16 Oct 2017

Access to Care for All Veterans

Access to Care for All Veterans

The Department of Veterans Affairs and APA are working to improve treatment for veterans in new ways

Hiring 1,000 more mental health professionals and increasing the number of private-sector mental health providers who are culturally competent in military issues are among the new priorities at the Department of Veterans Affairs (VA), according to VA Secretary David J. Shulkin, MD, who testified in March to the House Veterans Affairs Committee.

Shulkin also emphasized the need to strengthen suicide-prevention programs and announced his intention to open up access to treatment to veterans with other-than-honorable discharges.

APA is helping to ensure that the secretary's goals become a reality by pushing Congress to expand resources for VA mental health care and research. "We are thrilled that Dr. Shulkin was named VA secretary," says Heather O'Beirne Kelly, PhD, who in March was named APA's first-ever director of veterans and military health policy. "And we applaud all his newly announced priorities."

Saving lives

The number of veterans committing suicide has dropped to roughly 20 a day, the secretary told Congress. But when it comes to suicide prevention, he said, "What we are doing now—and we are doing a lot—is not enough." The VA is seeking new approaches, he said. "We are reaching out to the very best and brightest from the academic world and the community to come in and tell us what else we can do."

As part of Shulkin's suicide-prevention effort, he plans to make emergency mental health care accessible to the 500,000-plus veterans who have other-than-honorable discharges, which render them ineligible for VA care. "Our goal is simple: to save lives," said Shulkin, explaining that the suicide rate among veterans who don't use VA facilities is increasing at a greater rate than that of veterans receiving care within the VA.

Shulkin's proposal would give veterans with other-than-honorable discharges access to VA emergency departments, vet centers and the Veterans Crisis Line at (800) 273-8255. The secretary plans to meet with members of Congress, Department of Defense officials and representatives of veterans service organizations before finalizing his proposal this summer.

Veteran Thomas Burke, who received an other-than-honorable discharge after being booted from the Marines for smoking hashish to manage post-traumatic stress disorder (PTSD) in Afghanistan, supports the proposal. "When people think of ‘less-than-honorable' discharge, they think of dishonorable; to get a dishonorable discharge, you have to rape or murder someone," says Burke, now treasurer of High Ground Veterans Advocacy and a master's degree candidate at Yale Divinity School. But, he says, other-than-honorable discharges are often the result of behavior related to PTSD, traumatic brain injury, military sexual assault and other mental health problems. Of course, says Burke, the secretary's proposal is just a proposal. That's why he and other veterans in High Ground support the Honor Our Commitment Act, which seeks to transform the proposal into legislation requiring the VA to provide mental and behavioral health services to veterans with other-than-honorable discharges.

APA outreach

APA supports the secretary's proposals, says Kelly. APA generally supports the proposed legislation, too, although Kelly wants to keep a close eye on implementation details. There have been calls to retroactively assess veterans' discharge statuses, for example, and it would be critical to understand how and by whom those assessments would be performed and interpreted and how they would be used by the VA for health-care decision-making, Kelly says.

Of course, the secretary will also need resources to fulfill his vision for the VA. APA called for that increased funding along with other requests in testimony to the House Appropriations Committee's Subcommittee on Military Construction, Veterans Affairs and Related Agencies in March:

  • Suicide prevention. APA supports Shulkin's commitment to enhanced suicide prevention efforts. In terms of other clinical priorities, Kelly urged Congress to support the hiring of more psychologists, increase support for integrated care and hold community providers to the VA's high standards.
  • Prescriptive authority. Kelly also urged Congress to grant prescriptive authority to appropriately trained psychologists in the VA.
  • Research funding. As part of the Friends of VA Medical Care and Health Research, APA asked for $713 million in fiscal year 2018 for VA research. "A strong VA psychological research program provides the scientific foundation for high-quality care within the VA system," Kelly told Congress.

One concern is the VA's push toward privatization, with more care being provided outside of VA facilities, adds Kelly. While many veterans groups were happy to hear the secretary talk of eliminating the rule requiring veterans who live close to VA facilities to get their care there, she says, APA is concerned that community providers may lack the preparation and capacity to handle the increased demand. Plus, says Kelly, having psychologists embedded into primary-care settings is vital to ensuring high-quality care for veterans.

"We will continue to work with Secretary Shulkin and the VA about what they mean by community care to ensure that the VA is strengthened as an integrated-care provider for veterans and not just as a funder of outside care," Kelly says.

To read Dr. Heather Kelly's full testimony to the House Subcommittee on Military Construction, Veterans Affairs and Related Agencies, go to www.apa.org/about/gr/issues/military/testimony_va_research.pdf.

By Rebecca A. Clay


This article was originally published in the June 2017 Monitor on Psychology

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