The VA’s Unkept Promises

“So much has been promised to veterans, and so little has been delivered,” Vietnam vet John Mulligan told Congress last month. The statement points to a disillusionment among veterans reflected in recent studies that accuse the Department of Veterans Affairs of low-balling the number of homeless vets and ill-treating those suffering from Gulf War syndrome.

Reform of the giant agency has been stalled since VA Secretary Jesse Brown left office in July. President Clinton has now chosen a successor, Army Secretary Togo West, who has won praise for his response to the Army’s sexual harassment scandals. But if West is confirmed, he will face a more daunting challenge: supervising the VA’s efforts to move its patients out of big hospitals and into the agency’s new and more efficient community health care clinics.

Most VA patients--over half a million a year--are battling psychiatric and substance abuse problems. Few would disagree that the VA’s old system for treating these vets--giving them an inpatient bed for several days and then releasing them--was highly ineffective. But it’s estimated that 20% to 40% of men in homeless shelters are military veterans, and their problems are not easily cured by occasional visits to community clinics either.

One obvious problem is a lack of job skills: A recent study published in the Journal of Mental Health Administration showed that the median annual income for veterans discharged from VA inpatient psychiatry units in a 1994-95 period was $7,817, contrasted with a median income of $20,950 for non-veterans. Another is social isolation; of veterans seeking psychiatric admission at one large VA medical center, only 2.2% were married.

The VA’s next boss can solve part of the problem by changing a VA rule that prohibits veterans with substance abuse problems from being admitted into homeless programs and halfway houses. The rule makes no sense, for these are the men and women who most need such resources.

Long-term success can be achieved only if the funds that the VA has been saving with its move toward outpatient care ($18 million a year since 1995) are reinvested in more responsive programs to keep the country’s promise to those who served it.