In April, the Department of Veterans Affairs announced plans to hire 1,900 new mental health professionals. The announcement, which would boost the department’s mental health staff to about 22,000 employees, was seen by many as both a welcome development and a troubling indicator of unmet needs as veterans seek mental health care.
For years, veterans advocates have warned of a looming shortage of mental health professionals to care for veterans coming back from the wars in Iraq and Afghanistan. But the VA won’t say how many it has been able to hire so far and experts question whether even this increase in staff will be enough to effectively handle the growing need from veterans.
Experts say the wars in Iraq and Afghanistan — characterized as they are by multiple deployments, a constant threat of attacks from improvised explosive devices and a lack of clarity about who constitutes the enemy — are particularly hazardous to mental health.
Between 2002 and 2012, more than 404,000 Iraq and Afghanistan veterans who have sought treatment from the VA have been diagnosed with mental disorders. Since 2007, the VA has seen a 35 percent increase in veterans receiving mental health services. It has not always been able to keep up with that increase.
According to an April 2012 report from the VA’s Office of the Inspector General, a little more than half of the new patients seeking mental health treatment at the VA waited an average of 50 days for a full mental health evaluation. After that initial evaluation, some veterans can wait months to be seen by a mental health specialist. Access to psychiatric services, too, varies widely across geography. In Denver, for example, veterans waited an average of 19 days to see a psychiatrist. In Salisbury, N.C., the wait time was 86 days.
And it’s not only the VA’s patients who are feeling the strain. A 2011 survey conducted by the VA found that 71 percent of the department’s mental health professionals believed it lacked sufficient staff to meet current veterans’ needs. The VA’s inspector general reported that the department’s greatest mental health challenge is in recruiting and retaining psychiatrists.
Most advocates agree that hiring more staff at the VA is a crucial step toward meeting the mental health needs of this new generation of veterans, though many say it remains to be seen whether the VA’s 1,900 planned hires will be enough to keep up with growing demand. And some experts question whether the VA will be able to recruit so many mental health professionals so quickly.
“Our own members [of the National Council for Behavioral Health] say that finding a well-trained workforce is hard. If we’re having a problem, we know the VA is too,” says Jeannie Campbell, the executive vice president at the National Council, which represents 2,000 organizations providing treatment in local communities. Campbell is a Navy veteran, and leads the organization’s veterans’ health initiatives.
The VA won’t comment on how many people they’ve hired since the April announcement. A spokesman said in an email that the department is “making good progress on hiring the additional staff,” and plans to complete the hiring process by the summer of 2013.
But beefing up staff at the VA is only one piece of the puzzle.
“The VA is doing a great job trying to hire up, but the truth is, it will never be enough,” Campbell says. She cautions against the misconception that all veterans use the VA for their physical and mental health care needs. In fact, many veterans — perhaps almost half — seek care outside of the VA system, in community clinics and hospitals. That’s what Campbell herself did, when she retired after 22 years in the Navy and moved to a small town 200 miles from the nearest VA office. “Getting to the VA was too much trouble,” she says, and she chose to seek medical care from local providers instead.
Whether local providers will have enough capacity to care for the influx of veterans is an open question.
Campbell says the ranks of people needing mental health services could exceed projections — not just because more service members are returning, but also because the stigma attached to mental health issues continues to fade, and awareness of mental health services continues to grow.
“The Department of Defense has made great strides to educate people in the military about mental health,” she says. “There’s far less stigma than there was even 10 or 15 years ago; people are much more accepting. And people are aware that there’s treatment that works. But that means that you’ll see a lot more people seeking treatment.” And, she says, with new health care policies coming into effect soon under the Affordable Care Act, “we’re gearing up to see many, many more civilians” seeking mental health services as well — which could affect veterans looking for help from community providers, too.
There’s also the question of whether civilian mental health professionals are fully equipped to handle the needs of returning veterans. ”When veterans seek treatment in the civilian world, the vast majority of therapists have no experience with the military,” Campbell says. Later this week, we’ll look at the special challenges of working with veteran populations, and dive into a program in California that’s grappling with that very issue head-on.