More than any other war in U.S. history, the conflict in Iraq has provoked a surge of concern for soldiers returning home bearing the psychological burdens of battle.
From the war's first days, veterans' groups, mental-health organizations and some members of Congress have claimed that the Department of Veterans Affairs (VA) is unprepared to treat the tens of thousands of U.S. soldiers likely to come back with post-traumatic stress disorder (PTSD), a debilitating psychological condition.A new federal report indicates that those fears are not unfounded. On Feb. 16, the Government Accountability Office (GAO), the investigative arm of Congress, released a report criticizing the VA for failing to improve its PTSD services, even when confronted with numerous reforms suggested by its own Special Committee on PTSD. The report follows a five-month investigation by the GAO that looked at whether the VA had implemented 24 of 37 recommendations made last year by the Special Committee on PTSD, a group of VA doctors who report annually to the VA. The GAO concluded that the VA had not fully addressed any of the 24 recommendations, which run the gamut from hiring regional PTSD coordinators, to developing credentialing standards for PTSD clinicians, to establishing PTSD screening and referral systems. Specifically, the GAO report found that the VA had met 14 recommendations only partially and left 10 completely unmet; nearly half of those were longstanding since 1985. The GAO also determined that the VA had no plans to address the majority of recommendations until at least 2007."This report confirms my concerns about the VA's capacity and ability to meet the rising demand of veterans seeking mental-health services," Rep. Lane Evans from Illinois, the ranking Democrat on the House Veterans' Affairs Committee, said in a Feb. 16 statement. "It is inconceivable that the VA has yet to even name a PTSD coordinator in each of its health networks as recommended by the Special Committee."Evans, a Vietnam-era veteran, asked the GAO to investigate last May after growing frustrated with what he felt was the VA's dawdling at improving its PTSD services.
National mental-health organizations and veterans' groups have long warned that such services are being overwhelmed by an emerging population of psychologically troubled veterans and an ever-tightening budget. In 2004, at the behest of former VA Secretary Anthony Principi, the VA began drafting a Mental Health Strategic Plan that involved reinforcing PTSD programs by 2007, but at an estimated cost of $1.65 billion that's not yet in the agency's budget and so far not on the table. Congressman Bob Filner, who also serves on the House Veterans' Affairs Committee, told CityBeat that although the GAO's report was completed before President Bush submitted his 2006 budget proposal to Congress, Bush still suggested cutting VA funding by nearly 15 percent. "They are not going to be able to deal with these issues if that budget goes through," Filner said. "Not only can't they move forward, but they are going backwards."Publicly, the VA has worried about a potential strain on services but has insisted that it's ready for the estimated 16 to 30 percent of soldiers likely to return from Iraq and Afghanistan with some psychological trauma.
The VA adamantly refuted the GAO's findings. "They've taken a negative stand on what this agency does, and the report discounts all the wonderful accomplishments we've made with regard to PTSD," says Dr. Mark Shelhorse, the VA's acting deputy consultant for patient care services for mental health. According to Shelhorse, seven of the recommendations the GAO categorized as partially met have been fully satisfied, including providing PTSD screenings for new veterans. He also says the VA allocated $15 million out of its 2006 $28 billion budget for additional PTSD and substance-abuse programs, and was placing teams of PTSD experts in locations with a high density of veterans.Here in San Diego County, home to the third largest population of veterans in the nation, VA officials say PTSD services are currently strained, but they're optimistic that the situation will soon improve.
As the PTSD director for the San Diego VA healthcare system, Dr. Dewleen Baker oversees one other full-time and three part-time doctors as well as a support staff of psychologists, counselors and clinicians that has treated 112 veterans returning from Afghanistan or Iraq. But the number of PTSD patients is artificially low, warn local VA officials, who cite as contributing factors poor PTSD reporting practices, a delay of months or years in the onset of PTSD symptoms and a current wait time of more than one month to receive PTSD treatment.Feeling the squeeze of the impending return of thousands more war-weary service men and women, Baker recently applied for federal funding that will allow her to establish a clinic incorporating primary care and mental health services in one location for all returning veterans. "When we get the new clinic up and running every veteran will get a full assessment," she said. "They are going to come straight into the clinic whether they have PTSD or not."
Baker said the funding has received verbal approval and if the money comes through this spring, she plans to have the clinic up and running by fall.
While there seems to be reason for hope in San Diego, for Congressman Evans, the VA's overall response is part of the problem. "What troubles me most about this latest GAO report is the VA's hyper-sensitive posture," Evans wrote in an e-mail. "VA leadership seems unwilling to accept that GAO has found areas where improvements are necessary."Cynthia Bascetta, director of veterans' health care issues for the GAO, says she, too, was surprised at the VA's reaction and that the agency needs to do a better job of prioritizing, given that wars in Iraq and Afghanistan have made the task of addressing mental-health gaps more pressing. While estimates have varied, the VA now says 6,400 veterans from Iraq and Afghanistan have sought help for PTSD since those wars began, but the GAO questioned whether that number is even accurate. Regardless, the PTSD rate is expected to rise substantially as more soldiers return home, and the GAO urged VA brass to speed all of the recommended improvements cited in its report. The agency plans a follow-up investigation later this year. Because the VA disagrees, it has 60 days to draft a response to the Senate Committee on Homeland Security and Governmental Affairs. The GAO issued an earlier report in September, proposing that the VA update its data-keeping methods for PTSD veterans; the VA concurred. Says Bascetta, "The VA's Mental Health Plan, which is still only in draft form, is set for 2007 or later. But this looks to be a serious problem right now." B
Staff Writer Daniel Strumpf contributed to this story.