Countdown to After the Uniform: The VA

This issue would appear, on the surface to be cut and dry - the VA is understaffed, underfunded, and overwhelmed.  The truth is not that simple and anyone paying attention knows it.  There has been a coordinated PR campaign by the IAVA among others to 'motivate' the VA to square themselves away.

Unfortunately, I believe that, while they are making life uncomfortable for politicians and pressuring them to end the claims backlog, the way in which the IAVA has gone about it has caused too many veterans to not trust the VA.  This loss of trust is tragic.  It keeps many from coming forward to get the help they desperately need.  Pushing for reform cannot be done quickly and piecemeal.

Let's examine the issues with the VA more closely:

• Ingrained Bureaucracy:  Federal bureaucracies are all fundamentally flawed.  They all focus more on getting everything done through ancient and outmoded procedure than they do on making sure that the end result of their efforts matches the efforts the customer is seeing on their end.  How many hoops to veterans have to jump through to just file a claim?  Why are non-medical administrators with little to no knowledge of the intricacies of providing care the ones in positions to make uneducated decisions?  These are all part of the culture that has not changes for decades at the VA.  During peacetime, this was not noticed because we didn't have a massive influx of new veterans seeking long-term care.  Now that we do, the deficiencies in not having updated policy and procedure becomes glaringly obvious.  Unfortunately, the care providers on the front lines are the messengers that end up getting a bad rap because of this.
• Change Can't Happen Without Leadership Continuity:  One of my good friends and I were talking about this the other day and it makes a lot of sense.  In a large Federal bureaucracy with ingrained bad procedure and policy, there needs to be continuity at the highest levels of leadership for change to take hold.  Secretary Shinseki is finally filling that void in continuity - and that's why we are finally starting to see positive change in the manner in which the VA operates.  Before Shinseki, there was a revolving door in that office.  In large government organizations like the VA, the employees could just wait out policy changes.  They could just wait until that Secretary was replaces with another warm body and policy changed all over again.  Without continuity and accountability (both of which Shinseki brings in spades), there is no possibility for long-term changes to go into effect.
• The Behavioral Health Hiring Fiasco:  So much pressure was put on the VA to provide better care to veterans with PTSD and other behavioral issues that the VA has been, in many cases, not performing due diligence to ensure that the clinical social workers and therapist that they hire are actually qualified to administer to the needs of veterans.  The VA has always made sure that the treatment modalities that were used by therapists were evidence-based and had a lot of research to back up their efficacy.  This latest round of hires has seen a disturbing increase in the number of social workers and therapists using pseudoscience to 'treat' veterans with PTSD.  Emotional Freedom Technique and Thought Field Therapy have absolutely no place in the VA.  Honestly, it scares the hell out of me that these people are allowed access to veterans with PTSD.  When there is no peer-reviewed evidence that a modality works any better than the placebo effect...the well-being of at-risk veterans should not be exposed to therapeutic Russian Roulette.  The other side of it is that the VA can't fill the vast majority of the openings they created.  Truly qualified medical professionals have better paying options elsewhere.  Additionally, these same professionals have heard how the VA does not allow their therapists to dictate the frequency or duration of individual sessions with veterans.  I don't know many therapists who would want to subject themselves to 'revolving door' care.
• Clinician Burnout:  Not many are tracking the number of caregivers that are burning out due to the insane treatment tempo, intensity of care being provided, and the emotional drain on the caregivers due to long hours and severely traumatized veterans.  If a clinician is burning out, you can usually tell and the effectiveness of the care they are providing drops off precipitously.  Being a VA caregiver is a thankless job and takes a heavy toll on caregivers at the VA.  Remember that the next time you go into the VA and are not satisfied with the level of care you are receiving.  I have found being compassionate about their plight has helped to facilitate getting me the level of care I have needed in critical situations.

Needless to say, there are a lot of problems at the VA.  Many of them are due to the fact that the majority of our politicians who voted for sending us to war accounted for the enduring costs associated with waging it.  Just remember - there's always three sides to every story:  Yours, Mine, and somewhere in the middle lies the truth.