Long waits for mental health care

EL PASO, Texas — Nick D’Amico, a deeply troubled Army veteran, was seeing a counselor every other week. But he found it next to impossible to get a follow-up appointment at the El Paso VA with a psychiatrist who could adjust his medication, according to his mother.

The best the system could offer, she says, was a half-year wait for a teleconference with a Veterans Affairs psychiatrist in Albuquerque, New Mexico.

That appointment was still two months away when D’Amico, 45, left his wallet, phone, watch and Desert Storm hat at home and committed suicide by driving off a cliff outside El Paso last September.

“It’s shameful. It’s disgusting. It’s got to stop,” says his mother, Bonnie D’Amico.

For years, veterans have complained about maddening waits for mental health services at VA medical centers, and for years federal officials responded by hiring more clinicians and expanding programs.

This week, a devastating internal investigation that looked at wait times for all sorts of care across the VA system showed the agency hasn’t solved the problem.

It found, for example, new mental health patients were routinely forced to wait a month or more to start treatment.

Not one of the 141 medical systems examined was able to meet the department’s goal of getting all new mental health patients an appointment within 14 days. At 30 facilities, the average wait topped 40 days.

For D’Amico and other patients, the delays have had real-world consequences, according to family members, vets and experts.

Dr. Paul Summergrad, a psychiatry professor at the Tufts University School of Medicine and president of the American Psychiatric Association, said aside from delaying needed care, the long waits destroy any sense of connection between the patient and the provider, making successful treatment less likely.

“We have a suicide crisis. We have a post-traumatic stress crisis. We have a traumatic brain injury crisis, all going on at the same time,” Summergrad said. “To have them wait is unconscionable.”

Andrew Danecki, a former Marine corporal who served in Afghanistan, got a taste of the waiting game in 2011 when he sought treatment at the Durham VA Medical Center in North Carolina for symptoms that included anger, depression and crippling fatigue.

Danecki said he was able to start seeing a counselor in a reasonably short amount of time and eventually got in to see a psychiatrist, but when the doctor suggested he undergo a sleep study to help understand why he was so exhausted, it took eight months to get the appointment.

During that wait, he kept falling asleep on his couch, nearly nodding off behind the wheel of his car, and wondering why, at age 25, he was such a mess.

When he finally underwent the study, doctors were able to quickly diagnose him with obstructive sleep apnea, a condition that can be linked to post-traumatic stress. Danecki was put on a machine called a CPAP that helps him breathe more regularly at night. His chronic exhaustion vanished immediately.

“If I would have done that a lot sooner, maybe a lot of those issues that I had dealt with could have been cured, or at least, you know, calmed down,” he said.

D’Amico was a missile defense specialist who served in the Army for four years in posts including South Korea and Saudi Arabia and never saw combat, according to his mother. She said he was withdrawn and moody and was diagnosed with major depression.

One time, he was already at the VA clinic in El Paso in 2012 when he was told his appointment with a psychiatrist was canceled. It was the fifth time that happened to him, according to his mother, who says her son went “ballistic” when told he would have to wait another two months.

“The guards there had him restrained and all,” she said.

The findings released Monday on long wait times for mental health care will not surprise anyone familiar with the VA system.

Multiple congressional hearings have highlighted long waits for care. The VA’s inspector general issued scathing reports in 2011 and 2012. VA clinicians have repeatedly come forward to complain about such things as staffing shortages and a scheduling system that was routinely manipulated to cover up delays.

In 2011, a federal appeals court in California was so disturbed by the system’s inability to handle mental health issues it declared the VA’s treatment of vets unconstitutional.

“The VA’s unchecked incompetence has gone on long enough; no more veterans should be compelled to agonize or perish while the government fails to perform its obligations,” U.S. District Judge Stephen Reinhardt wrote in a decision that was later overturned on jurisdictional grounds.

The VA hasn’t ignored the problem. It has repeatedly boosted mental health staffing levels — although in doing so it’s barely kept ahead of a surge in patients. The number of vets getting mental health treatment in the system climbed from about 900,000 in fiscal 2006 to 1.4 million in fiscal 2013.

Last June, the VA announced it completed yet another hiring campaign, ordered by President Barack Obama. An additional 1,600 clinicians and 300 support staff were hired. It also hired 800 peer counselors, launched a suicide prevention campaign and hosted more than 150 “mental health summits” to discuss the needs of vets and their families.

Yet, the internal investigation found 48 VA medical centers had an average wait between 31 and 40 days for new mental health patients. Fifty-eight centers had an average delay of 21 to 30 days.

DeAnne Seekins, director of the Durham VA, said the hospital opened a mental health access center a year ago to reduce wait times and is trying to recruit an additional 16 mental health providers.

The El Paso VA had some of the nation’s worst wait times: 60 days for new mental health patients and 16 days for patients seeking follow-up care. In fact, Texas had four VA facilities in the top 10 with the longest waits for mental health services. VA administrators cited recruiting challenges as a factor.

Sheila Austin, a spokeswoman for the VA in El Paso, where D’Amico was getting care, said attracting clinicians to the West Texas desert isn’t easy.

“El Paso is a medically underserved community. It is hard to recruit psychiatrists, not only in the VA but also in the private sector,” she said. “We offer incentives, but it still is a challenge.”