Compelling Series About Va Funding Shortfalls In Northwest Paper
Mr. Speaker, I am placing an article from the July 25, 2005, Seattle Times newspaper into the Congressional Record because I think it is important that all of my colleagues understand the real world impact underfunding the VA is having on…
Mr. Speaker, I am placing an article from the July 25, 2005, Seattle Times newspaper into the Congressional Record because I think it is important that all of my colleagues understand the real world impact underfunding the VA is having on veterans suffering from mental disabilities.
To those who say that VA is adequately funded, I say read this article. Spending on VA mental health care services, adjusted for inflation, is $630 million below the level in 1996, despite an 11 percent increase in veterans seeking services. During that same 1996- 2003 period, overall mental health staffing for the seriously mentally ill declined by 31 percent, and funding for drug and alcohol treatment dropped by 54 percent.
VA mental health professionals have been asked to cut back on the number of sessions offered to veterans on a monthly basis, to cut back on the time allotted for each session, lengthen the time between visits, and drop some patients altogether.
It is unacceptable to treat those who have served our country with such disdain. The President and Congress have found trillions of dollars to provide tax cuts to wealthy individuals and profitable corporations. And Congress and the President will send tens of billions of dollars to foreign governments this year. Clearly there is enough money to adequately provide for our veterans. The President and Congress have simply chosen not to make caring for veterans a priority. That has to change, immediately.
[From the Seattle Times, July 25, 2005]
VA Straining To Treat Post-Traumatic Stress
(By Hal Bernton)
ABERDEEN--During counseling, Vietnam veteran Rod Chenoweth
always sits in the same place--a blue fabric couch carefully
positioned in a corner to give his body the protective cover
of a side and rear wall as he talks about his life.
He recounts an argument that left him seething in anger. He
talks about an evening flashback to the grenade that wounded
him in the leg and killed his 19-year-old buddy.
Chenoweth says the therapy, paid for by the Department of
Veterans Affairs VA), has helped pull him back from thoughts
of suicide and other self-destructive acts in a life scarred
by post-traumatic stress disorder (PTSD)--a war injury that
ranks among the most common and the most difficult to heal.
Starting in July, Chenoweth's sessions with Aberdeen
therapist Jack Dutro have been reduced from twice to once a
month, a cut that comes as thousands of Iraq war veterans
join those of previous wars in seeking treatment from the
strained VA.
``I can understand that the new veterans need to be dealt
with,'' said Chenoweth, 56. ``But it's going to be tough.
Jack has been a lifesaver.''
The agency is required by law to take care of the war
wounds of all combat veterans.
But the agency's PTSD experts, in a report delivered last
fall to Congress, warned that the VA ``does not have
sufficient capacity to meet the needs of new combat veterans
while still providing for the veterans of past wars.''
Internal reports show the VA's mental-health network has
been frayed by years of staffing cuts and budgets that failed
to keep pace with the growth in patients.
According to an internal review of the agency's budget,
delivered to Congress in September, problems have been years
in the making:
Between 1996 and 2003, annual spending for treatment of the
serious mentally ill increased from $2.16 billion to $2.4
billion. But when those budgets were adjusted for inflation
in medical costs--the increased costs of salaries and
services--spending in 2003 was actually $630 million below
the 1996 level. Meanwhile, the number of veterans seeking
those services climbed by 11 percent.
During the same period, overall mental-health staffing for
the seriously ill declined by 31 percent.
Drug and alcohol treatment for the seriously mentally ill,
often a critical part of the program for those seeking PTSD
therapy, has been the hardest hit. Annual funding, adjusted
for inflation, dropped by 54 percent nationwide between 1996
and 2003.
``It's been a perfect storm of rising needs and tight
resources,'' said Tom Schumacher, who directs a Washington
state effort to assist PTSD veterans.
The Northwest VA network has fared better than most of the
nation, avoiding many of the staff cuts that hit other
regions.
But the four-state region that includes Washington, Oregon,
Idaho and Alaska also is one of the busiest hubs of
treatment. The PTSD patient load alone has increased from
3,194 in 1996 to 4,671 in 2004.
To help manage the crunch, the VA Puget Sound Health Care
System earlier this year imposed new restrictions on PTSD
therapy for veterans who already have undergone at least six
months of treatment.
The VA guidelines now call for no more than once-a-month
individual therapy, or twice-a-month group therapy. Those
apply to Puget Sound-area clinics and a network of VA-funded
private therapists who work around the state.
