Sunday, December 30, 2007

VA Mental Health meeting with Senator Tester

Statistics show VA Western Region not as good as they claim on mental health treatment

McClatchy Newspapers

WASHINGTON — Sen. Jon Tester, a Montana Democrat, took officials from the Department of Veterans Affairs to an auditorium at the Montana State University-College of Technology campus in Great Falls last summer to talk about the best way to provide health care to veterans in the region's vast rural areas.

The director of the VA region that includes Montana, Colorado, Utah and Wyoming detailed all that the agency was doing to provide for veterans' health needs — physical and mental.


"Comprehensive mental-health care is one of the top priorities for Network 19," Glen Grippen said, referring to the multi-state Rocky Mountain region. He said that mental health staff had been added recently, specifically for treating post-traumatic stress disorder.

Each medical center now has a suicide prevention coordinator, he said, and the VA's medical centers "actively collaborate with state National Guard and Reserve components to ensure that no returning soldier slips through the cracks."
An examination of VA data and documents, however, tells a different story. Internal documents that McClatchy Newspapers obtained show that, far from being a national leader, the Rocky Mountain region is in the bottom half of the nation's 21 regions in the VA's own scorecard of performance, which takes into account whether veterans are receiving regular mental-health treatment and how efficiently the region is spending its money and using its resources.

On a couple of important measures, Network 19 was dead last. For example, in a measurement of the effectiveness of treatment — in which researchers charted patients' mental status scores before and after treatment — the region ranked last, according to the documents, which were from fiscal 2006 and were made available under the Freedom of Information Act.

That was for a range of mental health treatment. On the more specific measurement of treating post-traumatic stress disorder, the Rocky Mountain region was last in the number of specialized PTSD treatment programs it offered, and 16th of 19 ranked regions in program effectiveness, based on the fiscal 2006 records.

The situation in Montana — which has sent more of its sons and daughters, per capita, to fight America's wars than any other state — is even more dismal:

The Montana VA hospital started a specialized PTSD treatment program only recently, though soldiers have been returning from Iraq and Afghanistan for more than four years, and experts have long urged that every VA hospital have such units.

Out of 139 VA hospitals nationwide, the hospital at Helena and its related clinics ranked 123rd in the proportion of their budget that goes toward specialized mental health treatment.

While the average veteran receiving specialized mental health treatment in the VA system got 11 visits a year, those who used the Helena hospital and its affiliated clinics got an average of 4.2 visits. That's dead last among all VA hospitals in the U.S., according to 2006 data.

Veterans waited longer to gain access to the Montana system for mental-health care. While the VA aims to get veterans who are new to the system in to see doctors within 30 days of their requested dates, that happened only 53 percent of the time in 2006 in the Montana hospital system. On that ranking, the Montana system was third to last.
In a statement to McClatchy last week, the VA said its Rocky Mountain region "showed substantial improvements in the delivery of mental health care" over the past three years and that the VA hospital in Montana had beefed up its staff and supplemented its services with contracts with regional mental-health centers. Those encounters, the VA said, weren't reflected in McClatchy's analysis.

In addition, the Montana VA is establishing new strategies to provide for veterans in rural areas, including telephone consultations.

"Much of the need for mental health care is met by providers at clinics, and by contracting or fee-basing to community providers," the VA said in its statement. "The strategy is to distribute these key resources to enhance statewide access to mental health care rather than clustering them" at the Helena hospital.

HELENA — Chris Dana came home from the war in Iraq in 2005 and slipped into a mental abyss so quietly that neither his family nor the Montana Army National Guard noticed.

He returned to his former life — a job at a Target store, nights in a trailer across the road from his father's house.

When he started to isolate himself, missing family events and football games, his father urged him to seek counseling. When the National Guard called his father to say that he'd missed weekend duty, Gary Dana pushed his son to get in touch with his unit.

"I can't go back," Chris Dana responded. "I can't do it."

Things went downhill from there. He blew though all his money, and last March, he shot himself in the head with a .22-caliber rifle. He was 23 years old.

As Gary Dana was collecting his dead son's belongings, he found a letter indicating that the National Guard was discharging his son under what are known as other-than-honorable conditions. The move was because of his skipping drills, which his family said was brought on by the mental strain of his service in Iraq.

The letter was in the trash, near a Wal-Mart receipt for .22-caliber rifle shells.

All across America, veterans like Chris Dana are slipping through the cracks, left to languish by their military units and the Department of Veterans Affairs.

The VA's ability to provide adequate care for veterans with mental ailments has come under increasing scrutiny, and the agency says it's scrambling to boost its resources to help treat post-traumatic stress disorder, prevent suicides and help veterans cope. It's added more mental health counselors and started more suicide prevention programs.

But the experience in Montana, which by some measures does more than any other state to support America's wars, shows how far the military and the VA have to go.

"The federal government does a remarkable job of converting a citizen to a warrior," said Montana Gov. Brian Schweitzer, a Democrat. "I think they have an equal responsibility converting a warrior back to a citizen.

