Community Mental Health Summit at the Manhattan VAMC

Community Mental Health Summit at the Manhattan VAMC

On Monday, September 21, the Manhattan VA Medical Center held its annual Community Mental Health Summit, where VA administrators sought to improve understanding and communication between the VA and service providers and veterans within the community. The event was held in Atrium A (the main conference center), and was well-attended by a large audience made up mostly of service providers from non-VA programs and nonprofits in the area. The program as a whole was informative and interactive, but left us with many questions about how much community input would go toward actual changes at the Manhattan VAMC, or whether there will be follow-up with community members about what was discussed.

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John Tatarakis introducing the Mental Health Summit

The event was hosted by Manhattan VAMC and co-sponsored by the Veterans Mental Health Coalition of NYC and the National Alliance on Mental Illness of NYC, both of which publicized the event broadly within the community of mental health service providers for veterans in the NYC area. We are grateful to VMHC-NYC and NAMI-NYC for letting us know about this so we could publicize it to the community members we reach.

VA Medical Centers are required to hold an annual Community Mental Health Summit, and it provides VAMCs with an important forum to be able to communicate its programs and goals to community members, while hearing back from the community on how it can improve. This is definitely a good thing. But it's been uncertain how much community input from these Summits over the last few years has resulted in any changes at the Manhattan VAMC or elsewhere. And community members are also left wondering how service providers or even veteran patients can provide feedback that will be heard and acted upon during the course of a year--and not only related to mental health.

VA staff explained the Veterans Choice Program that was enacted in 2014 as part of VA reforms passed in Washington, and veterans are eligible to use this program to be seen by non-VA providers if they reside more than 40 miles of driving distance away from their nearest VAMC, or would be excessively burdened by the travel distance, or if the wait time for an appointment exceeds 30 days, or if they meet other eligibility criteria. This was helpful information since this is a new program that has had even more recent modifications made to it.

VA staff also explained the National Resource Directory, which is a national directory operated by the VA and Department of Defense that allows users to enter a locality (by zip code, town/city, or state) and keyword to search for a broad span of resources in a specific area. It's a fantastic tool that more people need to know about, and resources can be rated with either a thumbs-up or thumbs-down. But if one looks for local NYC resources--many organizations we're familiar with in the community aren't listed, and very few resources have any thumbs-up or thumbs-down ratings. We might assume this is because the directory simply isn't as widely used as it could be, and organizations aren't being suggested as resources to be included in the directory. It will take the community as much as the VA to change this and utilize this tremendous resource to its full potential.

Most of the audience was aware that September is Suicide Prevention Month, and that the VA in particular has made an important national effort to publicize the Veterans Crisis Line (1-800-273-8255, veterans press 1) with the very moving new "Power of 1" video campaign that launched this month. Suicide prevention is a top-priority issue especially for the veterans we've surveyed and interacted with, as well as the many family members, friends, and service providers who have lost veterans from our community to suicide. Amid what was otherwise a very informative Summit, and given the national visibility of the VA's suicide prevention campaign--it was surprising to us that the Manhattan VAMC's Suicide Prevention Coordinator introduced her talk at the Summit by saying she'd just come back from a week and a half of vacation (during Suicide Prevention Month) and was unprepared to speak to the community. She stated that of the estimated 22 (or likely more) veterans who commit suicide each day nationally--an estimated 5 of them are actually receiving care from the VA. And she described non-serious calls referred to her from the Veterans Crisis Line--all of which together was disconcerting to those of us hoping to hear about more robust efforts to combat veteran suicide.

This isn't to undermine the vital work of so many great staff members who work at the Manhattan VAMC and other facilities across the NY Metro area--but rather to inform the community of what actually took place at the Summit, and to reflect that we as a community are looking for more from our local VA facilities--especially when it comes to veteran suicide. Everyone in attendance was handed a cloth bag full of Veterans Crisis Line brochures, folders, coasters, wallet cards, and dog tags, and we heard about their outreach to veterans at local job fairs, colleges, and other community events--where they hand out these promotional products. What we didn't get were details on how the VA--or the Manhattan VAMC in particular--is working to reach the 4 out of 5 veterans committing suicide each day who either can't or won't seek out help from the VA. We did hear about the "high risk" list that the Manhattan VAMC has--about 30 to 40 individuals at any given time, the Coordinator said--who have attempted or threatened suicide in recent months and who are sent home with "safe discharge" plans, a regimen for treatment, and are called periodically. But we did not hear on how the VA or the Manhattan VAMC in particular are working to eliminate veteran suicide for the veterans who are seeking help from the VA (around one in five who are still committing suicide each day).

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Promotion is good--but do coasters save lives?

