By Sandra Basu
WASHINGTON – A parade of grieving family members testified last month before a House of Representatives committee trying to determine why significant increases in VA’s mental health and suicide prevention resources have not stemmed the tide of suicides — estimated to average about 22 veterans committing suicide every day for the past 15 years.
Among them were Dr. Howard and Jean Somers who lost their son Daniel to suicide last year.
“There is no question that family involvement is beneficial,” Mrs. Somers told the House Committee on Veterans Affairs. In recommendations they presented, the couple recounted how they were told that privacy laws prevented VA hospital administrators from telling them that their son was having suicidal ideations.
Dr. and Mrs. Somers recommended that, when veterans make an initial contact with VA, the agency should determine if the veteran has a primary caregiver and ensure proper Health Insurance Portability and Accountability Act of 1996 (HIPAA) waivers are in place to include that person in treatment. They said they also believe the military should encourage servicemembers to establish a support network that could help them upon their return home.
“We really feel, if you are in treatment and there is an issue, then the therapist should certainly take the opportunity to contact the closest person to the patient,” Dr. Somers said.
Peggy Portwine, meanwhile, said she wishes she had been made aware of her son Brian’s high risk for suicide and his PTSD and TBI diagnosis before he committed suicide. “I would think a life-threatening event like this should be told to the emergency contact person,” she said in written testimony.
Challenges to Care
The hearing was one of a number of oversight reviews held in recent weeks on the VA healthcare system.
“Despite significant increases in VA’s mental health and suicide prevention budget, programs and staff in recent years, the suicide rate among veteran patients has remained more or less stable since 1999, with approximately 22 veterans committing suicide every single day,” Committee Chairman Rep. Jeff Miller (R-FL) said at the opening of the hearing.
The panelists told lawmakers that the mental healthcare system for veterans is not always compassionate or meeting the needs of patients.
Josh Renschler, a retired U.S. Army sergeant, suggested that a team-based interdisciplinary approach to mental healthcare should be used more widely in VA. He said he had benefitted from such an approach at a VA facility before it was deemed too expensive and ended, which he said should not have occurred.
“Working with a team increases the likelihood that one or more will see things that others missed,” Renschler testified in written testimony.
At the hearing, Susan Selke told lawmakers that before her son Clay Hunt committed suicide in March 2011, he had been seen at a Houston VA facility for mental health treatment but told her he could not go back because it was “too stressful.” Selke said that, after her son died, she went to the Houston VA to retrieve his records and also found the environment “highly stressful.”
“There were large crowds. No one was at the information desk, and I had to flag down a nurse to ask directions to the medical records area. I cannot imagine how anyone dealing with mental health injuries like PTSD could successfully access care in such a stressful setting without exacerbating their symptoms,” Selke stated.
Jean and Howard Somers also told lawmakers that they do not believe their son was treated compassionately when he reached out for care at the Phoenix VAMC. When their son presented to that hospital in crisis and asked to be admitted, he was told there were no beds in their mental health department or their emergency department, Dr. Somers recounted.
“The fact is that he went in to the corner. He lay down on the floor. He was crying. There was no effort made to see if he could be admitted to another facility. … But, he was told, ‘You can stay here and when you feel better you can drive yourself home,’” the deceased veteran’s father testified.
‘No Wrong Doors’
VA Deputy Chief Patient Care Services Officer Maureen McCarthy, MD, thanked the families for telling their stories. She said that a veteran in emotional distress deserves to find that “there are no wrong doors when seeking help.”
“At VA, we must ensure that those doors are swiftly opened, calls are returned, messages are responded promptly, efficiently and compassionately,” she said.
She told lawmakers that the suicide rate among VA users who have a mental health diagnosis has decreased. Still, she noted that about 22 veterans a day die by suicide and that five of those 22 veterans are veterans who have been in VA care.
“We acknowledge that we have more work to do, and we are fully committed to fixing the problems we face to better serve veterans,” she said.
McCarthy said that VA has taken actions to improve timely mental healthcare, such as deploying mobile veteran centers to locations with the greatest challenges in meeting needs. VA also has begun a program to ensure that veterans who have been waiting more than 30 days for mental healthcare can be treated by non-VA providers in the community, she added.
Meanwhile, lawmakers also said they were searching for solutions. Miller, with Reps. Tim Walz (D-MN) andTammy Duckworth (D-IL), introduced legislation following the hearing that would require an independent, third party to annually review both DoD’s and VA’s mental healthcare and suicide prevention programs. The bill also would create an education loan repayment pilot program to incentivize mental healthcare professionals to fill openings in VA.
While implantable devices have shown promise in reducing rehospitalization for heart failure (HF), VA researchers sought to determine if options that are less expensive and non-invasive would have comparable results.
Legislation to prevent VA from outsourcing creation of its drug formulary and to require more input from medical professions is being considered in Congress.