More than any other war in U.S. history, the
conflict in Iraq has provoked a surge of concern for soldiers
returning home bearing the psychological burdens of battle.
From the war’s first days,
veterans’ groups, mental-health organizations, and some
members of Congress have claimed that the Department of Veterans
Affairs (VA) is unprepared to treat the tens of thousands of U.S.
soldiers likely to come back with posttraumatic-stress disorder, a
debilitating psychological condition.
A new federal report indicates that those
fears are not unfounded. On Feb. 16, the Government Accountability
Office, the investigative arm of Congress, released a report
criticizing the VA for failing to improve its PTSD services, even
when confronted with numerous reforms suggested by its own Special
Committee on PTSD. The report follows a five-month investigation by
the GAO that sought to determine whether the VA had implemented 24
of the 37 recommendations made last year by the Special Committee
on PTSD, a group of VA doctors who report annually to the VA.
The GAO concluded that the VA had not fully
addressed any of the 24 recommendations, which run the gamut from
hiring regional PTSD coordinators to developing credentialing
standards for PTSD clinicians to establishing PTSD screening and
referral systems. Specifically, the GAO report found that the VA
had met 14 recommendations only partially and left 10 completely
unmet; nearly half of those had been asked for since 1985. The GAO
also determined that the VA had no plans to address most of the
recommendations until at least 2007.
“This report confirms my concerns about the VA’s capacity and ability to meet the
rising demand of veterans seeking mental-health services,” said
Rep. Lane Evans, D-Ill., ranking Democrat on the House Veterans’
Affairs Committee, in a Feb. 16 statement. “It is inconceivable
that the VA has yet to even name a PTSD coordinator in each of its
health networks as recommended by the Special Committee.”
Evans, a Vietnam-era veteran, asked the GAO to
investigate last May after growing frustrated with what he saw as
the VA’s dawdling at improving its PTSD services.
National mental-health organizations and
veterans’ groups have long warned that such services were
being overwhelmed by an emerging population of psychologically
troubled veterans and an ever-tightening budget. In 2004, at the
behest of former Secretary of Veterans Affairs Anthony Principi,
the VA began drafting a mental-health strategic plan that involved
reinforcing PTSD programs by 2007, but at an estimated cost of
$1.65 billion not yet in the agency’s budget. Publicly, the
VA worried about the potential strain on services but has insisted
that it’s ready for the estimated 16 to 30 percent of
soldiers who will likely return from Iraq and Afghanistan with some
psychological trauma.
Not surprisingly, the VA adamantly refutes the
GAO’s findings. “They’ve taken a negative stand
on what this agency does, and the report discounts all the
wonderful accomplishments we’ve made with regard to
PTSD,” says Dr. Mark Shelhorse, the VA’s acting deputy
consultant for patient-care services for mental health. According
to Shelhorse, seven of the recommendations the GAO categorized as
partially met have been fully satisfied, including providing PTSD
screenings for new veterans. He also says that the VA allocated $15 million of its 2006
$28 billion budget for additional PTSD and substance-abuse programs and
that the agency was placing teams of PTSD experts in locations with
high concentrations of veterans.
For Congressman Evans, however, the VA’s
response is part of the problem. “What troubles me most about
this latest GAO report is the VA’s hypersensitive
posture,” Evans said in an e-mail last week. “VA
leadership seems unwilling to accept that GAO has found areas where
improvements are necessary.”
Cynthia Bascetta, director of veterans’
health-care issues for the GAO, says that she, too, was surprised
at the VA’s reaction and that the agency needs to do a better
job of prioritizing, given that wars in Iraq and Afghanistan have
made the task of addressing mental-health gaps more pressing.
Although estimates have varied, the VA now says that 6,400 veterans
from Iraq and Afghanistan have sought help for PTSD since those
wars began, but the GAO questioned whether that number is even
accurate. Regardless, the incidence of PTSD is expected to increase
substantially as more soldiers return home, and the GAO has urged
VA brass to speed all of the recommended improvements cited in its
report. The agency plans a follow-up investigation later this year.
Because the VA disagrees, it has 60 days to
draft a response to the Senate Committee on Homeland Security and
Governmental Affairs. The GAO issued an earlier report in September
proposing that the VA update its data-keeping methods for PTSD
veterans; the VA concurred. Says Bascetta, “The VA’s
mental-health plan, which is still only in draft form, is set for
2007 or later. But this looks to be a serious problem right
now.”
This article appears in Feb 24 – Mar 2, 2005.
