Too Few Clinicians Complicate Care in VA, Military Systems

A continuing critical shortage of psychiatrists and psychologists in the armed forces and access to quality mental health care for veterans in rural areas are issues that must be addressed now, mental health leaders told members of Congress and their staffs last month.

Military and veterans officials and others identified key concerns in the treatment of mental illness during the 2007 Mental Illness Awareness Week Congressional Symposium, jointly sponsored by APA and the National Alliance on Mental Illness (NAMI). The Capitol Hill briefing described the progress made in identifying and treating mental illness among active-duty and veterans groups, as well as thesignificant work that remains (see also VA Told to Establish Multiple Prevention Programs).

“We have to be realistic that when we send men and women to war zones, we are placing them at great risk for developing psychiatric disorders,” said Daniel Blazer, M.D., Ph.D., a psychiatrist and member of the Department of Defense Mental Health Task Force, which recently concluded its work with the release of a report on the need to improve mental health services for members of the military and their families (Psychiatric News, August 3). “If we don't pay attention to their mental health, then we are closing our eyes to the real-life cost of sending them to war.”

The risk of developing mental illness as a result of combat exposure is as real as the risk of incurring physical injuries, and the government needs to be ready for that eventuality, he said. At this point the military is falling short of that commitment to provide sufficient care.

Blazer and others cited a shortage of psychiatrists and psychologists in the armed forces as the leading obstacle to effective mental illness detection and treatment for those who serve in the Iraq and Afghanistan war zones.

His conclusion echoed the leading finding in the task force's report:“ The Military Health System lacks the fiscal resources and the fully-trained personnel to fulfill its mission to support psychological health in peacetime or fulfill the enhanced requirements imposed during times of conflict.” The task force urged more funding to retain existing personnel and to add more, so members of the military would have greater access to care.

This proposal will require not a one-time infusion of additional funding, Blazer said, but “sustained increased funding to shore up mental health care for our soldiers.”

One way the military has attempted to increase access with limited personnel is to increase the use of telemedicine, including in Europe. However, technological limitations have restricted its use in Afghanistan and Iraq, according to Col. Elspeth Ritchie, M.C., psychiatric consultant to the Army surgeon general.

Access obstacles also limit the mental health services that the Department of Veterans Affairs (VA) is able to provide, according to several speakers. However, veterans' access problems were attributed more to geography than to staff shortages.

Ira Katz, M.D., deputy chief of patient care services officer for mental health in the VA, said, however, that the 200,000 VA employees—including 2,000 psychiatrists—have been able to meet most of the mental health care needs of U.S. veterans, fewer than 12 percent of whom require treatment for PTSD or other mental health problems. The hiring of 3,600 more“ mental health professionals” in the last three years has allowed the VA system to offer increased treatment sought by recent veterans of the wars in Iraq and Afghanistan, who are much more likely than older veterans to seek mental health care. Thirty-six percent of the 250,000 Iraq and Afghanistan veterans who have sought care in the VA system were treated for mental health problems.

Katz stressed, however, that “no matter how much the VA expands access, there will continue to be challenges in providing care, especially in rural areas.”