Very recently, beginning in 1995 the Veterans Health Administration (VHA) began a series of progressive reforms. The reform has included a substantive list of functional and fundamental changes, including everything from facility improvements to eligibility requirement expansion. The VHA has also adopted a list of changes that includes staffing and response time for mental health screenings for returning soldiers. These changes look good on paper as the VHA has stressed a rapid response time for initial screening that is a VHA policy standard, i.e. 14 days from the initial request for a mental health screening an individual is supposed to be evaluated. Given the nature of the last decade of war and the growing awareness of the mental health challenges that are being faced by countless returning soldiers this would seem a good thing, yet the actual reporting and records system is often delaying these initial screenings significantly, as is staffing issues. According to one reporter even though the VHA reported that 95% of all returning soldiers were being seen in that time frame further inquiry noted that this is simply not the case and the numbers are actually misleading. Upon further investigation the number was actually 49% and the average time for the rest of the soldiers was actually 50 days (Mcclatchy, 2012). This number is not in the least acceptable as studies have shown that screening delays in mental health situations create a reduction in the desire of the patient to continue with treatment. According to Mcclatchy (2012) the problem is a poor tracking and records keeping system and staffing shortages that challenge agencies to see patients in a timely manner. This is despite staffing increases of 46% between 2005 and 2010.
Given the recent growth in public awareness regarding the mental instability of many returning soldiers and the sheer numbers of soldiers who are currently and will continue to be returning from Iraq and Afghanistan in the coming few months and years these numbers are clearly failing the returning soldiers who must not navigate a very large and bureaucratic medical system unlike and separate from the medical system which followed them during their active duty. This work will look at research that has been conducted among VHA patients regarding the issue of mental health in an attempt to further understand both the scope and scale of the issue and the need for reformation. The objective of this work is to discern the actual numbers as well as to discover some sense of the scope, i.e. number of returning soldiers who are expected to be seen for mental health issues in the next 2 years and assess change needs for the agency to meet the needs of these individuals in a timely manner. Ultimately the work will attempt to discover how record keeping and reporting can be improved to facilitate better turnaround time for soldiers seeking mental health services and how staffing and availability issues can be resolved to increase availability.
The VHA is a medical delivery system on a scale that is unprecedented in the U.S. And elsewhere. The size of its offerings makes it the largest integrated health care system in the U.S. And the number of patients it is expected to serve is also very large. According to one researcher its size and relative success at positive reform could be a source of the problem of current high demands and unfulfilled responses, as it began to improve its systems and processes its improved reputation and outcomes increased demand yet again (Oliver, 2007, pp. 5-8). The VHA is headed by an appointed leader, currently the head holding the title of the Undersecretary of Health, the CEO of the VHA is Robert A. Petzel who was appointed by the president in 2010. In 1995 or earlier the VHA began to cave to rumors and reputations of poor service delivery and outcome, and began to implement changes that were sweeping and in many ways very successful, compared to private health sector delivery systems (Oliver, 2007, p. 9). The VHA has service delivery networks all over the U.S. including everything from acute treatment hospitals to long-term care facilities. Yet, it is hard to trust such statistics as McClatchy, has challenged the reporting and tracking systems of the VHA internal system and noted the severe discrepancy in reporting numbers. Which is supported by the VHA itself in congressional testimony which indicates that schedulers and physicians manipulate the date of desired care (the point by which the individual will have a full mental health workup, within 14 days by standard) not by actual patient's first access but by staff availability (Halliday, 2012). The historical reformation within the department has been a big step toward improving care across the board, reduction in inpatient bed services that reflect national trends and then shifting those funds to areas of greater need such as increased inpatient mental health beds, increased mental health staff and increased outpatient mental health care services (Petzel, 2012).
Additionally it is difficult to assess the severity of the problem because the returning troop numbers from the Iraq and Afghanistan wars will likely strain the system for at least a decade as physical and mental injury and illness surface out of these conflicts and among these young men. It must also be noted that the financial burden of war with regard to healthcare actually increases over time after a conflict end, as individuals age and experience greater than average health problems stemming from war service and simple aging. "History shows that the costs of war will continue to grow for a decade or more after the operational missions in Iraq and Afghanistan have ended," Shinseki said" (McClatchy, 2012) The interest in issues such as suicide rates and other mental health crisis has increasingly become a part of the public interest especially considering the staggering anecdotal evidence of concerns after return from deployment among current returnees from Iraq and Afghanistan (Katz, McCarthy, Ignacio, & Kemp, 2012, p. S105). Though there are significant indications that the system is improving regarding mental health care services, as research on suicide rates reflects,
Among men aged 30 years and older, suicide rates were consistently higher among VHA utilizers. However, among men younger than 30 years, rates declined significantly among VHA utilizers while increasing among nonutilizers. Over these years, an increasing proportion of male veterans younger than 30 years received VHA services, and these individuals had a rising prevalence of diagnosed mental health conditions. (Katz, McCarthy, Ignacio, & Kemp, 2012, p. S105)
Again the reporting issue challenges the reality of the improvements. Yes, the VHA is seeing and diagnosis more mental health illness among returning soldiers and it would seem is also intervening more frequently, likely associated with reformation changes but what statistics indicate helpful data and how can these reporting and recording processes be improved? Record keeping and reporting standards and application clearly need to be improved to ensure the hundreds of thousands of returning soldiers receive mental health services in a rapid and timely manner. Though there are no court decisions associated with the changes as the entity is rarely involved in litigation given its size and its position as a branch of the U.S. government the U.S. Congressional review and demands for audit and accountability increase in number nearly every session and congressional testimony is frequent. Last month, April 2012 there were at least two major testimonial processes in from of congress, first on the 4th of April when Petzel himself spoke and then later on the 25th when the assistant director Halliday testified as to the results of the audit demand which was likely spurned by Petzel's positive results reporting as a result of skewed statistics and other anecdotal and statistical testimony that contradicted time frames assessments offered by Petzel (Halliday, 2012).
Findings and Conclusions
The findings associated with this brief review of the problem indicate that the VHA has significant reforms to make to both ensure the high standards it has set for itself and to ensure that fewer returning soldiers in need of mental health care fall through the cracks. The services provided by the VHA are indispensable as many returning soldiers find themselves with no private pay options for health care delivery and their service records demand that the VHA respond to and provide the best care they can, not in the least of which as a result of their personal sacrifices to serve. The challenges facing the VHA over the next ten years are significant but it is not likely that there is an area where need is greater than in mental health as more and more people including the veterans themselves become aware of the substantial mental health issues they face as they return to civilian life and the need to address them as early as possible so they will be less likely than former war generations to struggle emotionally and mentally more than is necessary, commit acts associated with unstable mental health often…