About half of U.S. veterans who served during the wars in Afghanistan and Iraq don't get the mental health care they need, according to a new report that recommends changes to improve the care delivered by the Veterans Affairs health system.
While many veterans receive good mental health care through the VA, it's inconsistent across the system, according to the report from the National Academies of Sciences, Engineering, and Medicine-nonprofit institutions that inform public policy. The detailed, 439-page assessment of the VA's mental health services was ordered by Congress in 2013 and completed by a committee of 18 academics.
Veterans who seek help for post-traumatic stress disorder, substance abuse, depression or other mental health conditions can be stymied by the VA's bureaucracy or short-staffed clinics and hospitals. Other factors such as lack of social support, distance and fear of revealing a mental health issue may discourage veterans from seeking care at all.
The VA has had persistent problems trying to care for the more than 4 million service members who have left duty since the start of the U.S.'s 16-year war in Afghanistan. Those who served in Iraq and Afghanistan-in an all-volunteer military-often did multiple tours, with longer deployments and less time at home, compared with earlier conflicts, the report notes.
The stresses of that service have been evident for years. In 2014, the suicide rate among veterans was about 22 percent higher than among adults who had not served in the military, the VA reported in September.
While some of the VA's larger difficulties with providing care have been widely reported, the new report reveals some lesser-known hurdles. Researchers found that one seemingly mundane issue-parking-was a problem at almost all of the medical centers they visited. Veterans seeking mental health care were often late for appointments and stressed from looking for a spot. "You spend the first 15 minutes diffusing [sic] them from the frustration with the parking situation," one unidentified VA clinician in San Diego told the researchers. "You haven't even started the therapy. The parking is a nightmare."
Qualified staff in rural areas is hard to find. "There's a lot of burnout."
There's no quick fix to the problems faced by the VA in providing sufficient mental health services. Breaking down barriers to care will require reaching out to veterans and streamlining application processes, as well as investments in the VA workforce, facilities and technology, according to the report.
If the VA can better connect patients in need with high-quality mental health care, it could serve as an example for the rest of the country, the authors write. The VA "is positioned to inform and influence how mental health care services are provided more broadly in the U.S.," the report states.
The committee recommended the VA develop a plan to deliver reliable, high-quality mental health care throughout its system in three years to five years. That time frame is "an optimistic goal," said Emily Blair, manager of military and veterans policy at the National Alliance on Mental Illness, a nonprofit advocacy group.
Veterans are often confused as to how to get benefits, unsure whether they're eligible or frustrated by red tape, she said. The experience varies widely, depending on where veterans live. Particularly in rural areas, it can be difficult for the VA to hire qualified staff. Years of negative headlines following the scandal over wait times at a Phoenix facility in 2014 have exacerbated recruiting challenges, Blair said. "There's a lot of burnout," she said.
A VA spokesperson didn't respond to an email seeking comment on Wednesday's report. Veterans Affairs Secretary David Shulkin, the former health-care executive whom President Trump picked to lead the agency, has pledged to seek "major reform and a transformation" of the VA. Shulkin, a medical doctor, joined the agency as under secretary for health during the Obama administration in 2015.
The Trump administration has said it's moving to expand veterans' access to mental health. Trump signed an executive order on Jan. 9, giving military and VA officials 60 days to develop a plan to give people leaving the armed forces "seamless access to mental health treatment and suicide prevention" in the year following their service.
About 265,000 service members transition out each year, Blair said. The government hasn't specified how those additional services would be funded.