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TechnoratiVA Studies: PTSD Care Inconsistent
WASHINGTON - The Department of Veterans Affairs, which touts its special programs to treat post-traumatic stress disorder in returning soldiers, spends little on those programs in some parts of the country, and some of its efforts fail to meet some of the VA's own goals, according to internal reports obtained by McClatchy Newspapers.
In fiscal year 2006, the reports show, some of the VA's specialized PTSD units spent a fraction of what the average unit did. Five medical centers - in California, Iowa, Louisiana, Tennessee and Wisconsin - spent about $100,000 on their PTSD clinical teams, less than one-fifth the national average.
The documents also show that while the VA's treatment for PTSD is generally effective, nearly a third of the agency's inpatient and other intensive PTSD units failed to meet at least one of the quality goals monitored by a VA health-research organization. The VA medical center in Lexington, Ky., failed to meet four of six quality goals, according to the internal reports.
A top VA mental-health official dismissed the reports' significance, saying veterans receive adequate care, either in specialized PTSD units or from general mental-health providers. In addition, he said, some of the spending differences aren't as extreme as the documents indicate, and the department is working to increase its resources for mental health treatment.
As the VA prepares for a surge of Iraq and Afghanistan veterans experiencing PTSD, it's come under fire for staffing and funding shortfalls in its mental health units and for the wide differences in how much it spends on such treatment at its medical centers.
The agency maintains that it delivers consistently high-quality treatment. "The best measurement of success, and what really counts, is how well we are doing in improving our patients' health," the agency's top medical official, Michael Kussman, said in a statement to McClatchy Newspapers earlier this year. "When we make comparisons among our facilities, our results are uniformly positive."
The spending and quality numbers are in two reports that a VA mental health-research office produces each year. The reports used to be readily available to the public, but the VA removed them from its Web site in the past year. McClatchy obtained the most recent reports, for fiscal year 2006, under provisions of the Freedom of Information Act.
One of the reports indicates that the number of veterans using the VA's specialized outpatient PTSD services is growing much faster than the number of medical appointments the VA is providing. The report shows that the number of veterans treated grew more than 4 percent from 2005 to 2006, while the number of appointments the VA provided grew just 1 percent, meaning that the average number of visits each veteran got dropped.
The report also says that the data "suggest considerable variability" across the VA in the delivery of some PTSD services.
"It is the task of thoughtful planning, performance assessment and clinical care to assure that, as VA passes through a period of major change during the years to come, the treatment provided to veterans with PTSD is equitably distributed, accessible, effective and efficient," the report concludes.
Paul Sullivan, a former VA official who works for the advocacy group Veterans for Common Sense, said the numbers indicated that the VA wasn't prepared to treat the number of soldiers who were coming home with PTSD.
"If the ominous trend continues or if all our Iraq soldiers return home quickly, VA's crisis may deteriorate into a full-blown catastrophe," he said.
The VA already is contending with the influx of troops from Iraq and Afghanistan as well as Vietnam-era and other veterans battling the ailment.
The agency provides mental health treatment at inpatient hospital wards and outpatient clinics. Care also is divided between general treatment and specialized programs for conditions such as PTSD.
The specialized programs are staffed by experts who concentrate on PTSD, and they've "long been recognized as an essential feature in treatment of military-related PTSD," one of the reports concludes.
"The availability of specialized PTSD programs is an important indicator of the quality of health care provided by VA," it says.
The most prevalent type of specialized program is an outpatient unit called a PTSD clinical team, and members of Congress and VA experts have pushed the agency to establish such a team at every VA medical center.
The VA has 153 medical centers, and one of the reports lists 103 centers with the special PTSD clinical units as of the end of fiscal 2006. The VA has added such units rapidly in the past year, and by the end of this year about 120 centers will have them, according to a May statement by the department.
Spending varies widely among the units, however, from more than $2,000 per treated veteran in centers in The Bronx, N.Y., and Boise, Idaho, to about $300 per treated veteran in Augusta, Ga., and about $200 in Palo Alto, Calif., one of the reports says.
Ira Katz, a top VA mental-health official, said different medical centers used different accounting systems but that the VA was working to make its PTSD care more uniform across the country.
