VSOs: Veterans Waiting Too Long for Substance-Abuse Treatment

Julie Kroviak, MD, principal deputy assistant VA Inspector General

WASHINGTON, DC — Veterans in need of residential substance abuse treatment are facing too-long delays in finding beds both at VA facilities and through community care, according to veterans’ service organizations. Some legislators are blaming a VA policy that dictates wait-time goals for substance-abuse treatment, which are sometimes longer than those set out in the MISSION Act.

The MISSION Act dictates that, if VA cannot provide care within a reasonable time-frame or a reasonable distance from the veteran’s home, the department must refer them to non-VA care in the community.

Veterans also are being pushed into less-intensive care programs first before being ramped up to care that’s more appropriate for their needs, VSOs say. This, combined with the delays, can result in providers missing what they consider a golden window when a veteran suffering from substance abuse decides to seek care. 

“It needs to be quick,” explained Jen Silva, chief program officer of the Wounded Warrior Project, at a House VA health subcommittee hearing last month. “The window of opportunity, … it’s a really short window. So you have to have that availability. … If the community can provide that [care], it’s the best way to go, in my opinion. Ultimately, if the veteran has a positive experience, it’s still a VA referral. From a customer perspective, … it still leaves them happy with the overall care, even if it’s not within the VA medical center.”

According to VA policy, veterans in need of priority admission to a residential treatment program must be admitted within 72 hours. Those seeking more general admission must be given a spot within 30 days. The MISSION Act puts that wait-time maximum at 20 days and puts limits on how far a veteran is asked to travel to seek that care. 

However, several VSOs reported being stonewalled when advocating for a veteran seeking residential substance-abuse treatment in the community. A VA physician’s recommendation for community care would sometimes be overruled by an administrator. Other times, VA placed the veteran in a program far away, requiring at least one veteran to move in order to receive treatment. In one case, a VSO heard from VA officials that their policy was to check a minimum number of VA facilities before approving a request for community care.

“There were some cases where our casework team were told by an administrator that community care was not offered, or the staff did not even know community care was a lawful option,” testified Daniel Elkins, chief of staff for the Independence Fund. 

According to VA officials, some of these issues are due to the newness of the community care policy, and a need for the department to train its providers, as well as veterans. 

“We are in the process of continuing to educate within our own organization and certainly with the community the standards that we expect in terms of particularly such treatment,” explained Tamara Campbell, MD, PsyD, executive director of VA’s Office of Mental Health and Suicide Prevention. “We have completed regional conferences to make sure our staff is aware of the policies as it pertains to community care, as well as holding quarterly meetings with our VSO stakeholders to make sure they understand where our programs are and to listen and learn about the concerns they have.”

There also is a certain amount of misinformation being directed to veterans, Campbell noted. 

“VA has observed instances of community programs marketing directly to veterans and providers, resulting in confusion by veterans when informed of the availability of VHA to meet their needs,” she explained.

Whether the goal by VA is 20 days or 30, there was agreement among the VSOs and the VA Office of the Inspector General that the number had little to do with the best interests of the veteran.

“I think it’s a clinical decision,” said Julie Kroviak, MD, principal deputy assistant VA inspector general. “I think 30 days is arbitrary for a lot of the issues for which these veterans are seeking care.” 

However, Kroviak warned the committee that problems with the community care network as a whole should not be ignored in the effort to get veterans into treatment quickly. 

“Our office has published reports regarding community care detailing delays in diagnosis and treatment, lack of information sharing or miscommunication between providers, and significant quality of care concerns,” she explained. “While we recognize the importance of VHA staff consistently informing and offering veterans all options available to meet their care needs, ignoring that the current community care network does not adequately address critical gaps in coordination will further increase risks to patients.”