WASHINGTON — Poor coordination and staffing problems were identified as major factors in veterans’ receiving inadequate care at Atlanta VA Medical Center mental-health clinics, according to a VA Inspector General (IG) report released last month. This report is the latest of many released by oversight agencies that point out the gaps in VA’s mental-health services.
Legislators expressed frustration at these continuing problems and asked VA leaders why these gaps have not been filled, despite years of effort.
“More than one-third of veterans returning from Iraq and Afghanistan who have enrolled in VA care have post-traumatic stress disorder. An average of 18 veterans kill themselves every day,” said Sen. Patty Murray (D-WA), chair of the Senate VA Committee at a hearing last month on VA mental-health care. “In fact, the difficult truth is that, somewhere in this country, while we hold this hearing, it is likely that a veteran will take his or her own life. Just this past May, the 9th Circuit Court of Appeals issued an opinion that called attention to many of these gaps in mental-health care for veterans. And while that ruling has gotten the lion’s share of attention, it is one of far too many warning signs.”
The May decision was handed down by a three-judge panel of the appeals court. In July,VA asked for a full-court hearing, in which an 11-judge panel revisit and rehear the issues. The 9th Circuit has yet to respond to that request.
Fast-Growing Patient Population
The Atlanta VAMC has one of the fastest-growing patient populations in the VA system. In FY 2009, the facility served 71,000 patients — up 7% from the previous year. In FY 2010, that number rose to 77,000 — an 8% bump.
The number of veterans needing mental-health care grew at an even steeper rate. Required follow-up to positive mental health-related screenings rose from 3,848 in FY 2009 to 11,367 in FY 2010. The number of patients receiving inpatient mental-health care rose from 651 to 993 during that time, and the number of those receiving outpatient mental-health care rose from 201,915 to 225,000.
The result of this increase in demand was a proportional increase in waiting times for appointments. Between October 2009 and May 2010, the percentage of patients waiting longer than 30 days for an appointment rose from 0.6% to 4.5%. The IG report found that, in most cases, facilities leaders were aware of the lengthy wait times but were slow in doing anything to address them.
VA took a step to address this problem nationwide when it implemented a new performance measure in October 2010 to track the percentage of new patients waiting to be seen within 14 days of their desired appointment date. The goal was to track first appointment wait times and ensure patients were seen quickly by a mental-health professional.
However, this measure only tracks first appointments, and VA does not track subsequent appointments. The result was that the Atlanta VAMC was able to show 100% compliance with this performance measure during the first three quarters of FY 2010, despite having hundreds of patients on various waiting lists to see mental-health providers.