| | In all, only 27 percent of veterans receiving PTSD care received it in one of the VA's specialized programs, VA data show. And that varies widely. In the region that includes Wisconsin, 13 percent of veterans with PTSD received care from specialized teams. In Ohio, 45 percent did.
The uneven mental health treatment of veterans across the country can be traced to the VA's health system reorganization, which gave a lot of leeway to local managers.
McClatchy reviewed two dozen mental health measures, based in part on an analysis of every inpatient and outpatient visit in the VA health system. The 200 million records were contained in two fiscal 2005 databases.
Among the findings:
*Some veterans get in for visits far more than others. The average number of visits per veteran with PTSD ranged from 22 in the Hudson Valley, N.Y., medical center and clinics to a low of 3.1 in Fargo, N.D. The national average was 8.1.
*Some VA medical centers spend far more on mental healthcare than others. In Connecticut, it was an average of $2,317 for each veteran's outpatient psychiatric care. In Saginaw, Mich., it was $468.
*Some veterans get in quickly. Others wait. At the Loma Linda, Calif., VA network, only 39 percent of new mental health patients were able to get appointments within 30 days, the VA's standard. In other networks, 90 percent or more did.
*Once they are in the door, some veterans get visits of 75 to 80 minutes, while others get 20- to 30-minute appointments, the shortest psychotherapy appointments listed in the system. Of all the individual sessions for veterans with PTSD, those in the Amarillo, Texas, network got the shortest possible visits 87 percent of the time, while those in Butler, Pa., were given those short visits 6 percent of the time.
Asked about the disparities, the VA's Zeiss said: ``It's true there are disparities. . . . Disparity is a part of healthcare. . . . I can tell you that the data you're looking at we're looking at, too, and we're using it to make decisions about how to close the gap and ensure a standard of care nationally.''
The VA's top mental health services official, Dr. Ira Katz, added in a separate interview that variation in a host of mental health measures wasn't necessarily good or bad. It could reflect different strategies being tried in different states so that ''our system can better learn what works and what doesn't work,'' he said.
Through such trial and error, variations likely would decrease over time, as, for example, expensive medical centers become more efficient and underserved medical centers are given more resources, he said.
Different outcome
So far, that hasn't happened, McClatchy found.
For starters, the variations in many mental health measures are growing, not shrinking, according to a McClatchy analysis of key measures back to the time of the reorganization. A 2005 study by two VA mental health experts came to the same conclusion, noting that ``system reforms did not lead to decreases in regional variation.''
In addition, the variation in mental health spending is far wider than it is in primary and hospital spending, indicating that the system is having more trouble ensuring consistency in mental healthcare.
As for the wide variation in spending per veteran on mental healthcare, Katz said it could be explained by the presence of special programs in various medical centers. There's a national PTSD research center at the Connecticut VA, for example, that inflates spending figures there.
When asked how many of 128 medical centers ranked by that measure had special programs that might distort spending figures, Katz said he didn't know if it was a half dozen or if it was 50.
He added that ``the VA is involved in a very active process of identifying and filling gaps in care.''
Among other things, the VA has begun to pump more money into local clinics to ensure that they begin to provide mental health treatment. ''We have invested more personnel and more money in this in 2006, and are investing still more in 2007,'' Katz said. The 2008 budget released last week will continue those efforts, the VA said.
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