Veterans seeking mental health therapy at nearly a third of the Department of Veterans Affairs' hospitals must wait longer than the VA's goal of seeing patients in 14 days or less, according to a USA TODAY analysis of internal VA data.
The findings are in contrast to the VA's assertion that fewer than 5% of patients must wait too long to begin therapy with psychiatrists or psychologists.
The USA TODAY analysis follows concerns raised by scores of VA clinicians in an August survey that the VA does not have the resources to handle growing numbers of veterans with mental health issues. The survey showed that it takes about three to six weeks for veterans to begin mental health treatment.
"These numbers show that in many communities, the VA is unable to give our veterans the timely access to health care they deserve," says Sen. Patty Murray, D-Wash., chair of the Senate VA Committee, who plans a Nov. 30 hearing on the issue.
The number of veterans seeking mental health care has increased since 2006 from nearly 900,000 to 1.2 million last year, according to a Government Accountability Office study. The number of Iraq and Afghanistan veterans in therapy increased from 35,000 in 2006 to 139,000 in 2010.
During that time, the VA nearly doubled mental health staffing to 21,000.
VA officials say they do well on access when calculating the time period from the date requested by a veteran for a mental health appointment -- called the "desire date" -- to when therapy begins. By that calculation, the VA meets its two-week access goal for more than 95% of patients.
But by calculating the actual time that transpires between the date that a veteran makes a request for an appointment and when therapy begins for new patients, the VA meets its two-week goal 68% of the time at 152 hospitals and 974 clinics across the country, the USA TODAY analysis shows.
"While the VA has made good progress in increasing the number of qualified staff systemwide, there may not be enough of the right staff at the right place to meet the demand," says Tom Mannle, who co-authored a recent RAND Corp. study of the VA mental health program.
The RAND study gave the VA high marks for care of patients once in therapy. It did not address how long it takes the VA to provide care. The data analyzed by USA TODAY was made public by the Senate VA Committee and showed access rates for nearly all VA hospitals in the first six months of fiscal 2011.
VA officials acknowledge chronic difficulties in monitoring access to mental health care with a 25-year-old computerized scheduling system. The VA hopes to begin installing a new scheduling program by 2013, says Michael Davies, VA national director of systems redesign.
A VA document sent to Congress last year described about 20 ways that hospitals "game" the system in order improve access scores. In one case, the "desire date" was based on clinic availability and not the date requested by the patient. These "workarounds may mask the symptoms of poor access," the document says. VA Secretary Eric Shinseki vowed last year to crack down on workarounds.
To improve quality control, the VA aims to sample the way "desire dates" are entered by schedulers and whether they reflect a patient's desired date to begin therapy, documents filed with the VA Committee say.
According to the data, veterans seeking psychiatric care at hospitals in Pennsylvania, Alabama and Montana asked for desire dates five weeks away on average, while veterans at hospitals in California and New York ask to begin therapy in a week or less on average.
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