VA hospitals wrestle with substance abuse, mental health care

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Capital News Service
LANSING – A new report says the U.S. Department of Veterans Affairs has expanded its services for veterans but still has some room to improve, particularly with veterans who have substance use disorders.
The report by the Government Accountability Office (GAO) highlights how VA hospitals have made improvements and what they have left to do. Even though it doesn’t look specifically at any Michigan hospitals, it applies to all 20 VA hospitals and clinics in the state.
The GAO is a nonpartisan investigative arm of Congress.
The strengths of VA hospitals include increased addiction and mental health services, but the report said there are staffing difficulties.
Alan Mellow, the director of Mental Health Services for Division 11 of the Veterans Integrated Service Network based in Ann Arbor, says the report updates how VA is adapting to changes in providing mental health and substance use services.
Those changes began around 2004 and were compiled in the VA’s Uniform Mental Health Services Handbook in 2008.
“In 2005 the roll-out of that strategic plan began, and that entailed an infusion of a good deal of resources into the field for many different addiction and mental health services,” Mellow said.
“But we’re five years into this now, so we’ve been able to hire staff, create these venues of care and reorganize our care.
“It’s not perfect, but I think we’ve made enormous strides in the last five years,” he said.
There are VA medical centers in Ann Arbor, Battle Creek, Detroit, Saginaw and Iron Mountain, with 15 outpatient clinics throughout the state.
The report found that some centers have difficulty hiring staff for addiction-related jobs. In addition to new jobs in more traditional counseling areas, substance use disorder positions were added in 2008 to some non-addiction areas, such as at outpatient clinics. As of last October, the VA nationally had filled 182 of 226 of these new positions. In Michigan, five of six positions are now filled.
Robert Weiss, the state adjutant and quartermaster for the Michigan chapter of the Veterans of Foreign Wars, said that he’s seen evidence that some VA doctors carry an excessive workload.
“The main problem that I think we have in these hospitals is that we do not have enough doctors on staff,” he said, adding that the caseload for doctors is greater than in private practices.
Ray Essenmacher of Saginaw, the president of the Vietnam Veterans of America Bay City chapter, said he’s always had a positive experience with VA medical care.
Mellow said that although he can’t speak about the caseload of primary care physicians the VA is careful about the number of patients a doctor sees. However, hiring psychiatrists for substance use programs could be a problem because the market for psychiatrists is strong, he said.
“There’s turnover, and that’s always challenge,” he said. “I think that the challenges of recruitment are ongoing and will probably never stop. I don’t know if there’s anything unique about that.”
Geoff Voshel, the program coordinator of the substance abuse initiative at the Battle Creek VA Medical Center, said that overall he doesn’t have trouble hiring with-one-exception.
“Every facility in the nation has trouble finding addiction psychiatrists,” he said. “It’s just a very specialized field that not a lot of people go into.”
Weiss said the need for psychologists and psychiatrists familiar with substance abuse is linked to treatment for other mental health problems.
“A lot of people coming back from the Iraqi and Afghanistan wars right now are suffering from post- traumatic stress disorder (PTSD), primarily because of the number of times that they’ve been deployed,” he said. “People come back here and instead of getting help, they try to find it in the bottle or with drugs or something else. It’s not the way to treat this.”
Mellow said that combination has resulted in a focus on dual diagnosis at facilities to better treat patients who suffer from a combination of disorders.
“Dual diagnosis is a recognition of the very high likelihood of a combination of substance abuse with other psychiatric disorders,” he said. “There is programming that is dedicated to addressing in a parallel fashion these combinations.”
The GAO report said that almost 25 percent of veterans with substance use dependency have PTSD, and almost 20 percent have some form of depression. Overall, 58 percent of veterans with drug or alcohol dependency had one or more additional mental condition.
Mellow said that the VA is always trying to improve its services.
“There’s a view of the VA as a faceless bureaucracy,” he said. “Contrary to that view, we are constantly in a cycle of quality improvement, but not every veteran is going to be satisfied. Our goal is that every veteran is satisfied, but not every one is.”
© 2010, Capital News Service, Michigan State University School of Journalism. Not to be reproduced without permission.
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