VA data belie boast about Montana region's mental treatment

McClatchy NewspapersDecember 28, 2007 

WASHINGTON — Sen. Jon Tester, a Montana Democrat, took officials from the Department of Veterans Affairs to an auditorium at the Montana State University campus in Great Falls last summer to talk about the best way to provide health care to veterans in the region's vast rural areas.

The director of the VA region that includes Montana, Colorado, Utah and Wyoming detailed all that the agency was doing to provide for veterans' health needs — physical and mental.

"Comprehensive mental-health care is one of the top priorities for Network 19," Glen Grippen said, referring to the multi-state Rocky Mountain region. He said that mental health staff had been added recently, specifically for treating post-traumatic stress disorder. Each medical center now has a suicide prevention coordinator, he said, and the VA's medical centers "actively collaborate with state National Guard and Reserve components to ensure that no returning soldier slips through the cracks."

The region, he said, was "a national leader in care coordination."

An examination of VA data and documents, however, tells a different story. Internal documents that McClatchy obtained show that, far from being a national leader, the Rocky Mountain region is in the bottom half of the nation's 21 regions in the VA's own scorecard of performance, which takes into account whether veterans are getting regular mental-health treatment and how efficiently the region is spending its money and using its resources.

On a couple of important measures, Network 19 was dead last. For example, in a measurement of the effectiveness of treatment — in which researchers charted patients' mental status scores before and after treatment — the region ranked last, according to the documents, which were from fiscal 2006 and were made available under the Freedom of Information Act.

That was for a range of mental health treatment. On the more specific measurement of treating post-traumatic stress disorder, the Rocky Mountain region was last in the number of specialized PTSD treatment programs it offered, and 16th of 19 ranked regions in program effectiveness, based on the fiscal 2006 records.

The situation in Montana — which has sent more of its sons and daughters, per capita, to fight America's wars than any other state — is even more dismal:

  • The Montana VA hospital started a specialized PTSD treatment program only recently, although soldiers have been returning from Iraq and Afghanistan for more than four years, and experts have long urged that every VA hospital have such units.
  • Out of 139 VA hospitals nationwide, the hospital at Helena and its related clinics ranked 123rd in the proportion of their budget that goes toward specialized mental-health treatment.
  • While the average veteran receiving specialized mental-health treatment in the VA system got 11 visits a year, those who used the Helena hospital and its affiliated clinics got an average of 4.2 visits. That's dead last among all VA hospitals in the U.S., according to 2006 data.
  • Veterans waited longer to get into the Montana system for mental health care. While the VA aims to get veterans who are new to the system in to see doctors within 30 days of their requested dates, that happened only 53 percent of the time in 2006 in the Montana hospital system. On that ranking, the Montana system was third to last.
  • When Montana veterans got mental health treatment, it was more likely than it was for veterans elsewhere to be from a generalist, not a mental health specialist. Of all the veterans receiving treatment for mental health ailments in Montana, only 56 percent received at least some of it from specialized mental-health programs. That's a lower percentage than in any but two other VA hospital systems, most of which get 80 percent or 90 percent of their mental health patients in to see specialists.

In a statement to McClatchy this week, the VA said its Rocky Mountain region "showed substantial improvements in the delivery of mental health care" over the last three years and that the VA hospital in Montana had beefed up its staff and supplemented its services with contracts with regional mental-health centers; those encounters, the VA said, weren't reflected in McClatchy's analysis.

In addition, the Montana VA is establishing new strategies to provide for veterans in rural areas, including telephone consultations.

"Much of the need for mental health care is met by providers at clinics, and by contracting or fee-basing to community providers," the VA said in its statement. "The strategy is to distribute these key resources to enhance statewide access to mental health care rather than clustering them" at the Helena hospital.

McClatchy Newspapers 2007

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