13th annual Municipal Finance Conference


13th annual Municipal Finance Conference

The Department of Veterans Affairs has spared no effort to care for our soldiers wounded in Iraq and Afghanistan. Yet the number of affected individuals is too great—and their mental-health challenges in particular too demanding—to leave the VA on its own in this mission.

Instead, a major new private-public partnership is necessary. The federal government should be willing to reimburse private practitioners who take care of veterans or their families, expedite paperwork procedures to make this feasible, and involve the academic and other national networks that are already serving veterans.

Today, too many returning soldiers with mental-health problems do not get timely help. There is a backlog at the VA of nearly one million cases simply for processing claims for disability benefits. Patients who apply for help often must wait weeks or even months until their first treatment visit. And family members of veterans who also need help cannot routinely get it through the VA system.

Some two million Americans have served in Iraq and Afghanistan. Many have reported mental-health problems already; many more will do so in the years ahead. As of early June, according to the Pentagon, since the beginning of 2012 suicides in the U.S. armed forces have exceeded the number of combat fatalities in Afghanistan. These tragic endings to the lives of American patriots can often be traced back to inadequately addressed mental-health challenges such as post-traumatic stress disorder (PTSD) and traumatic brain injury. Recent veterans are coming to the VA at a time when the Vietnam-era caseload remains extensive.

There is still time to save thousands of those who might take their own lives, as well as tens of thousands of those who, without adequate treatment, might be afflicted by fear, anger, dysfunctional mood swings, and the inability to hold jobs or sustain relationships. Many fine groups, such as Welcome Back Veterans and Wounded Warrior associations, are working hard to help. But a larger fraction of the country needs to get involved.

Just before 9/11, the Department of Veterans Affairs budget was $47 billion. It is now $125 billion. The vast majority of VA resources have been well spent, and the government has been trying to hire enough psychologists, psychiatrists and claims processors to address the patient backlog. But many of the best providers have established practices and may prefer to deal with a broader set of mental-health conditions than are commonly represented among the nation’s military veterans. Others simply do not want to work for the government.

This deprives Veterans Affairs of great expertise that lies in the nation’s research hospitals and universities, where major strides are being made in mental-health care. We need to tap this expertise to care for as many veterans as they have the time and inclination to help. We also need a way to care for family members whose mental problems—such as depression and even PTSD caused by the repeated deployment of a loved one—often become just as severe as those of the veterans, back from war, who are not quite the same people they once were.

Taking this approach would dramatically expand our treatment capacity overnight. The capabilities exist, the people are trained, and many are enthusiastic about giving back a little to those who have done so much for all of us.

Dr. John Greden, director of the University of Michigan Depression Center and chairman of the National Network of Depression Centers, heads a private-public team of academic, VA and National Guard partners that have aided returning veterans and their family members for five years. “The Veterans Affairs Mental Health system is indispensable,” he says. “But so is greater involvement of the rest of the vast American health system.”

There are several working models of cooperation between the Department of Veterans Affairs and public teaching institutions and hospitals. One example is the collaboration between New York University Langone Medical Center and the Veterans Affairs New York Harbor Healthcare System. Another is the collaboration between Mt. Sinai and the Bronx VA hospital. Both programs provide treatment for veterans’ families.

Our armed forces and their families have made great sacrifices on behalf of the nation. Many of them need more of our help. They have given so much and deserve no less.