More than any other
war in US history, the conflict in Iraq has provoked a surge of concern for
soldiers returning home bearing the psychological burdens of battle.

From the war’s first
days, veterans’ groups, mental-health organizations, and some members of
Congress have claimed that the Department of Veterans Affairs is unprepared to
treat the tens of thousands of US soldiers likely to come back with
post-traumatic stress disorder, a debilitating psychological condition.

A new federal report
indicates that those fears are not unfounded. On February 16, the Government
Accountability Office, the investigative arm of Congress, released a report
criticizing the VA for failing to improve its PTSD services, even when
confronted with numerous reforms suggested by its own Special Committee on
PTSD. The report follows a five-month investigation by the GAO that looked at
whether the VA had implemented 24 of 37 recommendations made last year by the Special
Committee on PTSD, a group of VA doctors who report annually to the VA.

The GAO concluded
that the VA had not fully addressed any of the 24 recommendations, which run
the gamut from hiring regional PTSD coordinators, to developing credentialing
standards for PTSD clinicians, to establishing PTSD screening and referral
systems. Specifically, the GAO report found that the VA had met 14
recommendations only partially and left 10 completely unmet; nearly half of
those were longstanding since 1985. The GAO also determined that the VA had no
plans to address the majority of recommendations until at least 2007.

“This report confirms
my concerns about the VA’s capacity and ability to meet the rising demand of
veterans seeking mental-health services,” Rep. Lane Evans (D-Illinois), ranking
Democrat on the House Veterans’ Affairs Committee, said in a February 16
statement. “It is inconceivable that the VA has yet to even name a PTSD
coordinator in each of its health networks as recommended by the Special Committee.”

Evans, a Vietnam-era
veteran, asked the GAO to investigate last May after growing frustrated with
what he felt was the VA’s dawdling at improving its PTSD services.

National
mental-health organizations and veterans’ groups have long warned that such
services were being overwhelmed by an emerging population of psychologically
troubled veterans and an ever-tightening budget. In 2004, at the behest of
former VA Secretary Anthony Principi, the VA began drafting a Mental Health
Strategic Plan to reinforce PTSD programs by 2007, but at an estimated cost of
$1.65 billion not yet in the agency’s budget. Publicly, the VA worried about a
potential strain on services, but has insisted that it’s ready for the
estimated 16 to 30 percent of soldiers likely to return from Iraq and
Afghanistan with some psychological trauma.

Not surprisingly, the
VA adamantly refuted the GAO’s findings. “They’ve taken a negative stand on
what this agency does, and the report discounts all the wonderful
accomplishments we’ve made with regard to PTSD,” says Dr. Mark Shelhorse, the
VA’s acting deputy consultant for patient care services for mental health.
According to Shelhorse, seven of the recommendations the GAO categorized as
partially met have been fully satisfied, including providing PTSD screenings
for new veterans. He also says the VA allocated $15 million out of its 2006 $28
billion budget for additional PTSD and substance-abuse programs, and was
placing teams of PTSD experts in locations with a high density of veterans.

For Rep. Evans,
however, the VA’s response is part of the problem. “What troubles me most about
this latest GAO report is the VA’s hyper-sensitive posture,” Evans wrote in a
February 18 e-mail to this reporter. “VA leadership seems unwilling to accept
that the GAO has found areas where improvements are necessary.”

Cynthia Bascetta,
director of veterans’ health care issues for the GAO, says she, too, was
surprised at the VA’s reaction. The agency needs to do a better job of
prioritizing, she says, as wars in Iraq and Afghanistan have made the task of
addressing mental-health gaps more pressing.

While estimates have
varied, the VA now says 6,400 veterans from Iraq and Afghanistan have sought
help for PTSD since those wars began, but the GAO questioned whether that number
is even accurate. Regardless, the PTSD rate is expected to rise substantially
as more soldiers return home, and the GAO urged VA brass to speed all of the
recommended improvements cited in its report. The agency plans a follow-up
investigation later this year.

Because the VA
disagrees, it has 60 days to draft a response to the Senate Committee on
Homeland Security and Governmental Affairs. The GAO issued an earlier report in
September, proposing that the VA update its data-keeping methods for PTSD veterans;
the VA concurred. Says Bascetta, “The VA’s Mental Health Plan, which is still
only in draft form, is set for 2007 or later. But this looks to be a serious
problem right now.”

Dan Frosch, a former staff writer for The Santa Fe Reporter,
is a New York-based freelance writer for The Nation, In These Times, and other
publications. This article follows his “Soldier’s heart,” an
investigation into the VA’s ability to treat Iraq War vets with serious
psychological problems, which was commissioned by the Association of
Alternative Newsweeklies and appeared in City Newspaper’s January 12, 2005
edition.

This article appears in Mar 9-15, 2005.