In the break-out sessions, local service providers discussed the many veterans they see who are turned away from VA care because of discharge status or other failures to meet eligibility requirements--and the Manhattan VAMC's Suicide Prevention Coordinator did discuss that she fielded cases (referrals from the Veteran Crisis Line or other cases) that she had to turn away for treatment due to ineligibility. And some VA staff members in the break-outs showed a lack of awareness of local resources such as NYCServes and the new Veteran Benefits Counselors at the Mayor's Office of Veterans Affairs to point veterans to state, city, or nonprofit resources that can serve and provide effective treatment for these veterans.

There was great crosstalk between service providers, and between community members and VA staff at this event. John Tatarakis was the key host of the event, and showed how seriously he takes the mission of the Community Mental Health Summit by being very responsive to questions, and by ensuring that it was a highly interactive and productive event. Service providers from the community stepped up and co-led discussions with VA staff, and this was great to see also. We highly recommend that community members make every effort to attend and take a greater role in these Summits at VAMCs across the area each year. But we also hope to see more detail, more follow-up, and better local-level integration and referrals to local resources for veterans--especially for veterans who come to the VA for help but do not meet eligibility requirements.

A new startup that the NYC Veterans Alliance is working with that will provide veterans and community members an opportunity to provide feedback on care at VAMCs, as well as other service providers and veteran organizations, is called Pathfinder. This online evaluation and feedback tool will launch soon, and we will promote this to our members and those we reach in the NYC veterans community. In the meantime, Pathfinder asks for your feedback on your experiences with veteran services and organizations to help them develop and finalize the tool they are launching. More on this soon.

Please leave a comment below on the Summit if you attended, or if you have specific feedback for Manhattan VAMC mental health staff. We will ensure that your comments are seen by Manhattan VAMC staff. Please keep feedback professional and constructive, and respectful of the many dedicated people who work to serve veterans every day.

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  • commented 2015-10-01 23:47:08 -0400
    I haven’t served in the military and I have no background in psychology or mental health issues. Big disclaimer that I know there’s more to mental health than the risk of suicide, by my personal experience and bias will But my brother Mike served in the Marine Corps and we lost him to PTSD-related suicide on October 6, 2010. One of Mike’s best friends from his time in the Marines completed suicide on November 13, 2012; what would have been my brother’s 30th birthday. A friend’s brother completed suicide on September 30, 2013. I know of others with whom my brother served that have attempted. These are my “credentials.” I wish I didn’t have them. I mention all of this because the root of the problem, the things that drove them to the point of suicide, were all different. This makes the problem increasingly difficult to solve.

    Yes, we need more from the VA. We can’t have people waiting hours, days, weeks or months for any kind of appointments, mental health-related or otherwise. Mike used the VA system in Massachusetts and would sit in the lobby for hours until he was seen by someone. They should never be told to “get over it” and they should never be turned in to shadows of themselves through over-medication. These are fundamental issues that should be addressed immediately.

    We also need better collaboration between service organizations and health providers, so veterans looking for help with any medical issue, but particularly mental health, don’t have to retell their stories to new face after new face. There must be HIPAA-friendly ways to network and share information so the right people can be brought in at the right time.

    But to echo some of the other posts on this chain: what about the veterans that aren’t asking for help? How are the VA and other service organizations taking meaningful, impactful steps to reduce stigma associated with seeking help and support for their mental health? These are proud men and women who have been trained to support each other, sometimes at their own expense. How will the VA and others get them to see that they need to focus on themselves, instead of the team? How do you get them to see that they need help? That they can’t white-knuckle their way through it this time? What steps are being taken to get them to take that first step? To make that phone call? How do you get someone that has been repeatedly told they are strong, the best, the elite, to admit that they might need help to figure out what’s going on in their own head? How will we educate family members on recognizing signs that their loved one needs help? It’s not coasters. It’s not bottle openers.

    Additionally, what is the VA doing to better identify those within the system that are doing well but may still be at risk for suicide? Mike was seeing a VA therapist and that same therapist told us at his wake that she was shocked; that he had been doing so well. Many in the recent NYT article on the 2/7 were also in some way involved with the VA. How will the VA and other organizations better identify “at risk” veterans? How is the VA involving the families of those they’re treating, to potentially get another POV on what they’re hearing directly from the veteran? We heard so many times from his Marine friends that Mike had been the rock for others. That he was the one everyone else turned to. That he was the one they weren’t worried about. How could my family and I recognized signs that our loved one needed more help than what he had been receiving?

    Bottom line: if we’re only trying to help people once they’ve self-selected in to the broken system, we’re starting much too far down the path. We have to get to the root of the issue. I don’t have the answers and I’m putting a lot of responsibility on the VA and other health care providers here, but they’re the “experts.” I do believe that they shoulder a lot of responsibility here.

