Fellow Advocates -
Certainly, I am one of those "Veterans advocates (who sees) fundamental flaws" in the DoD and VA's response to the suicide rate and Veteran need for holistic primary and mental health care before it's too late for yet more families. Yes, I am one of the many advocates who 'get it,' and have written my responses to articles like the one reprinted below. But how do we get the answer into the right hands to effect change in policy and processes... 'tomorrow?' The primary reason we are not meeting the needs of Veterans, AND their family members, is we are trying to do it in silos resourced by separate funding streams and therefore disparate oversight. Our Vets, and the general public at large, need a Primary Care Provider Team who accepts and knows their responsibility to ensure 80% of the mental health screening and treatment needed for mental health conditions are met with same day access to behavioral health team members within the Patient Advisory Care Team (PACT), the VA's version of the Patient-Centered Medical Home (PCMH). Clearly, this is not happening in reality, only on paper. Instead, additional money and staff are being thrown into the old model of referral care centered on the Provider's schedule(s), NOT the Patient's! The additional "1,900 mental health specialists" the VA is hiring, following President Obama's directions in his Order to improve health care for Vets, are using archaic, out-dated access processes and treatment methods. It's actually the wrong resource being placed in the wrong location following traditional status quo methods and processes. (This is why they are "waiting an average of 50 days before getting treatment.") It is NOT "world-class care" we are investing in, Mr. President, it's 'status quo' care. David Rudd, director of the University of Utah’s Center for Veterans Studies, gets it. He pointed out that the VA continues to add (mental health) staff rather than coordinate with private (hopefully primary care) physicians." This same misappropriation of additional resources goes for the "increased number of crisis workers and phone lines" as well - the ones that get you a non-Veteran, not certified in crisis intervention, who has to follow a Federal mandate to call police or SWAT team within so many minutes of the caller admitting they have the means to kill themselves on hand. This bureaucratic approach does not establish trust. Vets talk to each other and pay attention to these details. Clearly, continuing to try and provide support within the same paradigm is wasteful and will get us the same results, over and over again.
Is anyone aware of VA Clinic locations where the paradigm shift IS happening to patient-centered processes? The "15 pilot programs on working more closely with community health providers" Petzel talked about are more of the same, silo'd pilots separated from the primary care team of the patient. And Primary Care Teams, as well as crisis line workers, are not aware of how to help the patient (Veteran) to access these programs...and if they will be paid for when they are accessed. These silo'd programs create gaps in getting timely care from the very start with barriers to access and lack of education on how to get to them in a timely manner! We do not need more research and pilots...we need health care access...now, with properly resourced and trained Primary Care Clinics in tough with available local community resources!
In addition, the Sec of the Army, John McHugh, is dumping more money into worn out "Resiliency" programs - the same programs that brow-beat sick troops for not 'manning up' when 'the going gets tough,' to 'suck it up and move on,' or "we'll administratively separate you from the Service" and make you the VA's problem. We keep trying to make sick patients be their own advocate. Doesn't work, hasn't worked, and won't work. We must revise our primary care clinics to a patient-centered approach with same-day access to the entire team, to include mental health, social work, AND FAMILY SUPPORT. How do we get this through to those who can make a difference? The measure of success will be reduction of suicides...period, NOT how many appointments are made (a "productivity" measure that says "look how busy I am!"). Would a letter straight to Veterans Affairs Secretary Shinsecki and Health Administration Undersecretary for Health Robert Petzel, pointing out they are NOT "on the right path" do the trick? Which "lawmakers remain frustrated?" Which ones need the letters or visits to straighten them out as to the real problem? Jeff Miller, chair of the House Veterans Affairs Committee, said it straight up - we must "treat our veterans where and how our veterans want, not...where (the)...VA wants,” in other words, patient-centered. The patient's medical home should be wherever the patient is, and resources should be available that the Veteran feels they need, same day. This can happen if every patient knows who their Primary Caregiver Team is and continuity is mandated with that resourced and balanced team. All specialists, to include mental health professionals, need to know they work for the the Primary Care Team, ultimately, the patient, through the Team. Let's get the system resourced in the proper order with the priority on Patient health.
Dr. George Patrin, Children's Mental Health Network Advisory Council Member