VA mental health system sharply denounced at hearing

April 24, 2012

The Department of Veterans Affairs’ mental-health care system suffers from a culture where managers give more importance to meeting meaningless performance goals than helping veterans, according to testimony before a Senate committee Wednesday.

The hearing before the Senate Committee on Veterans’ Affairs followed the release of an inspector general’s report Monday that found the VA has greatly overstated how quickly it provides
mental-health care for veterans.

“They need a culture change,” Linda Halliday, the VA’s assistant inspector general for audits and evaluations, told the committee. “They need to hold facility directors accountable for integrity of the data.”

VA facilities used practices that “greatly distorted” the actual waiting time for appointments, Halliday said, enabling the department to make claims that 95 percent of first-time patients seeking mental-health care received an evaluation within 14 days when, in reality, fewer than half were seen in that time.

Sen. Patty Murray (D-Wash.), chairman of the committee, described the findings as showing a “rampant gaming of the system.”

Nicholas Tolentino, a former mental health administrative officer at the VA Medical Center in Manchester, N.H., told the committee that managers at the facility pressed the staff to develop ways to see as many veterans as possible while providing the most minimal mental-health services possible.

“The plan that was ultimately developed gamed the system so that the facility met performance requirements but utterly failed our veterans,” said Tolentino, a former Navy corpsman who went to work at the Manchester facility in 2009.

One manager directed the staff to focus only on the immediate reason for an appointment and not to ask the veteran about any other problems because “we don’t want to know or we’ll have to treat it,” according to Tolentino.

“VA is failing to meet its own mandates for timeliness and instead is finding ways to make the data look like they are complying,” said Murray, who requested the report.

“It’s mind-boggling,” said Sen. Scott Brown, (R-Mass.), who raised concerns that the long waits that veterans seeking
mental-health services face leaves them at heightened risk for suicide.

“We fully embrace that our performance measures need to be revised,” William Schoenhard, deputy under secretary for health for operations and management, told the committee.

The data was often based on available appointments, rather than the patient’s clinical needs, according to the inspector general’s office. If the patient was given an appointment two months later because of a lack of openings, the veteran would still be recorded as having been seen within two weeks of the desired date.

The office issued reports in 2005 and 2007 raising similar concerns that the VA was using faulty data to calculate wait times.

“This has been an issue for many years and hasn’t been resolved,” John Daigh Jr., assistant inspector general for health-care inspections, told the committee.

Under pressure to reduce waiting times for veterans, the VA announced last week that it plans to hire 1,600 mental-health workers, an increase of more than 9 percent.

But the VA already has about 1,500 vacancies in mental-health specialties, positions that have been hard to fill given better pay in the private sector. “How are you going to ensure that 1,600 positions . . . don’t become 1,600 vacancies?” Murray asked.

Schoenhard said the department is studying ways to better recruit and retain mental-health professionals.

“In the interim, you have soldiers who are killing themselves,” Brown said.

Tolentino, who said his complaints “largely fell on deaf ears,” resigned from the Manchester facility in December.

“Ultimately, I could not continue to work at a facility where the well-being of our patients seemed secondary to making the numbers look good,” he said.

Steve Vogel is a reporter for the national staff of The Washington Post who covers the federal government and frequently writes about the military and veterans.
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