    Lastly, I know that there are many great people at the VA, in NYC and across the country, that are working tirelessly to help the veterans in their care. To help those within the system that are trying to help, family members should do their own research, ask their own questions and reach out to available resources to find ways to make their own impact on their veteran’s health and well being.
  • commented 2015-09-28 23:34:37 -0400
    I’ve always found these Summits to be informational, but not application-able. I must admit, I did not attend this one. But I have attended several in the past. There tends to be great dialogue and an overview of what is needed, but simultaneously an overall lack of ACTION. This is certainly not a statement about the Manhattan VA in particular, or any of the affiliate agencies involved in this Mental Health Summit. It is more of a testament to the epidemic we are in with regards to veteran service deficits in general. Yes, homelessness and suicide need addressing. I’d love to see NYC mental health agendas go directly toward backing these two issues by way of: increased funding, re-structured systems (housing and healthcare accessibility), and measurable accountability of agencies already doing the work. The content of this summit does sound on target and well positioned. I’d just like to see more actionable goals come out of these. The Veterans Choice Program directly addresses the ‘accessibility to healthcare’ issue, but I would like to see the parameters modified, in order to open doors to more diverse treatment options, not only based on geographic or time constraint criteria. There is no shortage of “need” out there. And judging from the statistics, there are needs that are clearly not being met. We all need to do a better job. And there is no one agency or summit or deficit to point the finger at. This lack of culpability is actually what drives the cycle we are in. The National Resource Directory also seems like a great tool. I would like to see data over the next few months, publicly outlining how it is being used, and what are commonly searched areas per region. Perhaps with tools like this, we can better reach, and address the growing needs of this population. What we need is more focused attention, accountability, data collection, and policy change, in order to determine where the gaps are falling and how to address them proactively. I see the NYC Veterans Alliance as a step in this direction.
  • commented 2015-09-28 18:40:44 -0400
    Really good post. The Veteran’s Choice program and the National Resource Directory both sound like they have the potential to help those who seek help. The tougher question is how to reach those who won’t seek. Not seeking help is a SYMPTOM of suicidal behavior. If we want change, we need to reach those who have fallen away, who are so hopeless that they lack the energy to call on us. We need to call on them, loudly, forcefuly, unapolegetically.
    Lisa DelliCarpini, Ph.D.
  • commented 2015-09-26 23:11:17 -0400
    “But we did not hear on how the VA or the Manhattan VAMC in particular are working to eliminate veteran suicide for the veterans who ARE seeking help from the VA (around one in five who are still committing suicide each day).”

    I think this is key— how is the VA to measure its own success when discussing the issue at large of veteran suicide but then only taking ownership of a smaller percentage of the problem? It feels irresponsible to narrow the scope of the issue, despite good intentions to frame what successes the VA has had. When 100% of those being treated are not taking their lives, however, then that is a step towards some success. In my work as a social worker with NYC adults in the mental health system, I’ve found that the Columbia Suicide Severity Rating Scale (C-SSRS) has strong fidelity in measuring suicidality and informing clinicians to provide early intervention to folks at risk. Fellow veterans and civilians – many of whom appear at these annual forums – can be taught to implement this model. We owe strong solutions such as this to veterans in crisis.
  • commented 2015-09-26 20:03:19 -0400
    I use the VA Healthcare System and overall have been satisfied with it, however I have experienced numerous ways in which the experience could be improved. The Summit showed some potential for making some improvements in a very critical area for our veterans, and I hope that the Summit coordinators will provide thorough and actionable follow-up. There is a community outside of the VA that showed a strong willingness to partner with the VA and work toward solutions. I hope that the chance to actually do that will come. Let’s not wait another year for any follow-up from Monday’s event.
  • commented 2015-09-26 15:28:02 -0400
    I did not attend this summit but I attended several others. I have not utilized the VA Healthcare System since 1978 and will never use it since I have other choices – but that is personal decision and I am not commenting to bash the VA Healthcare System – we all know its egregious failures of leadership.

    My comments are on Veterans suicides:

    1. While the #22 has been a rallying cry it is so totally misleading that it actually impedes understanding and therefore impedes effective interventions.

    2. The recent disclosure that 13 young Marines from the same unit (2/7) between the ages of 21 and 29 with none at a rank higher than E-5 took their own lives is worthy of in depth study – this tragedy is almost incomprehensible from many viewpoints and may be quite revealing.

    3. Each Veteran suicide is unique but each has a degree of hopelessness – interventions must be aimed at the sources of hopelessness – not simply at “mental health.”