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Thursday, July 14, 2011
VETERANS: Senator Murray Chairs Hearing on Gaps in Mental Health Care
Murray hears about long waiting lines and red tape from veterans who have attempted suicide, face chronic PTSD and depression
Hearing comes as VA says that 202,000 Iraq and Afghanistan veterans have been seen for potential PTSD at VA facilities through March 31, 2011
WATCH hearing now.
(Washington, D.C.) – Today, U.S. Senator Patty Murray, Chairman of the Senate Veterans’ Affairs Committee, held a hearing to discuss access to mental health care services, including waiting times and staffing levels, outreach to veterans, the linking of mental health care to primary care, suicide prevention and problems identified by the VA Inspector General in mental health care.
“In the face of thousands of veterans committing suicide every year, and many more struggling to deal with various mental health issues, it is critically important that we do everything we can to make mental health care more accessible, timely, and impactful,” said Senator Murray. “Any veteran who needs mental health services must be able to get that care rapidly, and as close to home as possible. Through its suicide hotline, VA has reached many veterans who might have otherwise taken their own lives. Each life saved is a tremendous victory, and we should celebrate those with VA. But we also have to recognize that these are veterans who reached out to VA. We want to hear about how VA is reaching out to veterans, and how easy or hard it is for veterans to access the care they earned through their service to this country.”
At the hearing, Senator Murray heard from Daniel Williams, an Iraq veteran who described how an IED explosion during his 2003/2004 deployment to Iraq led to traumatic brain injury (TBI) and post traumatic stress disorder (PTSD) injuries. Williams told the committee how those experiences then led to a suicide attempt in 2004 that was broken up by his wife and local police. He also discussed how his PTSD was received by fellow soldiers, his concerns over the stigma attached to the mental wounds of war, and his frustrations with the mental health care administered by the VA.
The Senator also heard testimony from Andrea Sawyer, wife and caregiver of Loyd Sawyer, who, after being deployed in Iraq, shared similar stories of frustration, including a failed suicide attempt. These two servicemembers, even after attempting their own lives, were met with red tape, wait times for initial appointments at the VA, and additional frustrations in seeking the mental health care they so desperately needed.
The hearing comes on the heels of a number of reports about gaps in mental health care. Two reports released by the IG showed unacceptably high patient wait times and long wait lists and an unacceptable number of veterans who are not contacted by VA between the time they were accepted and the beginning of the program. These reports also revealed that staffing levels for mental health works fell short of VA guidelines.
The GAO also published a recent report on sexual assault complaints in VA mental health units that found many of these assaults were not reported to senior VA officials or the Inspector General. VA clinicians also expressed concern about referring women vets to inpatient mental health units because they didn’t think the facilities had adequate safety measures in place to protect these women. And two weeks ago GAO issued a report that found the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury can’t adequately account for tens of millions of dollars it spent to improve treatments for the invisible wounds of war.
The full text of witness testimonies can be viewed here.
The full text of Senator Murray’s opening statement appears below.
“Welcome to today’s hearing to examine how we can close the gaps in mental health care for our nation’s veterans. We all know that going to war has a profound impact on those who serve. And after more than eight years of war, in which many of our troops have been called up for deployments again and again, it is very clear that the fighting overseas has taken a tremendous toll that will be with us for years to come.
“More than one-third of veterans returning from Iraq and Afghanistan who have enrolled in VA care have post-traumatic stress disorder. An average of 18 veterans kill themselves every day. In fact, the difficult truth is that somewhere in this country, while we hold this hearing, it is likely that a veteran will take his or her own life.
“Last week, the President reversed a longstanding policy and started writing condolence letters to the family members of servicemembers who commit suicide in combat zones. This decision is one more acknowledgment of the very serious psychological wounds that have been created by the wars in Iraq and Afghanistan and an effort to reduce the stigma around the invisible wounds of war. But clearly much more needs to be done.
“In the face of thousands of veterans committing suicide every year, and many more struggling to deal with various mental health issues, it is critically important that we do everything we can to make mental health care more: accessible, timely, and impactful. In fact, according to data VA released yesterday, more than 202,000 Iraq and Afghanistan veterans have been seen for potential PTSD at VA facilities through March 31, 2011. This is an increase of 10,000 veterans from the last quarterly report. Any veteran who needs mental health services must be able to get that care rapidly, and as close to home as possible.