Dr. Miles McFall, director of PTSD programs at the VA Puget
Sound, said that more frequent therapy does not necessarily
help, and those in trouble are welcome to check into an
inpatient VA hospital clinic.
``Even if money was not an issue, this is what we should be
doing,'' he said. ``We care about our Vietnam vets. We're not
going to turn our backs on them.''
Other therapists say while some veterans can handle less
treatment, the more unstable ones may suffer setbacks.
``Some of them are devastated and feel like they have been
abandoned one more time,'' said Jim Shoop, a Mount Vernon
counselor. He said his office is reducing service to more
than 50 vets with PTSD.
a lifetime of trouble
Soldiers have always suffered from the mental wounds of
war.
But the diagnosis of post-traumatic stress disorder only
emerged in 1979 in the aftermath of the Vietnam War as tens
of thousands of distraught veterans, suffering from
flashbacks, sleeplessness, anger and other symptoms, poured
into VA hospitals.
By 1988, the VA estimated that 479,000 vets suffered PTSD
symptoms.
For many of these vets, PTSD has meant a lifetime of
trouble.
Chenoweth served with the Marines in Vietnam from 1968 to
1969, when the U.S. sustained some of its heaviest
casualties. He turned 18 just before boarding the plane to
Asia and soon found himself fighting in villages where
anybody could be the enemy.
Chenoweth ended his tour of duty in a psychiatric hospital
in Oakland. But it wasn't until the late '80s--after more
than a dozen failed jobs, several more hospital stays and two
broken marriages--that he was diagnosed with PTSD.
``The killing doesn't stop,'' Chenoweth said. ``You taste
it. You smell it. And you feel it. It uses all your senses.''
The numbers of older veterans seeking mental-health
treatment surged again in recent years, as new wars unfolding
on television in Iraq and Afghanistan added to their stress.
That, coupled with the influx of soldiers returning from
Iraq, has ratcheted up pressure on the VA system.
more become eligible
In the '90s, the VA went through a dramatic overhaul,
moving away from a centralized hospital system as hundreds of
new clinics opened up around the country. Congress also
loosened eligibility requirements, so that more vets
qualified for services, and increased the agency's overall
health-care budget from $17 billion to more than $28 billion.
The transformation was lauded as a great success in an
Annals of Internal Medicine article last year.
But mental-health services often lost out as regional
administrators juggled budgets to pay for soaring caseloads,
new services and pricey new drugs.
Managers also sometimes balked at pouring money into
treatment for illnesses of the mind when compared with
physical illnesses that are often easier to measure and cure.
``I regret to report that there are stigmas in the VA about
the mentally ill,'' Thomas Horvath, a psychiatrist who serves
as chief of staff at the agency's Houston medical center,
told Congress in 2004.
``In this, we may be no worse than the rest of health care.
VA needs to do better.''
Sen. Patty Murray, who worked as a college intern in the
Seattle VA psychiatric ward, has helped lead the
congressional effort to boost funding for VA programs,
including mental health.
``I have talked to soldiers who are returning, and a number
of them say `my marriage is much more difficult . . . I am
having trouble getting my head back in to work,' '' said
Murray, ``It's the beginning of trouble. And the fallout from
this 10, 15, 20 years from now is tremendous.''
The issue of VA funding has been rife with partisan
politics recently.
Murray, a Democrat, initially was rebuffed by the
Republican majority in an effort to gain emergency funding
for VA medical services.
VA administrators in June acknowledged a roughly $1 billion
budget shortfall, prompting Senate Republicans to do an
about-face and work with Murray to boost funding.
Congress is expected to approve an additional $975 million
to $1.5 billion to help dig the agency out of the hole for
this fiscal year.
If this money is equally divided within the agency, mental
health would receive less than $300 million.
This emergency cash would fall short of shoring up the
system.
To fully meet the needs of the seriously mentally ill, the
VA would require an infusion of as much as $1.6 billion,
according to a draft of the agency's strategic plan.
That estimate didn't assess the added costs of treating new
Iraq veterans.
just good-enough care
There is no fixed formula for treating PTSD.
Instead, the VA offers general guidelines for addressing
the illness. This treatment may involve drugs that aid sleep
and reduce anxiety or help fight depression. It may include
classes in anger management and other coping skills.
Finally, there is therapy, which often enables the vet to
recount and come to terms with combat experiences.
Some patients may benefit from just a few classes and
counseling sessions. Others with chronic PTSD attend sessions
for months or years. Some patients do fine in group; others
do much better with individual therapy. But as budgets have
shrunk, some VA mental-health workers say, they have been
pressured to treat more people in less time.
