JENNIFER BOULDEN

In all 75 Arkansas counties, community mental health centers are on alert.
Depending on what happens with a bill currently in the federal pipeline, the Veterans Administration may soon be outsourcing mental health care for Iraq war veterans with many of these centers. In May, New Mexico Senator Pete Domenici introduced S. 38 — the Veterans’ Mental Health Outreach and Access Act of 2007, co-sponsored by Senators Blanche Lincoln, Barrack Obama, and eight others. The legislation, for which the Mental Health Council of Arkansas is actively campaigning, is now being discussed by the Senate Veteran Affairs Committee.

If enacted, the bill would require the historically self-contained Veterans Administration to establish a VA-contracted peer outreach, peer counseling and mental health care program to provide readjustment and mental health services to veterans who served in Operations Iraqi and Enduring Freedom (OIF/OEF) who are not adequately served by VA.

One provision of the bill requires contracting with local professionals and community mental health centers to reach vets in areas underserved by the VA system. This is a beautiful idea, says MHCA Legislative Committee Chair Pete Kennemer, M.P.H., because Arkansas has a strong, existing network of community mental health centers in every county that are available to help fill in the gaps in the VA’s coverage areas.

Kennemer, who is also executive director of Western Arkansas Counseling and Guidance Center in Fort Smith, said VA has a history of providing services themselves and limiting contracts for services outside their walls. “It’s very significant to see wording in a Congressional bill calling for contracts for mental health centers,” he noted. “There’s a recognition there that the mental health centers of America are pretty widespread and have a system of care in place where assessment and treatment can readily take place. Congress is trying to encourage VA to take advantage of that existing system.”

The proposed legislation also would require VA to train peer counselors and professional providers to care for veterans of OIF/OEF, specifically those who have no access to direct VA programs. Additionally, it would authorize members of the veterans’ immediate families to receive VA services such as orientation and education, support, counseling and mental health services for three years immediately following combat deployment to Iraq and Afghanistan. Theoretically, the state’s community mental health centers could assist with this family care as well in areas where VA services are sparse.

MHCA Executive Vice-President Kenny Whitlock said that while VA tends to keep their services in-house as much as possible, the state’s VA hospital has shown promising signs of reaching out to the community for support. “Last year we had a colonel visit our board and we talked about how we could help and do referrals and that sort of thing,” he said. “We did get some good dialogue, good exchange, but that’s been a little over a year.”

He said that while many states are frantically trying to re-establish a past network of community mental health centers, Arkansas for years has maintained a mental health center in every county.

Kennemer said, “VA has I think, eight to 10 locations in Arkansas, compared to 75 mental health centers. We’re not talking about replacing their services, but augmenting them.”

Rural areas are in the direst need of enhanced service coverage, especially since vets often have painful physical disabilities that make travel difficult in addition to mental health issues like depression and post-traumatic stress disorder. Besides having to overcome the stigma of having mental health issues, veterans with clinical depression also must overcome the disease’s accompanying feelings of lethargy, futility and despair to get help for themselves. Having to drive over an hour each direction for care is another barrier and incentive for the depressed patient to stay home instead of seeking help.

“For a veteran who lives in Waldron, for instance, where I have a clinic,” Kennemer said, “VA care in Fayetteville is available, but it’s sure not accessible.”

“Within our systems,” he explained, “we all have medical personnel who can prescribe medication, we have psychologists who can test and treat, we have social workers who can treat, we have intervention specialists who can go into the home or do further assessment outside of the office as it relates to work, travel, medication and being of general support. It’s a thorough system of quality care that is available, if we had the contracts to reach out to veterans. It’s a great approach to the problem.”

Not everyone agrees.

In Oct. 24 testimony before the Senate Veteran Affairs Committee, Joy Ilem, assistant national legislative director of the Disabled American Veterans, said the bill was flawed because quality control outside of the VA system was suspect and that a newly developed VA national mental health strategic plan should first be given a chance to work.

“Unfortunately, in most cases where VA authorizes care to veterans by contract providers, VA has not established a systematic approach to monitor that care, consider any alternatives to its high cost, analyze patient care outcomes, or even establish patient satisfaction measures. In fact VA knows very little about the care for which it now contracts,” Ilem told the committee. She continued:
“Our main concern with this bill is that VA, over the past several years, has received significant new funds targeted to providing better mental health services to all veterans. VA has been especially concerned about ensuring services to OIF/OEF veterans, particularly those who live in rural and remote areas without good access to care. VA has developed a national mental health strategic plan, to deploy several new programs within all the normal strictures in which the system is required to operate. DAV believes VA should rapidly deploy those plans and exhaust those program possibilities, and then determine the degree of unmet need in rural areas-rather than being required to contract out these services before those programs are given a chance to materialize.

Before Congress authorizes a program such as the one envisioned here for rural veterans, we recommend VA determine the degree of unmet need after it has done as much as practicable to meet that need directly. Since Congress recently enacted legislation that established VA’s new Office of Rural Health, we believe that office should be charged with implementing and managing these matters in conjunction with VA’s Office of Mental Health Services.”

Whitlock said, “It sounds to me like the VA really is trying to hire staff and get the resources together to extend their services. That’s really good because I think there are a lot of needs out there that aren’t being met, so we’re very supportive of them. But we’re available to help, too.”

Kennemer concurred. “I think it’s a new ballgame for VA as well as for us, and we’re probably all struggling with how to make something better happen,” he said.

MHCA plans to use that same network of centers and professionals across the state to help promote the bill and work towards its implementation. The committee is working out strategies, coordinating contacts and resources, and will soon talk with the Arkansas Congressional delegation.

In Ilem’s testimony, she agreed that despite its weaknesses, the provisions for rural care were among the bill’s strengths. In addition, she applauded the inclusion of measures to address the needs of the veteran’s immediate family, said the time-tested peer counseling methods called for “probably would increase the likelihood of engaging veterans in readjustment and treatment”, and could provide “new vocational rehabilitation options” for veterans providing the counseling.

Kennemer said he thinks there is widespread support for the bill on both sides of the political aisle. “This is just about supporting our troops who come back here changed individuals, regardless of whether you support the war,” he said. “I personally know three specific cases of naïve, gung-ho young men who went over there full of confidence and purpose and are not returning that way at all. They’re not the same. And all of us want to be ready to help out in those situations. We just have to work together to make it happen.”



December 2007