HOUSTON—For many veterans returning from Iraq and Afghanistan deployments, psychologist Ashley Clinton, PhD, is the first mental health professional they see and their entry-point to VA mental health care.

Clinton joined VA at a momentous time for the agency’s mental health care system. Part of the first wave of providers VA hired in response to many servicemembers returning from OEF/OIF with mental health conditions, and honored by the Texas Veterans Commission this year for her work, Clinton now finds herself in a position she has no intention of leaving.

Finding Her Niche in VA

After studying for her doctorate in clinical psychology at the University of Tennessee, Clinton went to Houston for a one-year internship at Baylor University. At the time, she had no exposure to VA. “It wasn’t part of our training at [the University of Tennessee]. It wasn’t on my radar,” Clinton said.“ But I had heard that VA was known nationally to have a very large, very good training program for psychologists.”

So following her internship, she entered into a fellowship program at the Michael DeBakey VAMC (MEDVAMC) in Houston. There, she worked with the veteran population for the first time. “I felt like I’d found something that really interested me. It’s such a good population to work with,” Clinton said.

At the end of her fellowship year, the MEDVAMC created two new positions for psychologists working onlywith veterans returning from Iraq and Afghanistan. Clinton applied for one of the slots and was hired in 2005. At the time, it was only Clinton and another psychologist who were responsible for screening, evaluating and treating new veterans who needed mental health treatment.

Six years later, she is part of a team that includes four psychologists, three psychiatrists and a social worker that work specifically with returning veterans as part of the facility’s Trauma Recovery Program, designed to help patients manage PTSD and anxiety. The expansion of her team is a direct result of VA’s realization of the scope of the wars’ mental health impact on returning veterans. “When they were first coming back, right when the war(s) started, people didn’t realize how difficult the transition was going to be,” Clinton said.

When an OEF/OIF veteran comes to see her for the first time, Clinton has two goals: Set the veteran at ease and get as much information as possible. “For a lot of these veterans coming in, just making a connection and letting them know we want to work with them and making that therapeutic alliance can be a very important goal,” she said. “This may be their first experience with a mental health professional.”

An Integrated Approach

She also wants to gather data, not just on any symptoms but also on their military experience, family background, childhood and their current life. All of that data will help her and her colleagues formulate a diagnosis. “We try to get a thorough, integrated picture of where they came from, what they went through and what’s going on with them now,” Clinton said. “We also like to give them some brief psychological education so they can put words to some of the experiences they haven’t been able to make sense of.”

The meeting—which can take several hours—wraps up with Clinton recommending a treatment plan. That might include medication management, individual and group therapy, or setting up the veteran with the team’s social worker. Frequently, if her caseload allows and the treatment plan calls for it, Clinton will take the veteran on as a patient, acting as his or her individual therapist.

Clinton has no plans to leave her post anytime soon. “I’m very happy where I’m at,” she said. “The war’s not over. We’re just going to keep having more and more deployments. And when the war ends, we’re going to see a huge discharge of veterans.”

To help prepare for that, Clinton spends part of her time at MEDVAMC working with interns and post-doctoral fellows in the facility’s psychology program. “That’s important to me,” Clinton said. “Helping VA recruit and train the next generation of psychologists.”

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