Paula J. Caplan Ph.D.

Science Isn't Golden

Veterans Affairs Department Fights Court Order to Improve Treatment

Veterans Denied Due Process In Getting Help for Emotional Trauma

Posted Aug 27, 2011

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©2011 by Paula J. Caplan                   All rights reserved

Veterans Denied Due Process In Getting Help for Emotional Trauma

More than three months ago, the Ninth Circuit Court of Appeals ordered the Department of Veterans Affairs to overhaul its mental health system, calling it “shameful” and plagued by “egregious delays.” At last, veterans thought, they might receive prompt and effective support as they tried to heal from the emotional carnage wrought by war and by the almost unimaginable culture clash between being at war and trying to come home [1].

The court order gave the VA a chance to make a major turnaround; take a good, hard look at what it has been doing that has failed to help and even made many veterans worse; identify those in its system whom veterans described as caring and helpful; try to make the approaches of the latter into its standard; and consider what other, perhaps less traditional approaches they might implement. The Court of Appeals sent the case back to district court so that a plan for providing better care could be devised. This opportunity was especially important in light of the steadily-rising rates of suicide committed by veterans not just of current wars but of earlier ones as well.

Instead, according to a recent New York Times report [2], rather than working with the plaintiffs — the nonprofit groups Veterans United for Truth and Veterans for Common Sense — to come up with a better plan,  the VA has chosen to appeal that ruling. This is all the more tragic and mystifying, given that the VA’s raison d’etre is surely to assist veterans and given that the court declared that the VA’s failure to address veterans’ needs constituted an infringement of their constitutional rights, i.e., to receive mental health care and to the timely adjudication of their emotional disability claims.

The court noted that the VA had no suicide prevention officers at any outpatient clinic and that at 70 percent of its locations there was no system to track potentially suicidal patients. Media coverage of veterans suffering from despondency has included alarming stories of those who contacted the VA, said outright — often on repeated occasions — that they wanted to kill themselves, and either received no appointments at all or only many weeks or months in the future or did not even receive a return phone call. Often, these stories are prompted by the fact that these veterans went on to kill themselves while waiting for VA staff to help.

Their ways of dealing with suicidal despair are far from the only major problems in the VA system. [1] For years, its senior officials have acknowledged in their press releases that they try one measure after another to stem the rising tides of substance abuse, family violence, and homelessness. But reports of successful programs are rare. [1] When writing my book about veterans, I was able to identify only two instances of specific programs that seemed to be meeting with success. Those involved the use of mindfulness work and meditation, and in one case, of explicit grappling with the intense and varied, moral conflicts that plague so many vets. [1] There are probably other effective VA programs, but what was striking was the way that, as I tracked the VA’s press releases since the start of the United States’ war in Afghanistan, those at the top of the VA hierarchy continued to report increases in the manifestations of emotional trauma and other psychological problems.

Recent months have brought reports of the ineffectiveness of psychiatric drugs in treating those with war-caused trauma and of deaths from drug interactions, sometimes interactions between psychiatric drugs and sometimes between those drugs and prescription drugs of other kinds. These reports are particularly disturbing in light of the heavy and increasing use of psychiatric drugs as the primary or only approach to emotional problems for VA patients. [1]

It is hard not to wonder what the top brass at the VA are thinking. Surely they realize that at the very least, their decision to appeal the court order makes them appear unconcerned about providing help for those they are supposed to serve. Bending over backward to give them the benefit of the doubt, we could assume that they have been as taken in as many in the mental health system by the claims of pharmaceutical companies that their products are cure-alls and by the claims of the powers-that-be that psychotherapy is effective for people who have been traumatized by war. It is rare to hear veterans report that psychoactive drugs have been helpful to them, though some do. It is almost as rare to hear veterans say that psychotherapy was the only thing they needed in order to heal, although it is effective for some. Almost invariably, however, those who have moved toward healing have said that connecting with other veterans, connecting with others in the wider community, and becoming involved in activities in which they focus on helping others and/or in creative realms have been helpful.

The VA would far better serve veterans if they dropped their appeal of the court order and instead invested some of their considerable resources in what veterans, rather than Pharma and the traditional mental health community, say they have found salutary. Furthermore, the VA could recognize that it is worth implementing throughout its system the mindfulness, meditation, and moral conflict foci that have been shown to be effective but that few of their staff all ever use. [1]

For now, as the Ninth Circuit Court panel declared, it is shameful that the VA is appealing the court order for it to reduce the suffering of those whom our government has sent to war.

[1] Paula J. Caplan. (2011). When Johnny and Jane Come Marching Home: How All of Us Can Help Veterans. Cambridge, MA: MIT Press.

[2] More excuses and delays from the V.A. (2011). New York Times, August 22.

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