As the nation becomes more aware of the scope and impact of mental health and substance use problems, behavioral healthcare providers have come under increasing scrutiny. Lately, the Department of Veterans Affairs (VA) has been in the hot seat.
Members of Congress have called for Dr. Ira Katz, the VA's mental health director, to resign for allegedly trying to cover up the number of attempted suicides by veterans (At the heart of the controversy is an e-mail titled “Shh!”). In addition, critics claim that an e-mail by a VA psychologist in Texas demonstrates that the department is trying to save money by limiting the number of PTSD diagnoses. Both accusations came up during a federal class-action lawsuit in which veterans groups asked the court to order the VA to improve its services. In a rare break in recent negative coverage of the VA, the judge did not rule against the agency, acknowledging the problems many veterans face accessing care but not believing they are system-wide.
Not surprisingly, the public does not have a positive view of the VA, with 65% of respondents in a Harvard/Harris Interactive poll believing that the military and VA do not provide high-quality mental healthcare to Iraq war veterans. Community mental health center executives have their own grief with the VA, with some claiming that it is using higher salaries and better benefit packages to lure away their staff members.
I was aware of these criticisms when I decided to write about the VA for this month's cover story. For several months I had been talking with Bradley E. Karlin, PhD, head of the VA's psychotherapy programs, about writing an article on his interest in psychiatric facility design before I asked to interview him on what's going on at the VA. Yet instead of focusing on the problems, well-documented in the popular press, I asked Dr. Karlin about what the VA is doing to transform its services. I think you will find some of the department's efforts quite ahead of the curve, especially its integration of behavioral health and primary care, as well as its widespread and growing use of telemental healthcare.
The VA certainly has many problems to address—including its public image. But while much work needs to be done, it's also important to recognize the good work that the VA is doing, and not simply tar and feather everyone who works in this large and complex system. After you read this month's cover story, I urge you to continue the conversation on our new discussion board.
Douglas J. Edwards, Editor-in-Chief