Vets’ suicides spur support for privatization
Legislation outsourcing mental health services lacks accountability and hurts VA, critics say
With unrelenting reports of thousands of veterans dying by suicide each year, Congress is considering opening the door to mental health treatment outside the Veterans Health Administration, speeding the pace of privatizing care for former members of the military.
Texas, where veterans’ suicides have increased at a faster pace than nationally, already is a proving ground for veterans’ mental health treatment with several private mental health clinics. Legislation drawing wide backing on Capitol Hill would authorize the Department of Veterans Affairs to award tens of millions of dollars in grants for private mental health care, much like a VA program for homeless veterans that has proved successful.
Since early summer, the bill has drawn dozens of co-sponsors from both parties — 128 in the House alone — and endorsements from the Trump administration.
AMVETS, a leading veterans service organization, offered its support for boosting private programs after the VA reported last month that more than 6,000 veterans died by suicide in 2017 — 496 of them in Texas.
“Whenever people want the federal government to wholly own any effort, it’s a fool’s errand, especially when you’re dealing with something as intimate and deeply human as suicide,” said Sherman Gillums, AMVETS chief strategy officer, said in an interview.
But despite its growing popularity, critics are questioning whether shifting resources away from the VA is useful given that the veterans’ agency already provides the counseling and intervention services that the legislation would place in private hands.
They also question the wisdom of underwriting specialized care without assuring that it comes from highly trained professions.
In a withering analysis, an alliance of professional organizations that deals with veterans’ health contends that the legislation is based on the false premise that non-VA services are the missing link in identifying veterans in crisis.
“At its core, it would duplicate and erode VA’s existing successful mental health services, ignore what interventions are most needed to reduce veteran suicide and hasten outsourcing of veterans’ health care to the private sector,” the analysis reads.
Those signing that assessment include representatives from nonprofits that deal with veterans’ health: the American Psychological Association; the Association of VA Psychologist Leaders; the Association of VA Social Workers; the Nurses Organization of Veterans Affairs; and the Veterans Health Care Policy Institute.
Network focused on Texas
Shifting veterans’ care away from the VA has long been a goal of advocates for smaller government despite worries by skeptics that removing resources will “hollow out” the nation’s largest health care system over time.
In June, acting on new authority from Congress, the Department of Veterans Affairs began an all-new Community Care Program for general needs. Through midSeptember, more than 1 million veterans have sought private care that, for the first time, includes urgent care outside of VA facilities.
In Capitol Hill testimony last month, a VA official said the proposed grant program to combat veterans’ suicides would cost $85 million over a three-year period. Legislative aides said hundreds of local programs would be able to take advantage.
In Texas, among nonprofits that could be funded are mental health clinics in San Antonio, El Paso, Killeen and Dallas funded by billionaire Steven A. Cohen, a hedge fund manager who was barred from trading for two years after an insider trading scandal in 2012.
In 2016, after his Marine son returned home from duty in Afghanistan, Cohen announced that he would devote $275 million to mental health care for post-9/11 veterans and their families.
The Cohen Veterans Network includes 14 clinics thus far — more in Texas than any other state — with a plan to open 11 more by late next year or early in 2021, a spokesman said.
“If there’s one thing our group stands for, it’s about access to mental health care and taking away as many barriers as we can,” said Paul Wood, the Cohen Veterans Network chief external affairs officer.
Wood suggested that VA money would be of little significance to the Cohen network. “We’re vastly funded by Mr. Cohen’s philanthropy and, in fact, reimbursements of these types are a very, very small portion of our revenues,” he said.
Lobbying records show that Cohen paid $360,000 in 2017-18 to a Washington lobbying firm that employed former U.S. Rep. Jeff Miller, a Florida Republican who has been a leader in the drive to privatize VA services. The records showed lobbying for PTSD research and increasing access to veterans’ mental health care.
The impetus for passing legislation likely received a boost from the VA report last month showing the prevalence of suicides among veterans — among men, 1.5 times higher than for non-veterans and for women, 2.2 times higher. Nearly 7 in 10 of veteran suicides died from firearms.
The problem was spotlighted when three veterans killed themselves in April on VA properties. Those deaths occurred weeks after a presidential executive order focused on veterans’ suicides that called for more collaboration between government and private and nonprofit mental health care.
Scant evidence of success
The number of veterans’ suicides has remained relatively steady at about 6,000 annually since 2005, according to VA reports, which are based on research compiled by the Centers for Disease Control and Prevention
In Texas, veterans’ suicides have grown more prevalent. Fewer than 400 suicides yearly were reported in the early 2000s, but that number increased to an average of about 500 from 2015 through 2017.
Psychologists attribute the alarming statistics to several factors — homelessness, stress and traumatic brain injury often compounded by a stubborn resistance to seeking care.
Matt Miller, the Department of Veterans Affairs’ acting director for suicide prevention, said he sees “anchors of hope” in the grim statistics, including 824,000 same-day mental health appointments the VA provided last year for veterans who said they needed help immediately. VA screening of 3.8 million veterans for suicidal thoughts saved many lives, he said.
Miller believes also that suicide is a national problem that goes beyond the scope of his agency. “Partnership, to the fullest extent possible, is something we embrace in the name of caring for veterans and caring for our fellow citizens as a whole,” he said.
Members of Congress are using statistics to promote the legislation in both the Senate and House, where companion bills are pending in committees. They hope that even in deeply polarized Washington, a measure aimed at the tragedy of war veterans taking their own lives can muster support for passage on its own or get attached to one of the catch-all bills rammed through these days in the late stages of Congress.
Senate Veterans Committee member John Boozman, R-Ark., expressed sentiments of many in Congress when he observed that the amount requested by the VA for suicide prevention has increased fourfold in a decade with little evidence of success. This year, the agency seeks $222 million.
“Congress has provided significant resources to the VA to decrease veteran suicides, yet the number of veterans who take their own lives every day remains unchanged,” Boozman said at a hearing he conducted in June.
In making their case, Boozman and others cite a statistic that just six of the 20 veterans on average who end their lives are receiving health care services at VA — a potentially compelling argument to bring more private care into the equation.
At the George W. Bush Institute at Southern Methodist University, Kacie Kelly promotes partnerships between government and nonprofits while managing veterans’ health policies, similar to a role she played in a 15-year career at the VA.
“When I was at the VA, partnership was almost seen as a dirty word. There really wasn’t an understanding of how to partner with the private sector in ways that could have meaningful impact,” she said.
The Bush institute doesn’t endorse legislation and wouldn’t be in line for funding. But, Kelly says, new approaches are needed, given the rising costs of health care with limited availability of mental health care.
“We believe we have to stop asking veterans to come into our health care systems and go to where they already are going,” she said.
Sherman Gillums of AMVETS put it this way: “By allowing there to be a shared responsibility to serve this unique community of veterans, you expand the capability of the VA and you also have care providers who would otherwise never see veterans become better at it.”
Yet in the debate over a vexing problem, some professionals see risk in paying for outside care without proof of adequate training or even a requirement to report suicides of those in their care.
Heather O’Beirne Kelly, director of military and veterans’ health policy at the American Psychological Association, called the bills well-intended but added: “They may not only have little effect but actively prevent veterans from accessing other, higher-quality care.”