"I can't imagine that it's only Montana that's experiencing this. Our men and women are part of this country, and we have common experiences. It's not as though the water we drink and the air we breathe in Montana make our experience completely different than everywhere else."

McClatchy Newspapers analyzed a host of VA databases and records, and found that mental health treatment across the country remains wildly uneven. While mentally ill veterans in some parts of the country are well-tended, those in other places — especially Montana — are falling by the wayside.

The data and records, obtained under the Freedom of Information Act, included all 3 million VA disability claims in the nation and 77 million medical appointments in the agency's health system in fiscal 2006.

At a U.S. Senate committee hearing last summer in Great Falls, a top VA official touted the success of the department's mental health operations in the region that includes Montana. But the agency's records indicate that it ranks below most other regions in measures of access and success.

In fact, Montana veterans trail far behind their peers around the country on the two main VA functions:

— By several measures, the agency provides less specialized mental-health care in Montana than it does in most other states. Veterans seeking to enter the mental health system at Montana's only VA hospital had longer waits and received fewer visits than veterans did at almost any other VA hospital in the country.

— Recent veterans in Montana with mental ailments receive far lower payments, on average, from the VA disability system than veterans in almost any other state do.

Adam Olivas of Laurel had his post-traumatic stress disorder payment cut this month.

Olivas had been regular Army and had come home from Iraq with a Purple Heart, shrapnel in his left side, ringing in his ears, back problems and the nightmares, hair-trigger responses and survivor's guilt that are hallmarks of PTSD.

Since Olivas left the military, his life has been a blur of sleepless nights, drowsy days, nightmares, flashbacks, constant fatigue, spotty memory, counseling sessions and medication. He goes to work, goes home and rarely sees other people.

"I married Adam right before he went to basic training," said his wife, Shannon. "The only reason I am married to this man is because I know who he was before he went to Iraq."

His PTSD was rated a 50 in the VA's complicated system, and with his other injuries he was entitled to a monthly disability check for $1,567. Earlier this year, however, the Montana VA benefits office sent Olivas a letter proposing to drop his PTSD rating from 50 to 30. It would cost him $2,600 a year.

PTSD is rated at zero, 10, 30, 50, 70 or 100, and the VA office in Montana, the McClatchy analysis found, is less likely to rate recent war veterans 50 or above than any other office is. The McClatchy analysis zeroed in on veterans who've left military service recently and most likely had combat experience in Iraq or Afghanistan.

The lower rating was a slap in the face to both Adam and Shannon Olivas, who said that the past four years had been "absolutely horrific."

Adam Olivas, who works in hospital security, and his wife, a schoolteacher, drove three hours to Helena to appeal the decision, assisted by experts from two veterans groups. A representative from the American Legion said that Olivas' PTSD rating probably should go up, not down.

But the Montana VA office said that Olivas' symptoms weren't severe enough to warrant a 50 and that he'd gotten it only because of a quirk in the rating rules. The Montana office dropped the rating after it was allowed to do so.

Olivas doesn't know how he'll handle the cut in income.

"I can't afford to pay for the gas to go to all these meetings and counselings and all this stuff," he said. "Which probably isn't going to be the best thing for me."

More than 2,500 members of the Montana Air National Guard and Montana Army National Guard are among the 10,000 men and women from the state who've served in Iraq and Afghanistan or elsewhere in the war on terrorism, according to Department of Defense numbers.

"When they were called to active duty, they were running a business, driving a truck, working at a mill, teaching school," Schweitzer said. "When they returned from being a soldier, they didn't go back to a military base. ... They don't have people they can talk to. They are 300 miles away from their detachment, and everybody where they work didn't experience what they've gone through.

"In fact, nobody where they work experienced what they've gone through. Their family doesn't understand it well."

Montana has more veterans per capita than any other state, and they return from war to a vast expanse with few hospitals and miles between the ones that do exist. The VA has only one hospital in the state, Helena's Fort Harrison.

Chris Dana's suicide roiled Montana, which set up a task force to determine how a Guardsman had slipped through the cracks. It concluded that the Montana National Guard was following the national standard program, designed by the Department of Defense, to catch mental health issues as soldiers return from war.

But the task force also found that the national program is "deficient" because it doesn't provide the vision or the resources necessary to pinpoint veterans' mental heath problems.

Among other things, the task force said, the standard demobilization process is "ineffective for identifying mental health issues," and coming-home briefings include such a blizzard of paperwork that things get lost in the shuffle. It noted that veterans are reluctant to disclose their mental health problems and that counseling is lacking and uncoordinated in many parts of the state.

Guard members themselves — more than 40 percent in a survey the task force conducted — said they didn't think they were getting sufficient information about the health benefits and services available to them.

The Montana Guard is working to beef up its demobilization process significantly, hoping to keep better tabs on its soldiers as they return to their small towns and their businesses, farms, schools and families.

Another great article by Chris Adams

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