Twenty eight thousand veterans of Iraq and Afghanistan are enrolled with the VA Medical Center in La Jolla. So a ruling this week from the state's 9th Circuit Court of Appeals, calling for a major overhaul of the VA's mental health care gives us pause here in San Diego.
Guests: Michael Smolens,government editor, SDUT
Jeanette Steele, reporter, SDUT
Scott Lewis, CEO, Voiceofsandiego.org
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ALISON ST JOHN: 28,000 veterans of Iraq and Afghanistan are enrolled at the VA medical Center in La Jolla. So a ruling from the California Ninth Circuit appeals this week calling for a major overhaul of the VA mental health care gives us pause here in San Diego. We would like to hear your opinions on this issue. You have any personal experience of the treatment at the VA? Do you feel like we have devoted enough resources to treating people coming back from combat. 888-895-5727 is the number to call. So Jeanette, you've covered this story. Fill us in on the lawsuit. What just happened this week?
JEANETTE STEELE: So, the US Ninth Circuit handed down a decision this week saying that the VA is just been incompetent, very frankly, and providing a specially mental health care, specifically mental health care to veterans that come 18 veterans commit suicide on any given day in America and the wait times to get mental health care are not what they should be.
ALISON ST JOHN: What were you seeing in terms of wait times?
JEANETTE STEELE: What they said is they would like to see their same day, if you show up with a primary care physician says yes you have some kind of moderate depression, you should go in for treatment, they wanted to be treated that they were within 24 hours in what they were fighting according to a 2007 Inspector General report was that people were having to wait several weeks to get their first visit with a therapist.
ALISON ST JOHN: Who filed the suit, by the way?
JEANETTE STEELE: It was by two nonprofit veterans groups, one was in Santa Barbara and the other one was was in Washington DC and they are no individuals. I thought that there may be would be somebody from San Diego because we have so many veterans but there were no individuals just the two groups say hey, this is unacceptable, that it breaches constitutional rights to services.
ALISON ST JOHN: And what does the court want the VA to do?
JEANETTE STEELE: The court directed the VA to go back to the lower court level and hash out with the plaintiff some kind of solution that will fix the wait time situation so that people are getting care quicker. And now the VA can appeal up the line. This was a three-person panel with the Ninth Circuit Court, there is an 11 person panel that can appeal to if they want to and they can ultimately appeal to the US Supreme Court. Or they could sit down and hash it out and come up with some kind of memorandum of understanding with the plaintiffs about how things could change.
ALISON ST JOHN: Okay, has the VA here in San Diego given any kind of response to this?
JEANETTE STEELE: You know, the VA seemed to be caught somewhat flat-footed by this decision and they had no response on the day, they referred comment to the Department of Justice. The next day they put at national statistics on what they are doing to treat PTSD and suicide prevention and claims backlog. But you know, no response from the local VA.
ALISON ST JOHN: No response particularly.
JEANETTE STEELE: I think they are being told by DC that it will be a national response, not in hospital.
ALISON ST JOHN: My understand is the policy is that you can see within 14 days but that does not jibe with what the court is saying, does it?
JEANETTE STEELE: The Inspector General's report found that that is not the case in many VA hospitals and if you talk to veterans about what they have experienced this sample is to show up and say I'm going to harm myself right now are some knows that it can take a month or three months to get your point.
SCOTT LEWIS: May I ask a question actually, what makes us a legal issue as opposed to just a disappointing sort of public service or performance issue?
JEANETTE STEELE: Right, I'm not a lawyer but what the court said is that these people's constitutional rights were being preached by just the VA feeling them so badly.
ALISON ST JOHN: Michael?
MICHAEL SMOLENS: Again, just to grill our expert here, Jeanette, is this an outgrowth of, we've talked about the over the decades that the military has not been looking to mental health issues, post genetic stress, the focus on that is relatively recent it was sort of like nothing they had dealt with. And we've had a lot of discussion about how that has been improving at least in the focus and there is no shame in admitting that you've got some sort of psychological or stress related problem, but Jeanette, is this still an outgrowth of that that there's still less of a focus because of the focus and rightly so on the physical and injuries that dominate so much?
JEANETTE STEELE: The opinions I've heard from people is that the VA has thrown a ton of resources that PTSD and for whatever reason it is just not enough. They say that 18% of recent vets come back with PTSD, and that doesn't sound like, is one of five, which, but you think that we have forgiven reporting what has happened on the battlefield you think it could be much higher but it is just so many people that the resources have just been overwhelmed is what some people think.
ALISON ST JOHN: I know that the VA here at La Jolla says that their suicide prevention units that they've beefed up in the last couple years is a model for the nation. Have you done any stories on that?
JEANETTE STEELE: I haven't done any stories on suicide prevention of it in terms of PTSD they have 13 psychiatrists dedicated to that, and then an army of case managers and social workers that you know, it recently for treatment for PTSD, there are two kinds of therapies that require intensive outpatient treatment, and kind of Homer, you're supposed to go home and work on what you have talked about in her counseling sessions. And apparently it is pretty intense and desire to do if you are also working and you have kids.
