Last Wednesday, Department of Veterans Affairs Secretary Robert Wilke published an opinion piece “In Congress, Veteran Suicide Prevention Is a Bipartisan Topic. Here’s the Plan” that put heavy pressure on the House Committee on Veterans’ Affairs to pass the “Improve Well-Being for Veterans Act” without revision. The bill awards grants to private programs ostensibly to help prevent suicide of veterans who do not use Veterans Health Administration (VHA) care.
If only the bill were as “elegant in its simplicity” as Secretary Wilke claimed. On the contrary, in arguing that this legislation should be immediately approved, Secretary Wilke made numerous false claims about why it was needed and what it would do. Readers can examine the bill’s language if they wish to confirm.
Secretary Wilkie declared that the grant recipients “can more quickly identify the risk factors that put veterans at risk… and get veterans the help they need more quickly than ever before.” However, the bill does not require entities to provide services in a timely manner. In fact, it contains no mention of any time frame whatsoever.
Secretary Wilkie stated that, “many veterans live too far away from VA’s brick-and-mortar health care facilities to get effective help, and will require help locally.” The bill has no requirement that entities focus efforts in rural communities. In fact, grantees are allowed to be located close to VA Medical Centers, VA Community Based Outpatient Clinics, Vet Centers and MISSION Act’s Veterans Community Care Program providers. The bill ignores the fact that the very best access to veterans’ mental health services in rural areas is already available through the VA industry-leading, evidence-based telemental health care.
Secretary Wilkie maintained that the bill would “finally help us reach the roughly 60 percent of veterans who die by suicide each day without any recent connection to VA care.” That’s not how the bill is structured. Only a fraction of the money is for outreach and identifying at-risk veterans. The bulk of the entities’ services would be mental health treatment that explicitly duplicate services the VA already widely offers. These include, among other services: direct mental health treatment, individual and group therapy, medication management, substance use reduction programming and family counseling.
Secretary Wilkie claimed the bill is needed for veterans who “distrust the government” or “are reluctant to seek help at the VA.” The VA already deals with this problem – and has since the Vietnam War. Over 300 Vet Centers and 80 mobile Vet Centers function in every state and target precisely this group of veterans who are reticent to use VA services and/or distrust the government.
There’s an important reason we’re highlighting the false statements in Secretary Wilke’s opinion piece. The bill, which Veterans Healthcare Policy Institute previously analyzed in detail, has critical flaws that potentially endanger veterans’ healthcare.'
Unlike homelessness grants which effectively augment services the VA itself does not provide, the grants in this new legislation potentially supplant the critical function of the VA’s Office of Mental Health and Suicide Prevention. Although we’ve been told that many Congresspersons who support this legislation believe entities will refer veterans to the VA for needed care, nothing in the bill requires grantees to direct veterans to VA’s highly recognized mental health care.
There is no expectation that private entities be held to any standards of training, provider qualification and documented best practices for mental health care to which VA holds itself. There is no expectation that the grantees track and report on suicide attempts of veterans who receive their services. This lack of monitoring is particularly troubling given that preventing suicide is the Trump administration’s stated goal in pushing so hard for this legislation.
Private sector treatment rendered by this bill would not require VA pre-authorization. That’s one giant step toward privatization of veterans’ healthcare. Equally concerning is the fact that there are no safeguards against private programs feathering their own nest through self-referrals.
Successfully addressing veterans’ suicide requires the right priorities. As Secretary Wilke concluded, and we concur, “all of us, working together, will win this fight.” We will not win it by financing more and more care by private sector providers of unknown quality in the service of the administration’s privatization agenda.
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CHART: Asserted & Actual Effects of IMPROVE Well-Being for Veterans Act
ANALYSIS: At its core, IMPROVE would duplicate and erode VA’s existing successful mental health services, ignore what interventions are most needed to reduce veteran suicide, and hasten outsourcing of veterans’ health care to the private sector.