Link: http://www.wsj.com/articles/report-va-falls-short-on-mental-health-care-despite-hiring-push-1440537211

By Ben Kesling
August 25, 2015

The Department of Veterans Affairs lacks enough full-time psychiatrists to meet demand for services and those on staff aren’t being used efficiently, despite a multiyear, multibillion-dollar effort, says a report from the department’s internal watchdog.

The VA hasn’t been “fully effective” in hiring psychiatrists or in using those it has, the VA’s Office of Inspector General reported Tuesday, adding that the department has focused on meeting overall hiring goals rather than on hiring personnel to fill gaps at specific facilities.

The VA “did not effectively use psychiatrists in its efforts to improve veterans’ access to psychiatric care,” the inspector general said in the report, adding that poor “clinic management practices resulted in unused capacity of its psychiatrists.”

In fiscal year 2014, the department spent nearly $4 billion on outpatient mental health services, the report says, yet the inspector general identified 94 of 140 facilities that year that needed additional psychiatrists to meet demand and found that 25% of psychiatrists’ time wasn’t used effectively.

The report serves as a follow-on to a 2012 study that identified wait times of more than a month for psychiatrist appointments by veterans and a large number of vacant psychiatrist positions.

In 2012, then-Secretary Eric Shinseki announced an initiative to hire 1,600 mental health professionals, bumping up pay scales to help recruit them. In 2014, Secretary Robert McDonald announced another hiring initiative as part of a broad reform package pushed through in the wake of a departmentwide scandal that led to the resignation of top officials, including Mr. Shinseki.

Since then, the VA hasn’t come up with effective hiring goals or an effective departmentwide system for managing psychiatrists, leaving these determinations to local hospital networks that haven’t been fully effective,the report says.

Earlier this year, Congress passed further legislation to help bolster mental health care, including student-loan forgiveness for psychiatrists, the category of providers the VA has said are among the most difficult to recruit and retain.

“This VA OIG report highlights some very important areas for improvement,” said the Iraq and Afghanistan Veterans of America, an advocacy group, in a statement. The group “continues to recommend the VA conduct regular analyses of staffing needs to continually track current and predict future needs for mental health clinicians, including psychiatrists,” it said.

Sen. Johnny Isakson (R., Ga.), chairman of the Senate Committee on Veterans’ Affairs, said in a statement that the report “does not appear to reflect any sense of urgency to address the shortages or operational inadequacies.” He added that he will be asking the VA secretary “to reconsider addressing the recommendation in a more timely manner.”

The VA concurred with the report’s findings and said it has laid out plans to improve efficiency and management techniques as well as establish more effective hiring goals. The department said it already has begun to make improvements, including requiring mental health providers to maintain productivity targets and establish staffing benchmarks for each facility.

“The Department of Veterans Affairs appreciates the review by the Office of Inspector General, and the opportunity to improve services we provide to our Nation’s Veterans,” said a spokeswoman for the department in a statement. Most of the improvements have a target completion date of September 2016.