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Spokane, Washington  Est. May 19, 1883

Local vets endure long line for care

Senator criticizes wait time for mental health appointments

Patients of the Spokane Veterans Affairs Medical Center often have to wait three weeks to see a mental health care provider – a wait that’s longer than the national average.

“It is not acceptable to have veterans, who have stepped up and shown the courage to ask for help, be denied care,” U.S. Sen. Patty Murray said in a letter this week to Dr. Robert A. Petzel, VA undersecretary for health.

Murray, who is chairman of the Senate Veterans’ Affairs Committee, called for improvements in mental health care delivery, the need for which was revealed in a survey of 272 VA mental health providers nationwide.

U.S. military involvement in Iraq and Afghanistan has created a new generation of combat veterans for whom mental health issues are a real concern, the senator said.

At a time when 18 veterans a day nationwide are committing suicide, 70 percent of VA mental health care providers said they did not have adequate staff or space to meet the needs of the veterans they serve.

Nearly 40 percent of the providers said they could not schedule an appointment for their patients within the VA-mandated 14-day window, according to the survey, which Murray requested this summer.

Psychologist Quinn Bastian, head of behavioral health at the Spokane VA Medical Center, cited a shortage of staff as a reason for the average 21-day wait time. His department has 29 providers, including psychiatrists, psychologists, clinical social workers and nurse practitioners.

“We have lost 40 percent of our therapy staff over the course of the last year,” Bastian said, citing attrition through retirement, illness and providers taking jobs elsewhere. “That’s one of the things that have contributed significantly to our being behind the curve.”

The medical center has seven psychiatrists and a psychiatric nurse practitioner on staff, an increase from five psychiatric providers in 2009. At that time, all five providers told the administration they could not in good conscience take new patients because of their high caseloads.

The current average caseload for Spokane VA mental health providers is between 550 and 650 patients, Bastian said. The average VA caseload nationally was 515 patients last year.

Two years ago, there were six suicides among veterans in the area served by the Spokane VA, including three veterans who had contact with the medical center. That was a dramatic decrease from the period between July 2007 and July 2008, when 21 area veterans killed themselves, including 14 who had contact with the medical center.

This year, Bastian said, there have been three veteran suicides in the area, one of whom had contact with the Spokane VA.

Bastian cited VA improvements in care, including 24-7 emergency psychiatric coverage, a suicide risk management team, a suicide prevention coordinator and a national suicide hotline, (800) 273-TALK (8255).

In addition, the Spokane VA has increased the number of inpatient psychiatric beds from eight to 12.

“There are currently eight patients on the ward and most of the time we have the capacity for admission,” Bastian said.

The psychologist said there is greater use of mental health services by veterans of Iraq and Afghanistan and higher rates of diagnoses of post-traumatic stress and mild traumatic brain injury.

“The big focus for VA for the last couple of years has been to make sure when people come to our attention that we get them plugged into care quickly,” Bastian said.

However, Murray said, more remains to be done to improve VA mental health care. She cited “the apparent lack of a plan of action to address the issues” raised by the survey.