time if it completed the evaluation on the same day it was conducted.
Is provider capacity to blame?
Although IG investigators also blamed some of the long wait times on shortages in mental health staff throughout the department and noted that from 2005 to 2010 mental health services increased their staff by 46 percent. However, according to the report “VHA’s mental health care service staff still did not believe they had enough staff to handle the increased workload and consistently see patients within 14 days of the desired dates.” These flaws in the VA’s appointment system has for example, led to an average wait time of 28 days for patients at the Milwaukee VA Medical Center and over 80 days at the Spokane VA center in Washington state. And in several extreme cases reported in the media, lack of immediate access to mental health services has resulted in veteran suicides.
Although the IG recommended, among other things, that the VA revise its method of measuring waiting times and analyze its staffing levels to ensure that it is able to abide by its own policies, it remains unclear as to how this will be accomplished so that VA facility and VISN directors can no longer “game” the system. Under Secretary for Health, Dr. Robert A. Petzel, said in a letter to the IG that the VA generally agreed with the recommendations and that it would initiate a timeliness review of its entire medical system, not just the four regions analyzed by the inspector general. Thus, we are forced to ask the questions: Precisely how will this be accomplished so as to finally end this despicable practice, and exactly what productivity and performance measures will be utilized to determine whether the VA’s measurements and analyses are real and correct?
- Have you had to wait more than 24 hours to receive an initial mental health evaluation?
- How long did you have to wait to receive a full evaluation after your initial appointment?
- How can the VA centers and hospitals improve on wait time between appointments?