ALISON ST JOHN: 888-895-5727 is the number and Thomas is calling us. Thanks for joining the Roundtable, Thomas. Go ahead.
NEW SPEAKER: You're welcome. Hi, Jeanette, this is Tom Richards.
JEANETTE STEELE: Hi, Tom.
NEW SPEAKER: As I said in my e-mail the VA isn't ultimate culprit here. Congress---
JEANETTE STEELE: Tom is the chairman United veterans Council of San Diego.
ALISON ST JOHN: Thank you, thanks for calling, Tom. Go ahead with what you want to say to back up the argument.
NEW SPEAKER: As a veteran I have several disabilities including disability for PTSD. And representing the United veterans Council in San Diego and several other things, we all know that the response time by the VA is not what we would like it to be. On the other hand, the VA has allocated X. amount of money with which they can hire ex-number of people and that is not nearly enough. But, to say that in favor of our local VA, the local VA is one of the best in the country, we get good treatment here relative to other places. I personally know that the recently retired director and CEO of the VA medical Center, they are both working to make things better and they are doing as well as they can with the money that they are allocated. Anybody that has a gripe with the VA needs to address it with their Congress person.
ALISON ST JOHN: Thomas thank you very much for that one of the things I learned as I have 12 or 13 mental health professionals for, according to the figures they gave me, was 1200 people who have returned for Iraq and Afghanistan who have returned with PTSD and that is a ratio of 1 to 100 so Thomas would you say that that is a decent ratio or do you think they need more mental health professionals? I beg your pardon---
NEW SPEAKER: They simply, they do need more mental health professionals but they cannot hire any more with a limited budget that they have.
ALISON ST JOHN: Okay thank you so much for the call 888-895-5727 is the number to call. Do you feel that the country has really kind of absorbed the implications of the war? I mean, we are allocating so much money towards defense contracts, to wage a war and win, but the aftermath which is coming down the line as we perhaps start to withdraw from these areas of conflict do think we are prepared for that, any comments?
SCOTT LEWIS: Obviously not very well but how do you prepare for that is the culture of the military needs to address this in its turn, not only is mental health not dealt with as well as it could be in some cases, but it's actually institutional enough accepted that you seek treatment in some capacities if you're in the military, they would actually be allowed to perform your job if you seek treatment, or take drugs for mental health. It's almost in some ways better to become alcoholic and you get better service if that happens. I think all military infrastructure needs to deal with that. But as far as it is a massive social problem that I can't even imagine how you would begin to solve.
ALISON ST JOHN: Jeanette, and you get a sense as reporters working this beat, that the situation is, how do you think the situation is going to evolve in the sense that this particular illness, and PTSD, TBI, the mental illnesses, how terrible would you say they are? It is a problem that is going to be cured and will go away?
JEANETTE STEELE: The people I interview who are experts in the field say that the two therapies that they have that they are using my network developed in the late 90s, kind of came into force in the early 2000s, that they were, that they help people feel much much better. I interviewed one of the VA doctors last year and she said if you do the 12 to 15 weeks of tough therapy that people feel much much better. So, I also talked to a vet, and I said a very young 30-year-old Iraq is obvious... wouldn't give to be a pretty big black eye would you do if you had to magic one can access it is such an enormous bureaucracy in DC, and he said we can fix anything. If they would just, we can fix anything any year. If we could just rehab, I hear complaints all the time about the bureaucracy, how long it takes for anything to happen.
ALISON ST JOHN: So that does jibe with your experience of it takes a long time to get the care they are expecting?
JEANETTE STEELE: I hear also sometimes one will file claims and talk to people in the process that they don't understand the combat experience. They wish they had people they were talking to at the VA that understood the combat experience.
ALISON ST JOHN: 888-895-5727. Ashley is calling is from OB. Thanks for joining, Ashley. Go ahead.
NEW SPEAKER: I think it's unfortunate that we are pointing the finger of blame squarely at the VA I am speaking as a veteran of the rumors support for mental-health issues in the active-duty military that VA system to be a would not be bogged down by these cases. Basically people are very much discouraged seeking treatment, there is an incredible stigma around seeking treatment so (inaudible) there's a lot of people who would lose their jobs if they were diagnosed with a mental issue in the military. So I think the active-duty system could get under control than the VA would not be having this problem.
ALISON ST JOHN: Interesting point, the issue of stigma that is a testament of makes you wonder if people did come out front with it, the problem could be even worse because you would need even more mental health professionals.
JEANETTE STEELE: (Inaudible) underdiagnosed and I talked to one that was said when he got out he did not want to get involved with the VA because that was an old man's organization. He did not want the stigma of what the Vietnam vets had to deal with and he said he only went to the VA when he had no other recourse but it was useless for him and he is and PTSD treatment now.
ALISON ST JOHN: Okay well thank you so much for coming and I would like to thank Jeanette Steele of the UT, Michael Smolens of UT and Scott Lewis as well as from Voice of San Diego.org and thank you for listening. To those of you who called in I'm sorry we couldn't get all of your calls this hour. I'm Alison St. John, thanks for listening.
