Long waits at the VA for mental health care

EL PASO, Texas (AP) — Nick D’Amico, a deeply troubled
Army veteran, had been seeing a counselor every other week. But he found
it next to impossible to get a follow-up appointment at the El Paso VA
with a psychiatrist who could adjust his medication, according to his
The best the system could offer, she says, was a half-year
wait for a teleconference with a Veterans Affairs psychiatrist in
Albuquerque, New Mexico.
That appointment was still two months
away when D’Amico, 45, left his wallet, phone, watch and Desert Storm
hat at home and committed suicide by driving off a cliff outside El Paso
last September.
"It’s shameful. It’s disgusting. It’s got to stop," says his mother, Bonnie D’Amico.
years, veterans have complained about maddening waits for mental health
services at VA medical centers, and for years federal officials have
responded by hiring more clinicians and expanding programs. This week, a
devastating internal investigation that looked at wait times for all
sorts of care across the VA system showed that the agency hasn’t solved
the problem.
It found, for example, that new mental health
patients were routinely forced to wait a month or more to start
treatment. Not one of the 141 medical systems examined was able to meet
the department’s goal of getting all new mental health patients an
appointment within 14 days. At 30 facilities, the average wait topped 40
For D’Amico and other patients, the delays have had real-world consequences, according to family members,
vets and experts.
Paul Summergrad, a psychiatry professor at the Tufts University School
of Medicine and president of the American Psychiatric Association, said
that aside from delaying needed care, the long waits destroy any sense
of connection between the patient and the provider, making successful
treatment less likely.
"We have a suicide crisis. We have a
post-traumatic stress crisis. We have a traumatic brain injury crisis,
all going on at the same time," Summergrad said. "To have them wait is
Andrew Danecki, a former Marine corporal who
served in Afghanistan, got a taste of the waiting game in 2011 when he
sought treatment at the Durham VA Medical Center in North Carolina for
symptoms that included anger, depression and crippling fatigue.
said he was able to start seeing a counselor in a reasonably short
amount of time and eventually got in to see a psychiatrist, but when the
doctor suggested he undergo a sleep study to help understand why he was
so exhausted, it took eight months to get the appointment.
that wait, he kept falling asleep on his couch, nearly nodding off
behind the wheel of his car, and wondering why, at age 25, he was such a
When he finally underwent the study, doctors were able to
quickly diagnose him with obstructive sleep apnea, a condition that can
be linked to post-traumatic stress. Danecki was put on a machine called a
CPAP that helps him breathe more regularly at night. His chronic
exhaustion vanished immediately.
"If I would have done that a lot
sooner, maybe a lot of those issues that I had dealt with could have
been cured, or at least, you know, calmed down," he said.
was a missile-defense specialist who served in the Army for four years
in posts including South Korea and Saudi Arabia and never saw combat,
according to his mother. She said he was withdrawn and moody and had
been diagnosed with major depression.
One time, he was already at
the VA clinic in El Paso in 2012 when he was told that his appointment
with a psychiatrist had been canceled. It was the fifth time that had
happened to him, according to his mother, who says her son went
"ballistic" when told he would have to wait another two months.
"The guards there had him restrained and all," she said.
The findings released Monday on long wait times for mental health care will not surprise anyone familiar
with the VA system.
congressional hearings have highlighted long waits for care. The VA’s
inspector general issued scathing reports in 2011 and 2012. VA
clinicians have repeatedly come forward to complain about such things as
staffing shortages and a scheduling system that was routinely
manipulated to cover up delays.
In 2011, a federal appeals court
in California was so disturbed by the system’s inability to handle
mental health issues that it declared the VA’s treatment of vets
"The VA’s unchecked incompetence has gone on
long enough; no more veterans should be compelled to agonize or perish
while the government fails to perform its obligations," U.S. District
Judge Stephen Reinhardt wrote in a decision that was later overturned on
jurisdictional grounds.
The VA hasn’t ignored the problem. It has
repeatedly boosted mental health staffing levels — although in doing so
it has barely kept ahead of a surge in patients. The number of vets
getting mental health treatment in the system climbed from around
900,000 in fiscal 2006 to 1.4 million in fiscal 2013.
Last June
the VA announced it completed yet another hiring campaign, ordered by
President Barack Obama. An additional 1,600 clinicians and 300 support
staff were hired. It also hired 800 peer counselors, launched a suicide
prevention campaign and held over 150 "mental health summits" to discuss
the needs of vets and their families.
Yet, the internal
investigation found that 48 VA medical centers had an average wait
between 31 and 40 days for new mental health patients. Fifty-eight
centers had an average delay of 21 to 30 days.
DeAnne Seekins,
director of the Durham VA, said the hospital opened a mental health
access center a year ago to reduce wait times and is trying to recruit
an additional 16 mental health providers.
The El Paso VA had some
of the nation’s worst wait times: 60 days for new mental health patients
and 16 days for patients seeking follow-up care. In fact, Texas had
four VA facilities in the top 10 with the longest waits for mental
health services. VA administrators cited recruiting challenges as a
Sheila Austin, a spokeswoman for the VA in El Paso, where
D’Amico was getting care, said attracting clinicians to the West Texas
desert isn’t easy.
"El Paso is a medically underserved community.
It is hard to recruit psychiatrists, not only in the VA but also in the
private sector," she said. "We offer incentives, but it still is a
Associated Press writers Christopher Sherman
in McAllen, Texas, Michael Biesecker in Durham, North Carolina, and
John Raby in Charleston, West Virginia, contributed to this report.