Oregon study finds that number of providers a significant issue for veteran health
By TATIANA PARAFINIUK-TALESNICK | The Register-Guard, Eugene, Ore. | Published: August 24, 2019
(Tribune News Service) — Oregon veterans may be at lower risk for depression or sadness, but they are more likely to die from suicide and opioid overdose than non-veterans, according to a recent state study on veteran health.
"We're just so focused on the mission," Laura Follett, a Springfield resident and a 15-year Navy veteran, said. "We're not necessarily focused on ourselves, you know?"
Follett is one of about 310,000 veterans in Oregon – a group that makes up 10% of the adult population. Navigating the medical system is far from the only obstacle for veterans in need of health care. One in four Oregon veterans experience frustration in seeking care for mental health or substance use issues, according to the 200-page health study funded by the Oregon Health Authority and the Oregon Department of Veterans Affairs.
The study is made up of 3,915 veterans from across the state who completed an online questionnaire and 63 veterans who participated in focus groups. The project set out to describe the type and availability of behavioral health services for veterans in Oregon, provide findings regarding facilitators of and barriers to the use of behavioral health services for veterans and to make recommendations that may result in improved accessibility of behavioral health services by veterans in Oregon.
Some of the notable findings include:
- 1 out of 3 veterans surveyed who felt they needed behavioral health care didn't seek services because they felt uncomfortable or unsafe.
- Specific needs and expectations of veteran subgroups vary in ways that affect how those veterans seek care. Tribal representatives report a need for services that meet cultural needs with an emphasis on a preference for traditional healing methods and peer support as the most important factors in care-seeking behavior for tribal veterans.
- Sexual harassment and assault impacts service members of all genders, including at least 50% of female veterans. Interviewees reported a need for more community-based, gender-specific options in Oregon, particularly for military sexual trauma.
- Oregon veterans ages 18-34 are at the highest risk for suicide. Lane County has the second-highest rate of veteran suicide of all Oregon counties. In 2016, 79 people died by suicide in Lane County – around a fourth of those who died were veterans.
Out of the study's key findings it offered 19 recommendations to help improve veteran care.
Following one of the study's recommendations that OHA, ODVA, and the VA Health Care Systems in Oregon should collaborate to develop a cohesive, well-researched, and targeted education and outreach effort to destigmatize behavioral health issues and treatment, OHA and ODVA are taking a statewide tour to learn more from particular communities over the next several months.
As part of the statewide tour, in Eugene the first hour of a community forum will be reserved for LGBTQI-identifying people. This relates to the recommendation that VHA and Vet Centers make plans to build capacity for cultural competency practices with measurable objectives that address the unique needs of groups of veterans, such as tribal, LGBTQI and women.
Other major recommendations include:
- Cross-agency collaboration among OHA, ODVA, and VA Health Care Systems in Oregon should drive increase of state and federal agency coordination across behavioral health systems.
- OHA, ODVA, and VA Health Care Systems in Oregon should improve access to treatment for military sexual trauma by reconfiguring clinical spaces and intake processes, increasing the number of providers who are specially trained to identify and treat military sexual trauma, and conducting a cost analysis study for establishing an inpatient option in Oregon.
Follett is no stranger to the difficulty of working with the VA – as a patient and a former employee. Her first job after her service was with the Veteran's Affairs in Roseburg. Conflict in the workplace caused her to jump-start her retirement, but also allowed her to be a whistleblower and contribute to a 2018 New York Times investigation of Roseburg's VA Health Care System.
The investigation from the Times found RVAHCS was denying sick patients care in an effort to boost its quality-of-care ratings, fewer patients result in fewer bad outcomes and better scores for the facility. Improved ratings resulted in bonus checks for the facility's leadership. The facility's rating jumped from one star to two in 2016 and the director earned a bonus of $8,120.
The facility continues to be troublesome for the state. On Aug. 16, RVAHCS closed its emergency department. This change will leave Roseburg-area veterans with few immediate medical care options after 8 p.m. on weekdays and anytime on weekends.
"An Emergency Department requires a full staff to provide safe, patient-focused emergency care," Timothy Parish, a spokesperson for RVAHCS, said. "Due to a shortfall in qualified providers to staff Emergency Department ancillary services, such as laboratory services, radiology services and respiratory services, the Emergency Department converted to an extended-hours Urgent Care facility."
The closure gained the attention of U.S. Rep. Peter DeFazio, and his office penned public letters to Robert Wilkie, the secretary of the US Department of Veterans Affairs, and Brenda L. Roberts, U.S. Office of Personnel Management Deputy Associate Director of Pay and Leave, to urge the agencies to collaborate on solutions. He also hosted a town hall meeting about veteran health in Roseburg on Friday.
"Without appropriate VA Central Office intervention, I am concerned that RVAHCS will continue to suffer from recruiting and retention issues, which will ultimately lead to degraded care for veterans," DeFazio wrote in his letter to Wilkie. "Neglecting or abandoning Southwest Oregon's veterans is not an option."
Follett was one of the facility's whistleblowers, but she's careful not to throw her former co-workers under the bus.
"I can honestly say that all the people that I worked with, really worked," Follet said. "We really worked our tails off."
Just as Roseburg's VA troubles exposed, the OHA's study finds one of the biggest issues for veteran health care in Oregon is in the amount of providers.
"Workforce is a big issue, not just for veterans' behavioral health, it's an issue systemwide," said Saerom England, OHA spokesperson. "There's just a lot there that we could do to improve, and we actually have a workforce report also coming out in the fall. I think all of that can kind of work together to improve services for everybody."
DeFazio's office, Roseburg's VA and Laura Follett all identify recruiting and retaining providers as the problem.
"One of the things that can be done here locally is to somehow incentivize, give incentives to the providers to stay," Follett said. "We need providers and we need good providers."
After she left her job at the VA, Follett no longer uses the VA's services and she's among the more than 60% of Oregon veterans who receive care through the private sector. In her retirement, she advocates for mental health awareness. Follete is launching a coloring book project in hopes it helps other people like her who are challenged by PTSD, depression, and other mental health conditions.
Like many veterans, Follett's journey has been challenging, which is why she's passionate about doing her part to destigmatize the conversation.
"The more I talk about it, I wouldn't say that it's easy, but it's easier."
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