Senate Veterans’ Affairs Committee
Hearing: VA Mental Health Care: Evaluating Access and Assessing Care
April 25, 2012

“Welcome to today’s hearing to evaluate VA access to mental health care services.  Today’s hearing builds upon two hearings held last year on this issue.

At each of the previous hearings, the Committee heard from VA how accessible mental health care services were.  This was inconsistent with what we were hearing from veterans and VA mental health providers.

So last year following the July hearing, I asked the Department to survey its own mental health care providers to get a better assessment of the situation.  The results, as we all know, were less than satisfactory. Among the findings, we learned that nearly 40 percent of providers surveyed could not schedule an appointment in their own clinic for a new patient within 14 days, over 40 percent could not schedule an established patient within 14 days of their desired appointment, and 70 percent reported inadequate staffing or space to meet the mental health care needs.

The second hearing held in November looked at the discrepancy between what VA was telling us, and what the providers were saying.  We heard from a VA provider and other experts about the critical importance of access to the right type of care - delivered timely - by qualified mental health professionals.

At last November’s hearing, I announced that I would be asking VA’s Office of Inspector General to investigate the true availability of mental health care services at VA facilities. 

I would like to thank the IG for their tremendous efforts in addressing such an enormous request.  The findings of this first phase of the investigation are at once substantial and troubling.

We have heard frequently about how long it takes for veterans to get into treatment, and I am glad that IG has brought those concerns to light.

The IG will also discuss an entirely different, and more useful, way of understanding access to care.  This model would give more reliable data, and reduce the rampant gaming of the system that we have seen thus far.

IG has also found that the existing scheduling system is hopelessly insufficient and needs to be replaced.  VA has struggled with developing a new scheduling system.  I understand VA is working to get a replacement system in place.  I would like the Department’s commitment that they will work to get this done right, and get it done soon.

The IG findings also show some serious discrepancies in what VA has been telling this Committee, and veterans.  VA stated that 95 percent of veterans received mental health evaluations within 14 days.  In reality, it was only about 50 percent.  VHA data reported that after the evaluation was completed, 95 percent of veterans received a treatment appointment within 14 days.  In reality, it was only 64 percent.  For those in treatment, 12 percent were scheduled beyond the 14 day follow-up appointment window, with providers telling the IG that they were delaying follow-ups for months, not because of the veteran’s needs, because their schedules were too full.

VA is failing to meet its own mandates for timeliness, and instead is finding ways to make the data look like they are complying. 

VA can and must do much better.  Important steps have been taken in the right direction by the Department.  Last week, VA announced the addition of 1,600 mental health providers and late last year VA announced an increase in staffing levels at the Veterans Crisis Line.

But as we will see today, the hard work remains in front of us.  Veterans are dying by suicide at an alarming rate.  However, we know that the sooner a veteran can get a mental health appointment after they request it, the more likely they are to follow through with care.

We can’t afford to leave them discouraged when trying to access care.  When in care, we must be getting veterans their next appointment in a clinically appropriate time.  We need to be sure there are enough resources so providers do not have to delay treatment because their schedules are too full. 

While I commend VA for the decision to hire another 1,600 mental health providers, there is still no reliable staffing model to determine where these individuals are needed.  Without that model, VA needs to explain how they will know where to place these additional providers.

There are other challenges with getting the best providers into the system.  I understand that nationally there are shortages of mental health providers, and it is even harder for VA because they cannot always pay the highest salaries in the community.

There are still a large number of vacancies in VA’s mental health ranks.  I want to hear from the Department how they will fill the existing gaps, and ensure the new positions they have announced do not become 1,600 empty offices.

Ultimately, what really matters is how long it takes for a veteran to start that first treatment session.  What really matters is not abandoning that veteran.  I recently saw Andrea Sawyer, whose husband Loyd suffers from PTSD and depression.  Andrea bravely testified before this Committee in July about the tremendous difficulties she and her husband faced in getting him into care.  Loyd still faces challenges, but he is now getting the care he needs.  That is what matters.

We cannot let our veterans down, especially when they have shown the courage to stand up and ask for help.

I look forward to hearing from VA how they intend to address the issues the IG has found. Now more than ever is the time for action and for VA to show effective leadership.

Let the hearing today serve as an unequivocal call to action.  The Department must get this right. 

In closing, I want to be clear that, while we have discussed a number of problems with the system at large, none of this reflects poorly on VA’s providers.  I believe I can speak for all of us in thanking VA’s many mental health providers for the incredible job they do.  Let there be no mistake, these individuals are incredibly dedicated to their mission. 

They choose to work harder than most of their peers, often for less lucrative benefits, all because they believe in what they do, and because they have a deep and unshaking commitment to our veterans. 

To all of VA’s psychiatrists, psychologists, social workers, and other providers, and to all of the administrative staff who support them – thank you so much, and keep up the good work.

And with that, I will turn it over to Senator Brown for his statement.”