Sen. John McCain, R-Ariz., has introduced legislation to expand veterans' access to suicide prevention and mental health services.

Sen. John McCain, R-Ariz., has introduced legislation to expand veterans' access to suicide prevention and mental health services. Gerry Broome/AP

Veteran Suicides Highlight Tragic Consequences of Bureaucracy

Senate hearing on improving mental health care access for vets poignantly underscores the new secretary’s management challenges.

“Mom, I can’t go back there,” Clay Hunt told his mother back in March 2011.

The place was just too stressful, said the Marine Corps combat veteran suffering from post-traumatic stress. Hunt wasn’t talking about Iraq or Afghanistan. He was talking about the Veterans Affairs Medical Center in Houston, Texas.

Two weeks later, he killed himself. He was 28 years old.

Hunt’s mother, Susan Selke, testified before the Senate Veterans’ Affairs Committee on Wednesday during a hearing on vets’ access to mental health care and suicide prevention resources within the VA. On Monday, Sen. John McCain, R-Ariz., introduced bipartisan legislation to improve and expand that access, and require a third-party evaluation of how well the existing suicide prevention programs at the Defense Department and the VA are working. It’s a companion bill to H.R. 5059, the Clay Hunt Suicide Prevention for American Veterans Act, introduced in July by Rep. Tim Walz, D-Minn.

Approximately 22 veterans commit suicide every day. Hunt, who deployed to Iraq and Afghanistan, was diagnosed with post-traumatic stress in 2007. Selke described a frustrating process for her son, who encountered delays in trying to obtain education and disability benefits through VA, navigating a bureaucracy that lost his paperwork and made him wait excessively for care. Hunt had received a 30 percent disability rating for his PTS, and appealed that rating – an arduous and often, unsuccessful, endeavor. Eighteen months later and five weeks after he committed suicide, the VA granted his appeal and awarded him 100 percent disability.

“I look back and realize how proactive Clay was, and how determined he was that those were the benefits promised to him, that he needed them, and he was going to do what it took to get them,” Selke said.

In August, President Obama announced 19 executive orders designed to boost mental health care for veterans, and help troops make the transition from military health care to VA or civilian care through better coordination, the inTransition program and the uninterrupted delivery of mental health medications. The “inTransition” program pairs mental health professionals with vets through “warm handoffs” to new VA care pros, or to providers within the larger health care community.

VA Secretary Bob McDonald has rolled out the biggest reorganization in the department’s history, designed to rebuild trust with veterans and improve their access to services and benefits. With his “MyVA” approach, the former chief executive officer of Proctor and Gamble is bringing the business world’s laser-like focus on the customer to a government agency known for intractable bureaucracy. As part of that massive effort, he has said he wants to streamline online access to services and benefits, so vets don’t have to deal with multiple websites and points of contact, and recruit 28,000 new physicians, including mental health care professionals, to handle the increased volume of veterans from Iraq and Afghanistan.

“VA has expanded access to mental health services with longer clinic hours, telemental health capability to deliver services, and standards that mandate immediate access to mental health services to veterans in crisis,” said Dr. Harold Kudler, chief mental health consultant at the department’s Veterans Health Administration, during the hearing. The department also uses “evidence-based” psychotherapies to help vets suffering from PTS, and is studying potential benefits from alternative therapies, including acupuncture and meditation.

The use of prescription drugs to treat vets suffering from PTS, a critical component to treating mental health disease in many cases, also has a dark side. Vets have complained of being overmedicated, experiencing adverse side effects, or being prescribed drugs that do not help them. Selke said her son, Clay, “received counseling only as far as a brief discussion regarding whether the medication prescribed was working or not. If it was not, he would be given a new medication.”

Since March 2012, VA has added 2,444 full-time mental health employees and hired more than 900 peer specialists and “apprentices,” said Kudler. The department so far has reduced the national new patient primary care wait time by 18 percent, managed to roll out the first two phases of a “choice” program that allows vets faster access to private health care rather than waiting for a VA appointment or traveling several miles to a VA facility, and scheduled more than 1.2 million more appointments in the last four months than in the same period in 2013. But as McDonald has acknowledged, implementing such a large-scale restructuring and culture change to improve veterans’ experience with the department takes time. In August, Congress passed a $16 billion bipartisan VA reform bill to help jump-start the department’s overhaul, after delays in wait times for vets seeking health care across the country as well as an attempt to cover up those shortcomings in some VA facilities came to light this past spring.

For Selke, and Valerie Pallotta, whose son Joshua served in Afghanistan and committed suicide just six weeks ago, any improvements to the navigation of VA’s health care system will be too late for their children. “Everyone always says, ‘If there is anything you need, let me know,’” Pallotta said during Wednesday’s hearing. “The only thing we need and wish for is to have our son back, and we don’t have the heart to tell them that that is not something they can give us.”

She urged lawmakers to “please make this a priority to end the battle our veterans face with bureaucracy in getting the benefits and support they deserve so that their only focus can be on healing themselves and their families.”