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With many veterans waiting for care, the VA may change how it uses outside doctors


The suicide rate among America's veterans is almost double that of civilians. And many parts of the country face a shortage of mental health care providers. As NPR's Quil Lawrence reports, that means many veterans are facing long waits for the care they need.

QUIL LAWRENCE, BYLINE: In recent years, the VA and the military have been trying to break down the stigma about asking for help with mental health. But many troops still say things like this.

UNIDENTIFIED PERSON: We all know that something like this would ruin my career. He says things like that.

LAWRENCE: This National Guard lieutenant is talking about her husband, who's also still in the active reserve. The fear of career repercussions is why we aren't using their names. She's worked with many troops on issues of PTSD and suicide.

UNIDENTIFIED PERSON: We're trying to really decrease that stigma. I personally, as a commander, I'm very, very open about the help that I've gotten, and I very much encourage my soldiers to go get help.

LAWRENCE: Her husband has struggled on and off for nearly 10 years since he was wounded in a deadly attack in southern Afghanistan. He's got survivor's guilt. At least once, he's come close to suicide. But last month, when he reached out to the VA for an initial psychiatric evaluation, the soonest appointment was in March, next year.

UNIDENTIFIED PERSON: And so it's kind of amazing to me that, you know, now looking at a system that's supposed to be so helpful is backlogged six months for an initial intake for somebody who has documented suicidal issues.

LAWRENCE: He's managing right now. What they want is treatment to prevent a crisis. VA has greatly expanded telemedicine during the pandemic, but that's not for everyone.

UNIDENTIFIED PERSON: I also know my husband's the kind of person that wants to sit down and actually connect with somebody.

LAWRENCE: When the wait is too long or the provider's too far away, VA can refer patients to local, private health care.

UNIDENTIFIED PERSON: But those - the shorter wait times with those civilian providers are still 8 to 12 weeks out.

LAWRENCE: In the Rocky Mountain region where they live, the private sector is just as stressed as the VA.

DON KOENIG: It really varies by market.

LAWRENCE: Don Koenig is a special advisor to VA on integrated care.

KOENIG: There are some communities that have plenty of mental health appointments available, maybe New York City, and it's the very opposite in, perhaps, a more rural location out west.

LAWRENCE: Under the Trump administration, VA increased access to private care. This month, the Biden administration announced a redesign of how the VA uses outside doctors. No real details yet, but it's already stirring up a partisan fight in Congress. But public or private, that may miss the point. Kevin Griffith at Vanderbilt University co-authored a study on how long veterans wait for care.

KEVIN GRIFFITH: Overall, you know, the VA tends to, you know, have shorter wait times for mental health care. Although - again, there are some areas where, you know, veterans were able to be seen faster outside the VA. But it - you know, we saw that that wasn't the case in general. So if you had a long wait time at the VA, chances are you also had a long wait time for private sector providers.

LAWRENCE: VA has had vacancies in specialty jobs for years. It competes with the private sector to hire mental health care providers, which is no comfort to veterans like the lieutenant, whose husband can't get seen until March, even as everyone tells him to make his mental health a priority.

UNIDENTIFIED PERSON: Right now, he's like, well, clearly it's not a priority to them. If they can wait five months to see me, six months to see me. So it shouldn't be a priority to me either.

LAWRENCE: She is about to deploy, and he will be taking care of their kids. They've decided to keep the appointment for March instead of a private care appointment. They think for issues like combat survivor's guilt, sessions with a VA doctor might be better.

UNIDENTIFIED PERSON: But once he gets started on those, I think it's going to do nothing but make this next year easier on us as a family but easier on him just as a human being, which is the main priority.

LAWRENCE: Quil Lawrence, NPR News.

SHAPIRO: If you or anyone you know is considering suicide, call the National Suicide Prevention Lifeline at 1-800-273-8255. And if you're a veteran, press one.

(SOUNDBITE OF MUSIC) Transcript provided by NPR, Copyright NPR.

Quil Lawrence is a New York-based correspondent for NPR News, covering veterans' issues nationwide. He won a Robert F. Kennedy Award for his coverage of American veterans and a Gracie Award for coverage of female combat veterans. In 2019 Iraq and Afghanistan Veterans of America honored Quil with its IAVA Salutes Award for Leadership in Journalism.