By Sandra Basu
WASHINGTON—VA is falling short on its goals to hire more mental health professionals by the end of this year, VA Secretary David Shulkin, MD, told legislators at a recent Senate hearing on suicide prevention.
“We have to figure out a way to recruit more mental health professionals and, frankly, not just for the VA but for the country at large to be able to train more. … We are not making the progress that I need to make in recruiting them,” Shulkin said. He added that VA wants to hire 1,000 new mental health professionals by the end of 2017 but is having trouble recruiting them.
“We are not succeeding at that 1,000 net new professionals,” he told the senators.
“Doctor, what do we need to do?” Sen. Jon Tester (D-MT) asked. Shulkin responded that a recently passed law allowing VA to speed up the hiring process for medical center and network directors should be expanded to other critical healthcare professionals, including those in mental health.
That law, the Department of Veterans Affairs Accountability and Whistleblower Protection Act of 2017, is currently limited to medical center and network directors.
“I want that authority for all of our critical health professionals. I would urge us to work together on that. It is just too hard getting people hired into the VA,” he told lawmakers.
In addition, Shulkin advised that VA needs “the tools that the private sector has to be able to recruit the very best health professions.” Yet, he said his retention and recruitment dollars were cut in half in the Comprehensive Addiction and Recovery Act of 2016.
“That was short-sighted, quite frankly. … If we’re serious about tackling this, don’t tie one of my hands behind my back,” Shulkin emphasized.
VA needs the flexibility to expand training, he said, adding, ‘These are all important strategies, particularly the training one.’”
Lawmakers agreed that training is key.
“If you’re going to make [VA] an attractive place for professionals to come to, then you better have professional development and a retention program similar to the private sector. … I saw the number that the VA was spending on a per-employee basis, and it was pennies on the dollar compared to what I would have spent as a partner at Pricewaterhouse,” pointed out Sen. Thom Tillis (R-NC).
Also testifying at the hearing was Craig Bryan, executive director of the University of Utah National Center for Veterans Studies. He told lawmakers that VA data shows that, from 2001 to 2014, the suicide rate among veterans who do not use VA services increased by 39% from 2001 to 2014, whereas the suicide rate among VA users increased by only 9%.
“The rates are going up, even among VA users, but it’s at a much slower rate,” Bryan noted. “So the VA is doing something good that is not happening for those who do not receive the services. So a common question is, ‘How do we get more veterans in the VA?’ That’s an important question, but I think the other question we need to ask is, ‘Why are there not other adequate services available to veterans in their communities?’”
He also pointed to research indicating that adequate training of mental health personnel is needed both in and outside of VA.
“The problem of deficient training is not confined to the VA, though,” he said. “Tragically, deficient training is endemic across our nation’s mental health professional training system.”
Sen. Richard Blumenthal (D-CT) noted during the hearing that the Clay Hunt Suicide Prevention for American Veterans Act, passed by Congress in early 2015, was just a first step in addressing the issue.
“The more that I learn about the problem, the more complex and challenging I think it is,” Blumenthal said.
Given that the suicide rate is rising more slowly among VA users than non-VA users, Blumenthal highlighted the need to make sure that Other than Honorable (OTH) veterans know that they can now access some mental health care services at VA because of an initiative introduced this year. That potentially affects more than 500,000 such veterans.
Shulkin told the committee that while individuals with OTH discharges may access the system for emergency mental health services, those veterans are limited in the care they can get through the initiative. He said there needs to be a legislative change to address this.
“I did as much as I can,” Shulkin said in reference to the changes made. “Now I actually need your help. We are going to need legislative changes to allow [them] to be able to access our full array of mental health and physical services. All that I was able to do is offer 90 days of emergency treatment then I’m trying to find them other places to get care.”
A survey of veterans receiving mental healthcare through VA found that the vast majority would favor at least one option to restrict firearm access with the goal of reducing dangers of self-harm.
For more than 40 years, haloperidol and ziprasidone have been given to critically ill patients who develop delirium in hospital intensive care units.