"We want to increase the expectation of what kind of care every veteran can expect, no matter where they are," Katz said.
VA leaders are to meet this fall to help standardize the agency's PTSD program offerings. Over time, Katz said, spending on the programs will increase and the range among different centers will narrow.
Gauging the effectiveness of PTSD treatment is an inexact science, but one of the reports attempts to do so.
For treatment in hospital inpatient and other similar units, VA researchers track veterans' PTSD symptoms as well as their abuse of drugs or alcohol, propensity for violence and work habits.
They then adjust the results to account for the differences in the veterans being treated at each VA center, such as the severity of the veteran's mental illness.
Overall, the results show, treatment is effective: PTSD symptoms are reduced, for example. But some programs were better than others.
Only about 40 of the 153 VA medical centers had the specialized inpatient units, and not all of them had enough data to analyze. But 11 of the 36 that did, including the Lexington center, failed to meet at least one of the treatment goals the report tracked.
The VA researchers also came up with what they said was an overall measure of quality similar to a "cumulative grade-point average."
Lexington got the lowest marks; the VA center in Coatesville, Pa., was first. Katz said the Lexington medical center already had started to receive funding to support 20 new mental-health workers in an attempt to boost its outreach, education and treatment.
In a series of e-mails, however, he dismissed the reports' significance, saying they were produced by an internal VA research unit that's outside the agency's "formal quality improvement process."
Although the unit has been refining and publishing financial figures for several years, Katz said, the financial figures for individual PTSD programs aren't "meaningful" because of the VA centers' differing accounting procedures.
As for the services being provided, Katz said that veterans who weren't being cared for by the VA's specialized programs received "comparable care" from the system's general mental-health units. Finally, he said, the differences in outcomes among the units are minor.
"VA is always looking for ways to improve the care it provides," he said. "The apparent differences in spending and outcomes are possible signals, not scandals."
© 2007 McClatchy Newspapers
6 Comments so far
Show AllI am disabled veteran from the Iran-Contra era, but of course none of my special duty can be discussed. Nor is it ever mentioned on my DD-214 or any other forms the air force gives you or will release. You can read all about the running of black tar heroin and weapons under Dick Secord on the internet, but they never tell you who had to do it... and what they did to make you do what they wanted. I had no idea that the CIA could take a regular military person and make them a slave. I am royally fucked with PTSD. The VA just wants to send me drugs. They have at least one therapist in West Haven, CT, who actually cares, but they work her 'til she can drop. They now limit how many visits and how long your visits are-- as short as 30 minutes if you can get in. I cannot work because the rage inside comes out in the work place and I automatically go into fight and kill mode.. even after all these years. Medications don't work... they only make you feel like if you had to take these meds the rest of your life you would kill yourself. Medications are almost all the va offers. Drugs and if you don't take them they say you are noncompliant... not following the medical plan. I was a happy well-adjusted young WOMAN before I enlisted in the air force.. believing I could serve my country. What a crock of shit. My story of hell started in basic training with their vaccines from hell and ended with me getting a medical discharge for non PTSD related injury.. the middle is sheer hell.
I'm a veteran who's been under the care of one VAMC Mental Health Department after another for about 35 years now. If you want the inside scoop ask guys like me. The VA is the worst ass-covering herd of check-collecting hacks I've ever encountered. The goes in spades for their so-called Mental Health units. Every word of self-justification from their retirement-at-your-expense-craving mouthpieces is a complete tissue of self-serving merde. The typical level of incompetence in those funny factories is so egregious that it would be risible if people's lives weren't getting fucked over as the punchline. The VA, generally, is all smoke and mirrors, dedicated to telling Big Lies Real Regular, with shit-eating grins and starched shirts to people who either don't care or have a stake in seeing shiny new threads on the Emperor when he rolls by.
I've got PTSD that goes back to Viet Nam. I get no treatment at all ... and never have. They medicate you. Period. I've had to do my healing on my own, through genuine healers like AA, self-study, other 12 step groups, civilian therapists ... anything but the marathon clusterfucks that pass for treatment ala VA.
