Veterans Health Administration: Mental care needs improvement

U.S. Department of Veterans Affairs

Too many veterans hospitals are providing inadequate in-patient care and follow-up to individuals seeking treatment for problems such as posttraumatic stress disorder and substance abuse, according to a report on systemwide assessment  released on July 8.

In Healthcare Inspection: Review of Veterans Health Administration Residential Mental Health Care Facilities, the VA's inspector general concluded that some in-patient psychological and psychiatric programs lacked adequate staff, oversupplied patients with potentially harmful medications and failed to monitor patients' adherence to treatment plans both in the hospital and after discharge.

No facilities are named in the report on the investigation prompted a number of overdose deaths among patients of a Los Angeles VA mental care program during 2006 and 2007. To reach the findings and recommendations made public Thursday, Inspector General George J. Opfer and his staff reviewed 933 patient records, visited 20 facilities and surveyed all residential mental health programs.

Among the findings summarized in a VA press release were that five Veterans Integrated Service Networks failed to offer services in every recommended category, only about one-fourth of surveyed programs offered services specifically geared toward the needs of Iraq War veterans, and nearly half of patients left residential care without verifiable plans for the safe use of medications such as narcotic painkillers. Additionally, 11 percent of patients received prescriptions for up to a month of medications with a high likelihood for abuse when those patients were supposed to receive only seven-day supplies of medications.

Opfer made 10 recommendations for improving the deficiencies (see below), and The VA's acting under secretary for health, Dr. Gerald M. Cross, concurred that those steps were needed. Attached to the inspector general's report is a summary of how many of the recommendations have already begun getting implemented.

Recommendations for Strengthening VA Mental Health Care Programs

1. The under secretary for health should ensure that Veterans Health Administration program officials review the utilization, resource allocation, and distribution of general residential, posttraumatic stress disorder-focused, substance use-focused, Domiciliary Care for Homeless Veteran and Compensated Work Therapy-Transitional Residence programs.
2. The under secretary for health should ensure that Veterans Integrated Service Network directors include programming specific for Operation Iraqi Freedom/Operation Enduring Freedom veterans in residential programs.
3. The under secretary for health ensure that VISN directors should make sure that residential program managers ensure that patients on waiting lists are periodically contacted and/or engaged in treatment while awaiting placement in a residential program.
4. The under secretary for health ensure that VISN directors make sure that medical screening precedes admission for all patients in all residential programs and be documented accordingly.
5. The under secretary for health ensure that VISN directors make sure that minimum programming requirements are met 7 days per week.
6. The under secretary for health should further develop formal guidelines for mental health clinician staffing by mental health discipline for programs using an all-inclusive staffing model and for programs using a residential type clinical staffing model.
7. The under secretary for health should require the presence of at least one staff member on each separate wing and floor of residential programs on all shifts.
8. The under secretary for health ensure that residential programs limit dispensing of narcotic self-medication to no more than a 7-day supply for residential program patients.
9. The under secretary for health ensure that all patients on self medication have a documented order for self-administration.
10. The under secretary for health ensure that missed appointments by residential program patients should be captured, addressed, and case managed in a uniform manner.