“Over the years, VA has made great strides in improving mental health services for veterans. But there are still many gaps.
“As many of you know, just this past May, the 9th Circuit Court of Appeals issued an opinion that called attention too many of these gaps in mental health care for veterans. And while that ruling has gotten the lion’s share of attention, it is one of far too many warning signs.
“Today, we will hear from the Inspector General about ongoing problems with delays in receiving health care for those veterans suffering from the invisible wounds of war, like PTSD.
“In one report, published just this week by the IG, several mental health clinics at the Atlanta VA were found to have unacceptably high patient wait times. The report shows that facility managers were aware of long wait lists for mental health care but were slow to respond to the problem. The report also called into question the adequacy of VA’s performance measurements for mental health access times across the entire system.
“As the IG noted, the VA only tracks the time it takes for new patients to get their first appointment. This means that since the VA is not tracking the timeliness of second, third, and additional appointments, facilities can artificially inflate their compliance with mental health access times. This is simply unacceptable and must change.
“In another report on veterans in residential mental health care the IG found that an unacceptable number of veterans were not contacted by VA between the time they were accepted and the beginning of the program, and that staffing levels for mental health workers fell short of VA guidelines.
“GAO has also recently published a report on sexual assault complaints in VA mental health units that found many of these assaults were not reported to senior VA officials or the Inspector General. VA clinicians also expressed concern about referring women vets to inpatient mental health units because they didn’t think the facilities had adequate safety measures in place to protect these women.
“And just two weeks ago GAO issued a report that found the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury can’t adequately account for tens of millions of dollars it spent to improve treatments for the invisible wounds of war.
“Taken together, these reports show very clearly that there is significant work to do to improve mental health care outreach and treatment.
“One way to fill in these gaps, to overcome the stigma associated with mental health care, and to eliminate wait times is to provide primary and mental health care at the same visit.
“In the hearing today, we will hear from Providence Health and Services, which was recently recognized as one of the five most integrated health systems in the country, about how they have integrated mental health services into their medical home.
“I believe we need to look to Providence and those VA programs that work for guidance on making real progress.
“Through its suicide hotline, VA has reached many veterans who might have otherwise taken their own lives. Each life saved is a tremendous victory, and we should celebrate those with VA. But we also have to recognize that these are veterans who reached out to VA.
“We want to hear about how VA is reaching out to veterans, and how easy or hard it is for veterans to access the care they earned through their service to this country. As we will hear today, despite VA’s best efforts, veterans continue to experience problems when they reach out to the VA for mental health care.
“I have heard from veterans who have walked in to VA clinics and asked to be seen by a mental health provider, only to be told to call a 1-800 number. I have heard from VA doctors, who have told me VA does not have enough staff to take care of the mental health needs of veterans.
“And I have heard from veterans’ families, who have seen first-hand what effects untreated mental illness can have on the family. We are here today to see that this ends. I am looking forward to hearing from all of our witnesses today.
“I hope it helps us to better understand these issues, and to address them so that our veterans can receive the timely, quality care they earned through their service.
“I will now turn to Ranking Member Burr for his opening statement.”
It was an important hearing and it did garner some press attention. Brett Coughlin's "Iraq vet, rescued from suicide, tells of VA gaps" (POLITICO) reports on the hearing and notes:
Murray told POLITICO that Williams’s testimony was “heartbreaking” and sent a clear message to the VA: The department “needs to get out of its comfort zone when it comes to PTSD and to address this because of the real concerns, internally, that they are not meeting the needs of our veterans. I hope this hearing sent that message loud and clear.”
