Official defends VA's mental health effort

Official defends VA's mental health effort
Bob Egelko, Chronicle Staff Writer

Friday, April 25, 2008


The Department of Veterans Affairs' top health official, testifying in a lawsuit by veterans' groups that accuse the VA of inept mental health care, cautioned Thursday against overstating the problem of mental illness among returning troops and said most patients are satisfied with their treatment.

"We monitor outcomes and satisfaction of our patients, and they report very high numbers," Michael Kussman, the department's undersecretary for health, told a federal judge in San Francisco. "We have all kinds of performance standards that show that we meet the expectations of our patients."

He testified on the fourth day of trial in a suit by two advocacy groups that say the VA has improperly delayed or denied care and benefits to veterans suffering mental trauma after service in Afghanistan or Iraq.

The groups say the department is partly to blame for a steadily rising suicide rate - 18 suicides a day for veterans of all wars, according to a VA official, and a rate between three and seven times that of the general population, according to a suicide expert who testified Tuesday.

The plaintiffs' lawyer asked Kussman about a speech in 2006 by Frances Murphy, then one of his top deputies, who said the number of veterans seeking care for behavioral conditions was rapidly increasing and that some VA facilities did not provide mental health care or had long waiting lists. Murphy's job was eliminated shortly afterward.

Kussman said 35 percent of troops who are screened by the VA after returning from Afghanistan or Iraq show symptoms of possible depression or other mental conditions. But he said the problem shouldn't be exaggerated.

"The number of patients who have adjustment reactions to the experience that they have in Afghanistan or Iraq is very important, but we don't believe that's mental illness," Kussman said. "It would be unfair and inappropriate to stigmatize people with a mental health diagnosis when they are having what most people believe are normal reactions to abnormal situations."

He disputed Murphy's assertion that the VA didn't offer mental health care at some facilities. Murphy was hardworking and competent, he said, but Kussman did not object to a "management decision" to eliminate her position. Kussman also said he had offered Murphy early retirement, which she accepted, as a benefit and not a punishment.

Plaintiffs' lawyer Arturo Gonzalez tried to pursue the issue of Murphy's removal, but U.S. District Judge Samuel Conti, presiding over the nonjury trial, said it had little relevance to whether the VA now offered adequate mental health care.

The plaintiffs - Veterans for Common Sense and Veterans United for Truth - want Conti to order prompt treatment for suicidal veterans, and to expand legal rights and require faster decisions for those appealing the VA's denials of health care benefits. The average appeal now takes almost four years to resolve, according to VA records.

Kussman, a former Army physician who retired as a brigadier general in 2000 and went to work for the VA, has held his current position since 2006. He worked on the department's strategic plan for mental health care, which was issued in 2004 with timetables that the plaintiffs have cited as evidence of foot-dragging.

Kussman was asked Thursday why the suicide-prevention component of the 2004 plan was not scheduled to be implemented until this year. He said he didn't remember.

He disputed some of the criticism of VA mental health care in a May 2007 report by the department's inspector general. One of its findings was that 70 percent of VA facilities had no system for tracking veterans at risk of suicide. Kussman said the department had a tracking system, though it hadn't yet been fully implemented at the time of the report.

The report also found that when veterans came to VA facilities with symptoms of depression, almost one-fourth were not referred for treatment for two to four weeks, and another 5 percent were referred in four to eight weeks.

"They weren't going without treatment," Kussman said, adding that anyone with symptoms showing a need for urgent care "would have been seen right away."

Gonzalez, the plaintiffs' lawyer, asked him how he knew that.

"That's what doctors do," Kussman replied.

The trial resumes Monday.


Official defends VA's mental health effort

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Undersecretary of Health Reinforces Stigma of Mental Illness

Undersecretary of Health Reinforces Stigma of Mental Illness

by John M. Grohol, Psy.D.



You’ve got to scratch your head when one of the government’s chief advocates for health care in the Veterans Administration just reinforces the old stigmas associated with mental health concerns. Testifying before a federal judge in San Francisco, Michael Kussman said:

“The number of patients who have adjustment reactions to the experience that they have in Afghanistan or Iraq is very important, but we don’t believe that’s mental illness,” Kussman said. “It would be unfair and inappropriate to stigmatize people with a mental health diagnosis when they are having what most people believe are normal reactions to abnormal situations.”

Well, golly gee Dr. Kussman, are you saying that traumatic reaction to wartime situations isn’t a mental illness? Because posttraumatic stress disorder (PTSD) surely has existed in one form or another since all wars have ever been fought. Is PTSD simply an “adjustment reaction” (whatever that is)? Or are you saying that an adjustment disorder isn’t a real, diagnosable mental disorder? Because, if you are, you’d be wrong on that account as well.

Or, perhaps worse of all, are you suggesting that because mental disorders remain stigmatized within our society today — especially within the military — we therefore shouldn’t seek to properly diagnose and treat soldiers with real and often serious mental health problems? As the undersecretary of health for the VA, you don’t exactly help reduce the stigma with beliefs like this. One of your jobs is to help reduce the stigma of all health and mental health concerns through education and information. Instead you’re only reinforcing the stigma by suggesting people with mental health disorders are somehow damaged or treated unfairly. And if that’s the case, Mr. Undersecretary, I suggest you work to change the system you head that allows veterans to be treated unfairly because of such a diagnosis.

Having a depressive, traumatic or anxious reaction to combat is actually not a normal reaction (even if some of us believe it should be). And sadly, war and combat fighting is not an “abnormal situation” for a soldier — it is exactly what is expected of them (and what they signed up for).

In a perfect world, we wouldn’t need soldiers. But in a perfect world, we would definitely take care of those who fought for us. That especially means not minimizing the effects of wartime, nor reinforcing the stigma of mental illness — a condition that returns with so many of our military men and women who have seen combat.

Read the full article: Official defends VA’s mental health effort...here...
http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2008/04/25/BAS010BH7F.DTL

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posted by Larry Scott
Founder and Editor
VA Watchdog dot Org

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