Concerns Mount Over Waiting Lists at Veterans Affairs Mental Health Centers

The suicide of a 25-year-old Iraq war veteran has revived questions over how long returning troops are having to wait for treatment from Veterans Affairs hospitals for post-traumatic stress disorder and other mental health problems.

"We're hearing of too many cases of waiting lists — particularly involving cases of post-traumatic stress disorder," said Rep. Michael Michaud, D-Maine, chairman of the House Veterans' Affairs Subcommittee on Health.

"I'm not going to take a shot at the administration or the Democrats, it's just a problem that needs to be fixed, it's an American problem," said Larry Provost, an Army reservist who was given a two-month wait for an appointment to address his own PTSD.

Since 2002, tens of thousands of returning veterans have been treated for symptoms of the emotional disorder, brought on by the traumas of war in Afghanistan and Iraq.

Acknowledging the need for additional facilities to treat mental health, Veterans Affairs Secretary Jim Nicholson announced last week that the department would be incorporating 23 new Readjustment Counseling Service Centers in the next two years. That's on top of the 209 that are already operating around the country.

"Our vet centers lead the world in helping combat veterans successfully re-adjust to life at home," said Nicholson. "It's an important service which combat veterans have earned. VA continues to expand into more communities with our vet centers to bring our services closer to the veterans who need them."

"Care is available and it's available 24/7," said Dr. Lawrence Adler, a researcher in psychiatry with the Denver VA Medical Center. Adler told that returning veterans' mental health is a top priority and the vet centers are providing critical care for veterans and their families facing re-adjustment and substance abuse issues.

But that is not placating the family of Marine Jonathan Schulze, who hanged himself Jan 16. His family says four days earlier, Schulze had called doctors at the veteran's hospital in St. Cloud, Minn., and told them he was suicidal. They told The Associated Press that he was turned away on account of a waiting list for beds at the hospital.

As a rule, the VA does not put off veterans with suicidal tendencies, say VA officials. The Minnesota hospital would not comment directly on the claim, but officials say beds in their psychiatric unit do not have a waiting list.

Currently, 21 veterans are on a waiting list for a separate mental health residential treatment center, according to AP, which reported that the other unit is for less immediate, ongoing cases.

VA hospital records indicate that Schulze never told hospital staff he was contemplating suicide, but Schulze's father and stepmother insist they heard Jonathan tell hospital staff over the phone that he was suicidal. They say he told them he was informed he was 26th in line for a bed.

According to his stepmother, a day before the Jan. 12 call, Schulze went to the hospital with his bags packed and requested admission, but was turned away. The case is under investigation by the Department of Veterans Affairs in Washington.

The Schulzes, who opened Jonathan's records up to reporters, say they are upset the records do not reflect the severity of his case. Schulze had sought care from the Minneapolis Veterans Medical Center repeatedly since his return from a seven-month tour of duty in Iraq in 2004.

"The most disturbing part for me is their denial of Jon's suicidal condition," said Jim Schulze, a Vietnam veteran.

Tragedy Not the Rule

According to the latest VA records, out of the 205,097 Iraq and Afghanistan veterans treated by the VA since 2002, 73,157 had a potential mental disorder and 39,331 of them were tentatively diagnosed with PTSD. A March 2006 report in the Journal of American Medical Association revealed that 35 percent of returning troops from Iraq sought mental health care within a year of coming home.

This puts pressure on the system, particularly at the VA's Readjustment Counseling Service Centers, which focus on community-based counseling and outreach.

According to an October study commissioned by Democrats on the House Veterans Affairs Committee, staff at 15 of the 60 centers surveyed said they had or were contemplating limiting services or establishing waiting lists due to an increased patient load; 40 percent had sent patients to group therapy when they needed individualized treatment and 30 percent said they needed more staff.

But medical officials with the Department of Veterans Affairs question the veracity of the study. They also insist that not only do veterans who need emergency care receive it on demand, but according to 2006 data, those seeking non-immediate mental health care can get an appointment within 30 days of their request 94 percent of the time.

Dr. Ira Katz, the VA's deputy chief patient care services officer for mental health, said he is concerned that veterans will imagine the Schulze case is the norm when it is clearly not.

"Among our highest priorities nationally is addressing the need for returning veterans and we want to make that care available," Katz said. "Frankly, I'm concerned about the impact of the Minneapolis story, that it's making the point that care is not available and that a veteran killed himself over it. I don't want that to be contagious, that someone sees that and says, 'What's the use?"

Stories Differ

While advocates say the VA continues to offer superior care with compassionate staff, many veterans and their supporters say poor planning, inefficient resources and a stubborn bureaucracy has led to unnecessary service problems.

Steve Robinson, a Persian Gulf War veteran and spokesman for Veterans for America, said it is difficult to monitor actual wait times for veterans. Many advocates, having worked with veterans to help navigate the system, are dubious of the rosy VA data, he said.

"Anecdotally, we have talked to veterans who have waited 30 days to 45 days for an appointment," he said, noting that the Schulze case has shaken everyone.

Worse still, stories of suicides among Iraq and Afghanistan vets are not rare and have become a troubling outgrowth of the war on the homefront, he said.

"The biggest message I want to say besides it's a tragedy for this guy asking for help and not getting it, is there are going to be more veterans having the courage to go for help and not getting it," said Robinson. "It's the biggest betrayal, to seek the care that has been promised to you and be told to come back another day."

After doing search and rescue at Ground Zero in Manhattan after the Sept. 11, 2001, terror attacks, Provost, 27, who served in a civil affairs unit, was deployed to both Afghanistan and Iraq. He was having a hard time adjusting when he got home and after getting help at a New York VA, went to a veteran's hospital in Virginia, where he was going to school.

He was surprised by the two-month wait.

"I was told they were overwhelmed with guys and women coming home from the war," Provost recalled. He shot to the top of the list when a local newspaper got a hold of his story.

"They felt compassion," he said of the hospital staff, "but unfortunately, the system was overloaded."

Provost, who just received a masters' degree and is looking to launch a new career regards himself as one of the "lucky ones."

Sen. Larry Craig, R-Idaho, ranking member of the Senate Veterans Affairs Committee, said he is confident the VA is accommodating the wave of veterans with mental health issues, and believes that Congress has shown a continued commitment to putting resources where they are needed.

"The Senate and the House have added a tremendous amount of money in the past few years to improve mental health services for veterans and make certain that more care is available at more facilities closer to where our returning service members are living," he said. "We are on track to accomplish that goal and we will do even more next year."

But his colleague, Sen. Daniel Akaka, D-Hawaii, chairman of the panel, said he wants a thorough investigation of what happened in St. Cloud.

"I am concerned that reports of VA's failure to respond to Mr. Schulze's request for help may indicate systematic problems in VA's capacity to identify, monitor, and treat veterans who are suicidal," he said in a Jan. 29 letter to Dr. Michael J. Kussman, acting undersecretary for health at the VA.