V.A. Workers See Chaos In Services For Mental Care

For those of you who are new here, I read the top story in the New York Times every morning so that you don’t have to. If you were forwarded this, you can subscribe here. I’m also doing a five-minute video version of this, each morning at around 9 a.m. (depending on how long it takes me to read the newspaper). If you’d like to follow me on LinkedIn (you can always watch the recording later). If you subscribe to my Youtube channel it’ll also send you a notification when I’m “going live.”

Today’s story by Ellen Barry, Nicholas Negakas and Roni Caryn Rabin focuses on the impact of cuts to the Department of Veterans Affairs by Elon Musk’s DOGE operation. Would you believe the net effect does not appear to be positive?

It opens quoting a psychiatrist who works with veterans, many of whom have schizophrenia and bipolar disorder. Over the last two years she’s worked hard to gain her patients’ trust from her home office. Now because of a “return to the office” order, she must conduct virtual psychotherapy from one of 13 cubicles in a large office space, “the kind of setup used for call centers.” There’s no privacy. Other staff might overhear the sessions or even appear on the parient’s screen as they passed on their way to the bathroom and breakroom.

It’s the consequence of a “jarring policy reversal for the V.A., which pioneered the practice of virtual health care two decades ago as a way to reach isolated veterans, long before the pandemic made telegraph the preferred mode of treatment for many Americans.”

The piece quotes the head of practice at the American Psychological Association saying the “long-standing presumed practice for the delivery of psychotherapy” requires a private location, such as a room with a door and soundproofing.

Personally I like to see my therapist in private, too. When I do go to his office there’s a nice couch. When I talk to him on the phone I rarely overhear anything outside the room.

The piece also quotes an unsympathetic V.A. Spokesperson, Peter Kasperowicz, saying that the idea that a crowded working environment would compromise patient privacy is “nonsensical.” He also adds: “Under President Trump, V.A. Is no longer a place where the status quo for employees is simply to phone it in from home.” 

Ouch. Here’s Peter’s LinkedIn page. It notes that he used to work for Fox News and only has 167 connections. Maybe that’s all he needs? Presumably there’s no point in his making any new connections at the V.A., because most of them are going to get laid off, soon, and those who aren’t are unlikely to want to sit with him in the break room.

Messing with Veterans’ mental health, I needn’t tell you, is risky. Both because a lot of them have guns and tend to commit suicide at higher rates than the rest of the population but also because they tend to vote Republican. Or…they used to.

Mr. Trump has also campaigned on improving services at the V.A.

The story interviews a suicide-prevention counselor in California who can field up to 30 calls a day.

Her team was supposed to get three more staff who were canceled because of the administration’s hiring freeze. She’s worried about making a mistake. ““I’m not sleeping well, and it’s hard to stay focused,” she said.

Tell me about it.

About that suicide risk for veterans: “in 2022, the suicide rate was 34.7 per 100,000, compared to 14.2 per 100,000 for the general population. A major factor in this is the availability of firearms, which were used in 73.5 percent of suicide deaths, according to the V.A.”

The story catches up with a variety of people including those who previously worked with veterans and have been fired. It also features this harrowing image:

And there’s more about those veterans being treated from large office spaces. It quotes Dr. Ira Kedson, the president of AFGE local 310 at the Coatesville V.A. Medical Center in Pennsylvania:

“That would sound like you’re seeing them from a call center, because you’d be in a room with a bunch of people who are all talking at the same time,” Dr. Kedson said. “The veterans who are going to be in that position, I suspect they will feel very much like their privacy is being violated.”

Psychotherapy is “supposed to be a safe place, where people can talk about their deepest, darkest fears and issues,” Dr. Kedson said. And veterans, he said, trust that what they tell therapists is confidential. “If they can’t trust us to do that, I think that a sizable number of them will withdraw from treatment,” he said.

And after they withdraw from treatment? Here’s a couple of chilling graphs from last year’s V.A. suicide prevention report:

Perhaps the saddest thing is the number of male veterans aged 18-34 dying by suicide:

My sense is that rather than have a culture war over whether to force psychotherapists back to the office, Elon Musk and his compatriots might do better to consider “what, based on the evidence, might work best to prevent U.S. veterans killing themselves?”

And start from there. I thought tech bros were all about evidence-based practices, after all, unless they interfere with their ability to destroy human lives at the stroke of a pen.

Sadly, I suspect that we’ll lose a lot more people before this sad trend is reversed.

Thanks for reading the newspaper with me so that you don’t have to. Please share this with anyone you think might appreciate reading it.

Matt Davis lives in Manhattan with his wife and kid.