Shereef Elnahal’s Post

Too little, too late. I used to attend presentations at our local VA on Suicide topics including efforts to address causes. I always had the same question when it came time for questions . . . . How many of the approximately 22 veterans who ended their lives each day were eligible to use the VA? All of the topic presenters just shrugged their shoulders and said that information was not available. After about a year of asking the question, I was taken aside by a VA employee I knew through my volunteer work with homeless veterans. I was told that of approximately 22, maybe 6 were eligible for care at the VA. The remainder were referred to civilian mental health resources, most of them short on space, funds, and staff. The recent legislation making mental health care more readily accessible for those veterans not qualified to use the VA but with a need for mental health evaluations has to have been an improvement . . . I hope. Unfortunately, many VA facilities are chronically short on staff since the Pandemic wound down. I have been a volunteer driver at the Tucson VA since I retired in 2014 and I can see the evidence of staff shortages both as a volunteer and as a patient.

Great program and great intention. Shereef Elnahal but would be much better if VA published guidance on how to use it for non VA connected veterans. Also have a standard that is folllowed nationally for admissions. One VA will approve clinically and then the same clinicals will be denied at another VA. Would love to be part of the solution to help VA accomplish this mission. Just need to have two parties to have a two parties to have a collaboration.

The needs analysis surrounding this entire subject relates to the psychological death spiral related to co-occurring disorders amongst veterans- acuity mixed with perpetual SUD and leading to progressive dual diagnosis’ and demise. First comes trauma in combat, and then comes substance use. Homelessness happens because they can’t keep it together because of some dereliction of duty shaming mentality-keeping the cycle of not asking for help ongoing. Then the veteran hits rock bottom. Then living under a bridge. Outreach workers find the veteran and convince them to report to the VA for SUD help. VA takes days with bureaucratic red tape to make a determination that the veteran can be put on a waitlist. Community Care contracted vendors will have beds open and ready. VA doesn’t want to privatize it. VA tells the veteran no- you can wait or go to another VA within 30 days. And on and on and on… All the while a homeless drug-addicted veteran becomes disillusioned at how slow and unaccomodating VA is. Veteran gets discouraged because he thinks he has a choice but then finds out he has no choice. Veteran gives up due to the bureaucratic process. Veteran falls through the cracks and the psychological death spiral ensues until 22 die

But sadly there is half enough mental health workforce in 2621 counties with 40% of the population and 50% of veterans. VA facilities are located in counties top and higher in workforce concentrations. CMS, Congress, states and private payers shape and maintain access deficits whereever we have concentrations of elderly, poor, and disabled (public plans) and worst employers. Will the design for veterans pay less than cost of delivery like Medicare and Medicaid in these counties or will they boost revenue by paying more than costs. Public plans need to pay their weight, not short payments. Unlike counties with concentrations of workforce, the private plans do not pay 150% of Medicare or more. They arise from the 30 weakest states and the worst employers. Even worse these counties have their better plans designed away with declines in health care, education and government jobs. No training design can overcome 1.2 trillion more CMS votes against basic health access than all HRSA spending and all GME spending.

Think about this. Young men and woman join the military with a naive understanding of what they are contracting to do. There is a couple of vague sentences that imply that when their contact is complete, the VA will be there for you, with all these benefits. The military lifestyle creates belonging. The buddy system Insolates individuals from civilian community. You complete your contract. Your contract is cancelled. Medical issues cut the conteact short. Life happens. Services are complex to navigate. Everything is done on line (they can disassemble and put a weapon back together blindfolded) but keeping up with passwords and passwords to passwords are difficult for everyone. Alcohol is encouraged and punishable. Medications are prescribed for what ails ya. Then difficult to get refilled in a medically timely manner. No place to go…. New term “unhoused”. It is still homeless. Alone. Disenfranchised. No purpose. Tragic

And yet, just this week a beloved Veteran of mine, who is part of that 50,000, lost his life to suicide. Although I appreciate the strides that the VA is making, we are still losing our loved ones. I understand that we won't be able to stop all suicide, but the barriers he faced in getting care when actively suicidal is one of my greatest sorrows. The work that is done at the VA, DoD and HHS to prevent suicide is so vitally important and I remain steadfast in my hope that fewer people will lose loved ones as we solve the crisis of access to and follow through with mental health care.

They may have received some care but the VA facilities are so overwhelmed and under staffed. This may make the government look good but still poor care in these systems. You can't send someone to a broken system and expect a positive outcome. When the suicide rate for veterans gets under 15 or even 10 then you can show progress. God bless. Do better.

They have many issues. When my father (a Korean War veteran with 100% service connected disability) was in the system before he passed, I can't even explain the issues. While the care when he was in the VA hospital was good, the "system" of the non medical people was terrible. They actually at one point asked me to commit an illegal act by opening his mail without a PoA. I'm glad they are helping our most honorable citizens. Those in the military. Many who fought in a war. We cannot do enough to help them. And their families. Military, If you need help please ask!! And that every military member seeks help ... gets the help that they need. All that they need!!! 🇺🇸❤️

I remember hearing that on average, 22 veterans used to commit suicide per day. Although the number has decreased to 17, even one life lost is too many. It's always been heartbreaking to think about. If this program/act can save just one life, it's already a success! Our veterans and their families have given so much to us all, and it's important to support them in any way we can.

Shereef Elnahal, it is heartbreaking that the need is so great, but encouraging that our truest heroes are open to seeking care, and can access it. There is much to do for everyone in healthcare and gov't to be meeting these needs across all communities and populations.