Under the guise of reducing veteran suicides, the Trump administration has released a plan that could radically reshape veteran care in the United States. The stated goal is to expand mental health services for newly transitioned veterans, the proposal, which administration officials approved on May 31, contains provisions that could starve the Veterans Health Administration of needed resources, add impossible burdens to already struggling VHA staff, and privatize veteran mental health care by outsourcing it to non-VA providers. As studies have consistently shown, such private-sector providers are ill equipped to address veterans’ complex needs.
Released on May 3, the Joint Action Plan represents an outline of how the Departments of Veterans Affairs, Defense, and Homeland Security propose to implement an executive order President Donald J. Trump signed in January. The order called for providing all service-members transitioning out of the military—about 245,000 a year—with 12 months of free mental health care. The impetus behind the plan—preventing veteran suicides—and a number of things in it are praiseworthy, even essential. But according to a careful analysis by the Veterans Healthcare Policy Institute, the plan could actually jeopardize the stellar suicide prevention and mental health programs that the VA has long pioneered.
The action plan stipulates that transitioning service-members will have access to 12 months of mental health benefits. Service-members must also be informed that they don't have to seek help from the VHA and are free to go to private-sector mental health providers, if they are, for any reason, not interested in VHA care. The plan calls for some VHA oversight of these private-sector providers, but provides no funding for staff needed to monitor their care.
The danger is that VHA veterans could be cared for by providers who may not understand their specific problems or provide evidence-based treatment for them. As studies have documented, private-sector care falls well short of the public sector in treating veterans. Unlike the care delivered at the VHA, which is well-coordinated, veteran care in the private sector would be uncoordinated and their providers largely unaccountable. Even worse, the funds to pay for expensive care in the private sector will come directly from the VHA budget. Without new congressionally approved allocations, the VHA will be forced to cannibalize existing programs to pay for the mandates.
Such threats come at a time when the VA system is already plagued by underfunding and understaffing. On June 14, 2018, the VA Office of the Inspector General (OIG) issued a report that once again highlights the problems created by Congress’s long-standing failure to fully fund and staff the Veterans Health Administration. Its detailed, facility-by-facility list of staff vacancies includes the mental health professionals needed to serve a growing number of veterans with serious mental health and substance abuse problems. (Seventy percent of facilities had shortages of psychiatrists and 40 percent of psychologists.)
The Joint Action Plan does not require that the Defense Department or others provide transitioning service-members with information about the high quality of programs the VHA has developed to deal with complex mental health problems. This kind of education is essential because any current or future problems the VHA faces provide fodder for right-wing critics—like Fox and Friends—as they churn out a steady stream of anti-VHA stories designed to convince veterans that the VHA can never serve their needs. Neither conservative nor liberal media do much reporting on the many innovations the VHA has pioneered in the delivery of integrated primary care, mental health care, or suicide prevention. Yet as studies have shown, the VHA has a far better track record on these issues than the private sector.
The Joint Action Plan doesn't even call for measuring whether newly discharged service-members receive such information. It does, however, recommend measuring how quickly department personnel are trained on the referral process to community-based support resources.
The plan's defects don't end there. Without offering additional funding, the plan requires the VA to train outreach workers and peer support staff, who then must repeatedly contact all 245,000 transitioning veterans. Staff will also have to provide care for an estimated 32,000 veterans each year. Finally, the VA will have to evaluate the success of all these and other programs.
Yet the plan does not suggest conducting an assessment of how many new VHA staff would need to be added, and thus funded, to accommodate these new caregiving and outreach responsibilities. Because twice as many veterans receive mental health treatment compared with ten years ago, VA mental health staff are already overwhelmed by their high caseloads. A recent report on VA mental health care from the National Academies of Science, Engineering, and Medicine said that the VHA’s mental health-care system could be a model for the nation but that it was plagued by shortages of staff and clinical and exam space, which had created high staff burnout and turnover. Trying to accommodate thousands of new patients will lead to increased burnout and delays, which, absent attention to increased staffing, will fuel demands to outsource more and more care.
Because the Joint Action Plan claims that its provisions will advance the laudable mission of preventing veteran suicide, it may receive support from Congress and some Veterans Service Organizations. Like the recently passed VA Mission Act, the VA Accountability Act, and many other recent measures, it is rife with intended consequences. As advocated by representatives of the Concerned Veterans for America—a Koch brothers’-backed group whose representatives now advise the VA and White House—it is, in fact, just another step down the slippery slope of VHA privatization.
