For the second time in the last six years, the U.S. Department of Veterans Affairs (VA) is attempting to cut mental health services for veterans affected by Post Traumatic Stress Disorder (PTSD).
In July 2006, news stories about the treatment of veterans at the Redding VA outpatient clinic stirred a demonstration with nearly 200 veterans protesting on the street.
Henry Iasiello of Vietnam Veterans of America and California State Counsel for the Northern California District PTSD Committee Chair, sent a letter to Linda Nelson, who at that time was director of the Redding clinic.
In the letter, Iasiello stated, “I would like to reiterate that in my conversation with Dr. Greg Nelson about the reviews and cutbacks at the Redding Clinic, he assured me that money was not the issue. His concern was that extended fee-basis (or out of clinic care), especially as regards PTSD, did not serve the veteran. That, in fact, he believes many (veterans)are just scamming the system. It was, I admit, a little disheartening to hear him characterize the clinic as practicing frontier medicine and (characterising) PTSD as an overused diagnosis.”
I, too, interviewed Dr. Nelson in 2006 and was shocked when he told me, “If veterans want to see an outside practitioner, they can pay for it themselves.”
When the VA decided later to cut veteran’s services, many veterans wrote letters to the VA condemning Dr. Nelson for telling them, “There is no such thing as PTSD.”
On June 16, 2006, Congressman Wally Herger wrote a letter to Jim Nickelson, then the Secretary of Veterans Affairs.
In the letter, Herger wrote, “I understand that the VA policy is generally to provide services by VA staff when possible, and to pay private providers on a fee basis only when the VA does not have sufficient or sufficient specialized staff. While I understand the underlying rational for this policy generally — to prevent unnecessary duplication of services — I am not convinced that it makes sense to treat counseling and psychological services the same way as other medical service. The relationship between patient and counselor is a very personal and sensitive one, and it is very difficult for a veteran with PTSD who has been treated by one counselor for many years to switch suddenly to an entirely new counselor.
“Therefore, while I agree that in many cases it makes sense for the VA not to pay for services from an outside provider if the same services can be provided by the VA itself, I would urge you to consider the needs of veterans who have a long history of being treated by a single counselor or psychologist. In my view, it seems reasonable for the VA to consider “grandfathering” this small number of veterans so they can continue to get treatment from their established counselors on a fee basis, while any new patients would be automatically referred to the VA staff.”
The VA eventually reconsidered due to the resulting press coverage, the demonstration and Congressman Herger’s letter.
However, in 2012 there is a new frontal assault by the VA and the new offender is Dr. Brian O’Neil of the VA clinic in Mather, Calif.
Currently, nearly 300 California veterans are once again facing the same challenges from the VA as they did in 2006.
These military veterans have been diagnosed by the VA as Service-Connected for PTSD for Combat, Non-Combat and Military Sexual Trauma (MST) incidents. Some are currently receiving denials of authorization for their ongoing and continued individual psychotherapeutic sessions.
As one veteran stated, “PTSD is not like a cold or the flu, it does not go away, it is with you for the rest of your life. I have had dreams about the carnage and blood for over 40 years.”
It should be noted that apparently this is not a national program instituted by the VA and there is no one willing to step up to explain why this is happening just in northern California.
One veteran questions, “As this is just happening in Northern California, could we be the testing grounds to see what the VA can get away with nationally in the future?”
Shasta County veterans have dealt with the threats and rumors of cuts in services for several months. Not knowing is creating additional anger, frustration and mental anguish because as of this date, they have not been given any answers to any of their questions with regard to their continuity of care.
In addition, some veterans are currently been denied access to their fee-basis practitioners without any notification from VA officials who would rather leave notification to practitioners rather than face the veterans.
Many of these service-connected military veterans suffer from very specific conditions that do not lend themselves to sudden and/or dramatic changes in their mental health treatment. This includes changes to their mental health care provider with whom the veteran has developed a sound and trusting relationship.
Nearly all mental health clinicians agree that providing psychotherapeutic services is unique, in that, a therapeutic alliance is established between the patient and their counselor, as briefly referenced above. In most cases the veteran has made disclosures that he or she has not shared with another human being.
This is particularly typical in the PTSD- and MST-afflicted military veteran; and because this is the case, this is why all psychotherapists’ licensing and professional boards deem it an ethical violation to abandon a patient. To withdraw ongoing, stable and successful counseling from a patient would constitute ethics violations of the American Psychiatric Association (APA) and the California Psychiatric Association.
Most alarming however could be the sudden and potentially violent reactions from some military veterans suffering from both PTSD and MST or the potential for the veteran to regress to former states of dysfunction.