It's good to see POLITICO report on a hearing where the issue matters as opposed to just covering the hearing that's 'important' because some high profile government official is testifying. Stars and Stripes usually offers something but today relies on summarizing POLITICO. And there's an e-mail about their summary asking if Carol Williams is Daniel Williams' ex-wife or wife? In his verbal opening statements, when he talked about being in the bathroom with the gun barrel in his mouth, he stated his "ex-wife" called the police. I don't know if that was an error. Often people do make errors when they're speaking and when he was sharing his suicide attempt, his voice shook, his speech slowed down and I recall him stopping to take a breath. That was his verbal opening statements. In his written opening statement (his prepared remarks), he referred to her as his wife throughout, never using "ex-wife." In his oral response to questions, he repeatedly referred to her as his wife. My guess was that he misspoke when he said "ex-wife" -- and he only said it once in the entire hearing -- and did so because he was discussing a very traumatic event (the VA would not provide the help he needed and he'd reached what he felt was an end point and was attempting to kill himself). And by the way, Iraq War veteran Daniel Williams now works with NAMI which is the National Alliance on Mental Illness and a resource for those needing help in finding out information, finding a support group and more. NAMI has released Daniel Williams' prepared remarks (written testimony submitted to the Committee before the start of the hearing) as a news release and outlets, such as the Sacremento Bee, are carrying it, drawing further attention to the hearing. Steve Vogel files a report for the Washington Post which is also being carried by other papers.
The reports from POLITICO and the Post are strong ones. They leave out one big detail. So if some outlet is thinking, "Well I wished we'd covered it but it's over and nothing left to say," they could emphasize and follow up on that. Andrea Sawyer is married to Iraq War veteran Loyd Sawyer. She is the caregiver of her husband who has a 100% disability rating by the VA. She testified about how she had to leave her job to care for her husband and this did get noted in the reports.
What is not getting noted is the leaving of the job. The impression is that she made a decision and that was that. That's not reality.
Near the end of Chair Patty Murray's questioning of the first panel, Andrea Sawyer testified:
We've kind of been ostracized from the community. I left my job teaching. I had great scores, you know for the be-all-to-end-all test at the end of the year that all teachers are judged by whether we say they are or not, great scores. But I had missed a lot of work. It was my fourth year, my tenure year, and it was Loyd's first year after he was retired. We were spending a lot of time at the VA which meant I was spending a lot of time out of the classroom and the principal came to me and told me I had to choose between getting my husband better and teaching. So I left. So, no, the community does not understand.
If you asked Andrea Sawyer, she'd tell you she made the decision needed and doesn't regret it. But she shouldn't have had to have made that decision and I do think most people would like to know what the school was and who the principal was who went to a woman whose husband had just been medically retired by the military and given a disability rating of 100% and told her that her time managing her husband's care was just too much for the school to absorb. To me, that's as appalling as the illegal practice of refusing to giving a returning veteran back their job.
I'd further add that the students in her class were not being 'robbed' of an education when she was out and they had a substitute. They were instead getting to witness what sacrifice is about. There's a lot of grand talk about sacrifice when the cameras are around and the flags are waving. But her students knew when she was out that she was out due to her husband's care. That's not a minor lesson to learn. To draw more attention to that detail of the testimony, we'll use it for the title of this entry.
The following community sites -- plus Random Notes, War News Radio, Antiwar.com and the Guardian -- updated last night and this morning:
Okay, community notes. I said last night that this would be late and it is. In addition, it's taking forever to do the morning entries because Jim's right here combing through my dreams in the hopes of finding material for Third. Yesterday evening/night (it's all a blur) when we got home (California), Ava and I were greeted with Jim's announcement that this weekend we'd do the summer read at Third and were then told, "Try to dream some story ideas." The summer read is an annual thing at Third. Dona will tell you that one of the theme issues they studied in a journalism class in 2004 was a Rolling Stone "summer read" from the eighties that included short stories by Stephen King, Jackie Collins and others. (It also included the kickoff of Bonfire of the Vanities which first appeared serialized over many, many months in Rolling Stone and was then polished into a book or what passed for one.) As a result of that issue, Third decided they would do a summer read edition each summer and this is either the sixth or seventh (Jim says seventh) annual summer read. There will be the TV piece and the editorial. The rest will be creative writing -- or as much creative as we can muster (and I feel my own well is dry). Why this week? Jim's argument is that the week offered little new news. Everything was more or less a repeat of last week -- meaning the debt talks continued, this continued, that continued, etc. Forget 'creativity,' I'll judge the edition a success if we can avoid sameness. (For example, avoid every piece being told from the same perspective -- be it first person or whatever -- or every piece being on the nose and telegraphing every damn point, etc.) But that will be Sunday, probably very late Sunday, and that's the heads up Jim promised those who had been e-mailing, "When's this year's summer edition?"
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