If vets get better during or after any bullshit VA circlejerks it's because god designed all of us to heal, if given half a chance. Vets get better IN SPITE OF THE VA, NOT BECAUSE OF IT.
Several years back, I asked for an honest-to-god therapist from the Seattle VAMC Outpatient M.H. unit. The shrink I've seen for meds for 9 years, shoots the breeze with me for 20 minutes/month as he keeps track of whether my meds are working.
That's all. Shrinks do nothing but write scripts any more.
So I got a date with a 'psychologist'. But not a REAL one. No, they palmed me off on some yo-yo who was passing through on a rotation, sucking up clinical experience along the way. I was someone for him to practice on.
That's the kind of shuck they specialize in. They surely count that as 'therapeutic intervention' per my request. It's a LIE! He didn't know shit from shellac about therapy! I knew more about it than he did!
I've been nuts a long time. I'm pretty bright. I pay attention. I know how things work. One of the things I know is that a patient only gets better if they can establish a solid relationship with a therapist and commit to YEARS of regular sessions. That's what I was looking for. My head needed help. After a few direct questions, I learned he'd only be there, on rotation, about four months. Then it was sayonara sicko and he was out of there, leaving holding the bag of my head problems just like when I walked in. Meaning we'd have just enough time to establish some rapport before he hit the road. I spill my guts to this novice and for what? So he can tell his supervisor that HE made some progress. No thanks. So I declined. And you know what those fucks did? They put in my record that I 'declined treatment'. Is that lower than whaleshit or what? That's how they cover their own asses all the time, at the expense of vets.
See, they arranged it to look like they were there to help but the Bad Patient wouldn't play. They make sure that what was really going on gets neatly papered over, in the name of that top quality care they brag about.
Your tax dollars at work.
The VA is like that from top to bottom. They harm far more vets than they help. And should all be shoved out into the private sector and forced to work for a living as a punishment for it.
When the VA comes out and says they need more money, which they do (for patient care), first ask your local VAMC for these amounts: Under the Freedom of Information Act I request the amounts of money paid above and beyond regular salary and overtime, to all past and present employees of the "whichever" VAMC from January 200? through December 200?. This is to include, but not limited too, all Special Contribution Awards, Retention Incentives/Allowances, Retirement Incentives/Allowances, New Employment Incentives/Allowances, Relocation Incentives/Allowances, Special Pay Incentives/Allowances, ETC.
Please limit this request to amounts $500.00 and above.
I would like this information in a format of names/titles, award type, date given, and amount paid.
Any amount below $500 is going to the "little" workers. The VAMC in my area gave out over $6.4 Million "in these bonuses" during 2006. From the figures I have I know the VA as a whole, gave out close to 1/2 BILLION in these types of bonuses. Probably more if ALL totaled up. If you don't ask---they won't tell!
If you do ask and the VA says you will have to pay for this information, contact your representative and demand that Article 1 Section 9 of our Constitution be followed and that you want to know where and to who every dime is going that the VA receives from the taxpayers treasury. Ignorence is bliss and our fearless leaders like us that way, because then they can get away with anything.
My son went to Iraq without PTSD. Upon his return from Iraq he was diagnosed with PTSD. The VA refuses to treat him because they say it is not military service related and all this after a mental breakdown in Iraq in which his CO reports him as suicidal, still he recieves no treatment for his PTSD from the VA here in Phoenix, Arizona. What a travesty, all for a barral of oil.Shame on this country.
Knoxville, Iowa Veterans' Hospital, scheduled to close sometime in 2009, pioneered many of the treatments now used for PTSD. As I watch those who have survived this plan, and consider that the VA is all smoke, mirrors, and idiots behind curtains, I am constantly reminded that George Bush is responsible for more executions, deaths, and mayhem than any so-called al Quaeda could have ever accomplished.
The few Iraq veterans that have come here to Knoxville have not received anything near the care they deserve. And they never will.
Many Vietnam Veterans have started going to the VA for PTSD as a result of the Iraq war, it brings up old memories. Many combat veterans have been suffering for years and are now seeking help, they don't all receive it. Hopefully the new veterans will be more forthcoming and get some help. At least the Iraq veterans aren't being blamed for the war. Pat d from Baton Rouge