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The solution to providing veterans adequate mental health services lies in community partnerships and existing health networks, not a bigger Veterans Health Administration, members of a bipartisan House committee and veterans advocates said Wednesday.
House Veterans' Affairs Committee members said despite large increases in the Veterans Affairs Department budget for mental health services, many veterans remain unable to access care.
Since 2007, VA's budget for mental health services has increased 39 percent while its mental health staff has risen by 41 percent. In 2012, VA's budget for mental health services was $6.2 billion.
Yet a VA study released Feb. 1 noted that since 1999, the number of suicides by veterans each day has increased, rising from 18 to 22.
"Unfortunately, these significant increases have not resulted in equally significant performance and outcomes," said Rep. Jeff Miller, R-Fla., chairman of the veterans' committee. "Less than a year ago, the VA inspector general released a review of veterans' mental health care access … showing the majority of veterans who seek mental health care through VA wait 50 days. That figure amounts to thousands of veterans in need."
Miller has advocated for allowing veterans to tap into Tricare's network of mental health providers.
He and others noted Wednesday that federally qualified health centers also could provide veterans in remote areas mental health care services in addition to state programs that service veterans.
"We have no interest in privatizing VA. But I have concerns when it comes to mental health issues," said Rep. Michael Michaud of Maine, the committee's ranking Democrat. "When veterans need mental health care, they need it then. They can't wait two weeks. There's no reason VA can't partner with some of the providers that are currently out there."
Efforts to improve
VA announced earlier this week that it has hired 1,058 new mental health providers — doctors, social workers, nurses — of a planned 1,600 under an initiative announced last April.
VA also has filled 1,980 mental health vacancies since the start of the hiring effort.
Veterans' advocates say they are buoyed by the progress but don't see staff increases as a long-term solution for reaching many veterans, especially those in the rural areas.
"I don't believe the answer is getting the system any bigger," said David Rudd, director of the University of Utah's Center for Veterans Studies. "The reality is it hasn't had any real impact in terms of measurable outcomes like suicides and suicide attempts. The reality is you explore other options, other alternatives and look at new flexible approaches that don't have to be so centralized."
VA Undersecretary for Health Robert Petzel said the department is moving forward to improve access and care, and while it faces challenges, it has launched several initiatives to address the problem and is beginning to see progress.
Among the efforts: a pilot program in 15 locations — Atlanta and 14 rural areas — that partners VA with community health organizations.
VA also is putting mental health specialists on primary care teams and expanding telehealth counseling services, Petzel said.
Among VA's biggest challenges has been hiring psychiatrists. VA pledged in June to have most of the new behavioral health hires selected by December and the "hard-to-fill" positions completed by March 2013.
It has not yet realized these goals.
"Our pay is very competitive for nurses, psychologists and social workers … but of all of the professions in mental health, the most difficult problem we have is recruiting psychiatrists," Petzel said. "We've been barely able to recruit half of the new ones we want."
Making sense of the numbers
According to VA, the number of veterans receiving mental health services in 2006 was 927,052. It has risen each year, to more than 1.3 million in fiscal 2012.
The Feb. 1 VA studyon suicides estimated that about 22 veterans die in the U.S. by suicide each day. The data was derived from 21 states. Most experts believe the figure to be low, since it excluded two states with large veteran populations, Texas and California, and was derived from databases that often don't indicate veteran status on death certificates.
During testimony before the committee, Rudd said the VA study, which did not derive a definitive rate of suicide for the veterans' population, needed to be put in context.
"The overall rate in 2009 was 35.9 per 100,000. That's three times the national rate of 12.0 in 2009 and double the male suicide rate [of] 19.2 for the general population," Rudd said.
Miller said VA must be more open-minded in considering how best to reach veterans they are obligated to serve.
"VA must stand ready to treat our veterans where and how our veterans want, not just where and how VA wants," Miller said.