Make it easier for VA to hire more psychiatrists

The Department of Veterans Affairs is embroiled in a troubling scandal. An internal audit has found that more than 57,000 new patients have waited at least three months for their first appointment while 13 percent of VA schedulers have admitted to falsifying appointment request dates under orders to obscure these long wait times. The culture that has persisted at the VA constitutes an unacceptable insult and medical risk to the 22 million veterans across our country — women and men who have dedicated their lives in myriad ways to ensure our national security.

We applaud the actions underway in Congress to make much-needed reforms to the way VA provides health care services. However, as these bipartisan efforts proceed, we urge our leaders in Washington to ensure that the significant mental health needs of our veterans are not overlooked.

Veterans of all ages and backgrounds face significant mental health challenges. Anxiety, depression, post-traumatic stress disorder and substance use disorders are widely present and often undiagnosed. The VA reports an average of 22 suicides each day. Those preventable and tragic deaths rarely make headlines.

A number of factors have contributed to lack of adequate treatment for veterans with mental illness or substance use disorders, including improper patient wait times and insufficient community resources. One significant factor is the chronic shortage of VA psychiatric physicians. In 2012 the VA Office of the Inspector General reported that the VA’s “greatest challenge has been to hire and retain psychiatrists.”

Current policy makes it extremely difficult for the VA to compete with other federal agencies and private entities in offering employment incentives, such as medical education loan repayment, to new hires. For example, of 128 permanent full-time VA positions advertised in September 2013, only 33 (25 percent) were eligible for medical school loan repayment. We believe what is needed is a new dedicated way of encouraging more psychiatrists to choose a career with the VA.

We strongly support the bipartisan Ensuring Veterans’ Resiliency Act, introduced by Reps. Larry Bucshon, R-Ind., and David Scott, D-Ga., and Sen. Mark Begich, D-Alaska. This pilot initiative recruits a limited number of psychiatric physicians into long-term employment at the VA by offering guaranteed competitive medical school loan forgiveness incentives. The bill aligns well with ongoing congressional efforts to make comprehensive reforms to the VA. As the House and Senate resolve their differences on the legislation they’re working on, EVRA deserves worthy consideration for inclusion in any final conference agreement.

The longstanding problems at the VA have prompted a national outcry to provide our veterans that which we rightfully owe them: a robust health care delivery system. Such a system can be sustained only with a proper workforce in place — a workforce that can fully meet both the physical and mental health needs of its patients, both in hospitals and the community. EVRA enables us to build that system that will ensure the resiliency of all our veterans.

Saul Levin is CEO and medical director of the American Psychiatric Association. Mary Giliberti is executive director of the National Alliance on Mental Illness.

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