In Portland, the VA mental-health clinic staff by January
had shrunk by 25 percent due to budget freezes, according to
an internal staff newsletter. The newsletter described the
Portland program as ``unquestionably underfunded.''
Therapists in Portland earlier this year were asked to
consider cutting individual sessions from 50 minutes to 30
minutes, and lengthen the time between visits, according to
an internal VA memorandum.
They say they were also asked to consider dropping some
patients altogether, after refilling their prescriptions and
referring them back to primary-care physicians.
Megan Streight, a VA spokeswoman, said the Portland VA does
not expect staff to cut back services for patients who need
therapy. She also said that some jobs have been filled. ``We
are confident that veterans continue to receive high-quality
mental-health care,'' Streight said.
But several Portland VA therapists expressed worries that
expanding caseloads combined with a smaller staff threaten
the quality of some care. All requested anonymity, concerned
that speaking publicly could cost them their jobs.
These therapists say they have been asked to try to
complete treatment of new patients in 10 or fewer counseling
sessions, even those recently returned from Iraq. Some of
these vets arrive at the VA with marriages already in turmoil
or broken. Others have isolated themselves at home, and
balked at returning to work. One, who came in after beating
his wife, had penned a suicide note.
One therapist said she has been reluctant to stick several
troubled Iraq vets in first-step classes of 20 or more that
teach coping skills. But her own caseload already runs to
several hundred patients, so she has no openings for more
one-on-one counseling. To make room for the Iraq veterans,
she asks some of her older veterans to come less often.
``But what kind of message is that--that you're not as
important as the new guys coming in,'' she said.
The therapist says she needed to get used to the short-
staffed conditions.
``I was told that there needed to be some changes made at
the hospital due to the lack of resources, and I was going to
have to adjust my thinking,'' said the therapist. ``You need
to give Just good-enough care.' ''
The Puget Sound VA's mental-health programs also have been
caught in the regionwide budget crunch, which included a
partial hiring freeze that replaces only one worker for every
five who leave their jobs.
``We have to make the best use of resources that we can,''
said John Park, Puget Sound VA's director of health-care
planning, at an April 30 community meeting on mental health
sponsored by U.S. Rep. Jim McDermott, D-Seattle. ``You can
only cut so much of the budget before things get dicey.''
sharing hopes and fears
Most PTSD patients in Puget Sound are seen in a specialized
program that includes clinics and in-patient care. The
program has a national reputation for research and treatment.
McFall, who heads that program, says he was able to snag a
special grant that allows him to add several more positions
to the 21-person clinic staff in the months ahead.
``I want to say that the sky isn't falling. We can get
every Iraq veteran an appointment within a week,'' he said.
But the local VA policy to limit treatment for patients who
have had six months of therapy has caused a backlash. The
loudest protests have come from the state network of private-
practice therapists who are paid by the VA to treat vets with
chronic PTSD.
``I believe that in order to do long-term recovery, I have
to do a lot of work,'' said Steve Akers, a Vietnam vet who is
an Everett therapist. Akers offers weekly group sessions, as
well as individual counseling.
At the group sessions, the vets spend 90 minutes sharing
hopes, fears and a few laughs before ending with a healing
circle where they all grasp hands on a wooden staff known as
a ``talking stick.''
One veteran of both the Vietnam and Gulf wars still lives
on a razor's edge. At his house, he has installed a perimeter
trip wire that sounds an alarm to warn of intruders, and
outside lights that can turn midnight into day along a 400-
foot driveway. The house is full of loaded guns, weapons his
wife fears might be inadvertently used in a combat flashback.
``She doesn't want the one under the bed, and in every
room,'' the vet said during the session. ``But I've got to
live with myself. I don't feel secure.''
Akers opted to take things one step at a time, focusing on
a pistol in a bedroom drawer.
``So, at one point, would you be willing to put the pistol
in one drawer, and the ammo in another? You'll still have
your safety factor but have to think to react.''
``I could do that,'' the vet responded. ``But it will be
really hard for me. When they break in that door, they're
only going to do it once. ``
Under the new VA policy, the group's weekly meetings will
be reduced from twice a month to once a month.
Among the vets, that's the subject of much bitter debate.
``I try not to take it personally,'' said the veteran with
the loaded gun. ``There is an intimacy here that is
incredible. I want to save it. And the fear, you know, is
that it's not going to last.''