Lemonhead leadership in the VA and Memorial Day | Behavioral Healthcare Executive Skip to content Skip to navigation

Lemonhead leadership in the VA and Memorial Day

June 2, 2014
by H. Steven Moffic, MD
| Reprints
". . . care for him who shall have borne the battle . . ." -Abraham Lincoln

Memorial Day is supposed to be a somber holiday. It honors the men and women in the Armed Forces who have died while serving. 

Now just think of how leaders might feel if they could have done something to prevent deaths that were unnecessary for whatever reason, including by suicide. Could they bear the truth or would they have to deny it?

Fortunately, it seems like some progress has been made in military medicine over the last decade. In military mental healthcare in particular, addressing combat stress, suicide prevention, and sexual assault prevention have gotten more attention.

Of course, there are many more who survive but suffer upon return to civilian society. In regards to the current "war," up to 50% seem to have a diagnosable health and/or mental health disorder. Responsibility for these problems is handed off from the military to the Veterans Administration (VA).

Yes, there have been well-publicized success stories, of functional recovery from loss of limbs and other apparent medical miracles. Yet, most unfortunately, it seems that leadership at various levels of the VA have failed at times, and sometimes failed miserably. Perhaps the growing scandal about hidden wait lists and deaths, including suicides, while waiting will be particularly unbearable for such leaders. One hopes that the shame and guilt will lead to change. As the longest war in American history winds down, isn't 12 years more than enough time to establish timely and effective services for those of the Armed Forces who have risked their lives for all of us? For doing so, they deserve the best care, not less care, do they not?

Adding much insult to these injuries is that warnings and concerns have periodically surfaced before and since the so-called War on Terrorism began. In particular, mental healthcare has been the "canary in the coal mines" of the VA healthcare systems, as inadequate access, ineffective treatments, and insufficient disability compensation has led to unprecedented numbers of suicides, let alone persisting symptoms of Post-traumatic Stress Disorders (PTSD), all of which produce ripple effects, if not tidal waves, onto families and loved ones. 

In medicine, we call clinician-based bad outcomes iatrogenic. That is, there are apparently well-meaning clinical decisions that can backfire and cause more harm than benefit. The same can be true of leadership and administrative decisions in mental healthcare systems. Staff can be confidently hired, but turn out to be "bad apples". Focusing on what's best for a population of patients can result in inadequate resources for certain individuals. Iatrogenesis includes side effects, medical errors, instrument failure, poor bedside manner, and negligence. Negligece, of course, is at the center of the VA scandal. 

Lemonhead candy has become my favorite. At first, sucking on them tastes sour, but later there is a burst of sweetness to counter the sourness. The sweetness in the sour VA scandal is what we all can learn to make waiting times and accessibility more clinically appropriate. In the VA, the need to do so is only escalating. In the past two to three years, the number of patients has increased by between one to two million, with over 200,000 of these having PTSD. Given that symptoms of PTSD can be delayed for years, increased preparedness for years is required.



H. Steven Moffic

H. Steven Moffic

H. Steven Moffic, M.D. retired from the clinical practice of psychiatry and his tenured...

The opinions expressed by Behavioral Healthcare Executive bloggers and those providing comments are theirs alone and are not meant to reflect the opinions of the publication.