By Sandra Basu
WASHINGTON — In his first appearance before Congress as VA Secretary, David Shulkin, MD, said that “there is no other clinical issue” that concerns him as much as veteran suicides.
“What we are doing now, and we are doing a lot, is not enough. We are not satisfied, and we are continuing to look for new approaches to be able to address this issue,” he said.
In light of that, Shulkin told lawmakers that VA’s intends to expand provisions for urgent mental health care provided to former servicemembers with other-than-honorable (OTH) administrative discharges.
According to the VA, this is “the first time a VA Secretary has implemented an initiative specifically focused on expanding access to assist former OTH servicemembers who are in mental health distress and may be at risk for suicide or other adverse behaviors.”
VA estimates that there are a little more than 500,000 former service members with OTH discharges. As part of the proposal, former OTH service members would be able to seek treatment at a VA emergency department, Vet Center or contact the Veterans Crisis Line, the agency explained.
“So many veterans that we see are just disconnected from our system,” Shulkin told the House Committee on Veterans’ Affairs.
Noting that an estimated 20 veterans take their own lives each day, he added, “As you know, 14 [of those] are not getting care in the VA and yet we have this great comprehensive mental health system. We are going to do whatever we can.”
The idea stemmed from a bill proposed by Rep. Mike Coffman (R-CO) and Derek Kilmer (D-WA), according to Shulkin. That bill, which was reintroduced earlier this year, would direct the VA to provide initial mental health assessment and urgent mental healthcare services to veterans at risk of suicide or harming others, even if they have an other-than-honorable discharge.
“We want to work with Rep. Coffman on his bill on this…but I don’t think that it can wait. We are going to start doing this now,” the VA secretary emphasized.
According to VA, before finalizing the plan in early summer, Shulkin will meet with lawmakers, Veterans Service Organizations, and DoD officials “to determine the best way forward to get these veterans the care they need.”
However it is accomplished, veterans advocacy groups applauded the announcement.
“This policy change will forever alter the future for thousands of veterans and their families,” Paul Rieckhoff, founder and CEO of the Iraq and Afghanistan Veterans of America (IAVA) said in a written statement.
Vietnam Veterans of America CEO John Rowan also issued a statement, pointing out that “for far too long the VA had forgotten the intent of the 1944 GI Bill of Rights, which was to make sure that every veteran who set foot in combat was provided the care that they needed to recover from war.”
“With new leadership, Secretary Shulkin is righting the ship, and helping the department fulfill its sacred promise.” Rowan said.
Shulkin made his comments regarding mental health at a House hearing on the reauthorization of the Choice Program, which is set to expire in August of this year.
Lawmakers agreed on the need for community care, but also pointed to flaws in the Choice program.
“Through a series of four legislative changes and seventy contract modifications and counting, Choice has been continually improved upon and made stronger. But, it remains far from perfect and, in far too many cases, it fails the very veterans it was created to serve,” suggested House Committee on Veterans’ Affairs Chairman Rep. Phil Roe (R-TN).
Shulkin, meanwhile, urged lawmakers to eliminate the expiration date of the program as soon as possible.
“Without congressional action, veterans will have to face longer wait times for care,” he said.
He also said the agency is seeking changes to the program including “standardized, clear eligibility criteria for veterans to get care closer to home,” and the building of a “high-performing network of community care providers.”
“Our goal for VA community care is to deliver a program that is easy to understand, simple to administer and meets veteran needs. We know we are not there right now,” Shulkin said.
Shulkin noted that veterans rely heavily on both VA and community care. According to VA, in the first quarter of FY 2017, the number of Choice authorizations increased by more than 35% from the same period in FY 2016. Still, Shulkin said that only about 5,000 veterans use the Choice program as their sole healthcare provider.
“They overwhelming use both VA and Choice, and as you know many veterans prefer only to use the VA,” he stated.
A facility-specific survey found that 138 of 140 VA facilities reported shortages of medical officers, with psychiatry and primary care positions being the most frequently listed.
When Terrence O’Neil, MD, retired as chief of nephrology at the James H. Quillen VAMC in Johnson City in December 2016, he left in his wake decades of work treating kidney disease—nearly 35 years in the Air Force and DoD, plus 11 more at VA.