Senate Veterans’ Affairs Chair Calls for More Mental Health Care Providers in Rural Areas

Citing ProPublica’s reporting on barriers to mental health care access for veterans, the chairman of the Senate Veterans’ Affairs Committee, Jon Tester, called on VA Secretary Denis McDonough to increase the number of providers in rural parts of the country.

Tester sent a letter to McDonough this month raising concerns about mental health staffing shortages nationwide. In it, he referenced ProPublica’s investigation into a VA clinic in Chico, California, that went five years without a full-time, on-site psychiatrist and failed to have same-day appointments for patients in crisis. Two veterans who struggled to get treatment there killed their mothers during acute mental health episodes in January 2022.

“While I understand the Chico (clinic) now has several full-time mental health care providers and offers same-day appointments, I am concerned this was not an isolated issue considering VA’s shortage of mental health care providers,” Tester wrote.

Tester asked McDonough how many VA clinics currently lack in-person mental health providers and how many are equipped to facilitate telehealth appointments. He also inquired about how the VA ensures same-day mental health visits are available at all facilities.

“I commend the Department for all of its efforts to decrease veterans’ barriers to mental health care and bolster suicide prevention efforts,” he wrote. “Nevertheless, VA must continue to lead the effort to increase the number of mental health providers and ensure those providers are in locations where veterans need them most.”

In a statement to ProPublica, VA Press Secretary Terrence Hayes said the agency appreciated Tester’s letter and would respond directly.

Hayes noted the agency has several initiatives to increase capacity for mental health care, including an expansion of virtual services and a new team focused on growing the staffing pipeline. “One of our top priorities is to provide the world-class mental health care that Veterans deserve, whenever and wherever they need it,” he said.

ProPublica’s reporting grew out of an inquiry by the VA’s inspector general into one of the two Chico cases. The inspector general concluded the clinic had mismanaged that patient’s medications and failed to give her an appointment with a prescribing provider when she showed up at the clinic in crisis.

The patient, ProPublica learned, was a 27-year-old Navy veteran named Julia Larsen who had been diagnosed with post-traumatic stress disorder and was experiencing symptoms of psychosis. When Larsen couldn’t get an appointment that day, she went home with her parents and fired a handgun inside their home. One of the bullets she discharged struck her mother in the thigh, killing her.

ProPublica’s reporting revealed that a second veteran who had been receiving mental health treatment at the clinic also shot his mother that same week. Andrew Iles had been diagnosed with schizoaffective disorder and believed his relatives were conspiring against him. The day after Larsen’s shooting, he called the Chico clinic to speak with a mental health doctor. Instead, he was put through to a pharmacist. He killed his mother the next afternoon. Both Larsen and Iles have been found not guilty by reason of insanity and committed to a state-run psychiatric hospital.

ProPublica found evidence of systemic staffing issues in the clinic’s mental health department. The VA had tried to plug the holes with telehealth providers, but several had quit or stopped seeing Chico patients. Employees begged regional leaders for more personnel and resources, they told ProPublica. One said she warned her colleagues, “We are going to kill someone.”

ProPublica also found failures in mental health care at VA clinics across the country. At least 16 veterans who received substandard care since 2019 killed either themselves or other people, a review of records revealed.

After ProPublica’s investigation was published in early January, McDonough traveled to Chico and promised to increase staffing in the clinic’s mental health unit. “We have a very fast-growing veteran population here in Chico,” he told a local reporter. “We have to make sure that we are growing commensurate with that population so that they can get the timely access to care and the timely access to benefits that they have earned.”

Tester’s letter raised continued concerns. He pointed to a December 2023 report from the VA that found the number of outpatient mental health encounters or treatment visits ballooned from 11.4 million in 2008 to 21.8 million in 2019 and that staffing shortages have persisted. Tester also noted in-person mental health services tend to be clustered at large VA medical centers in urban areas, while nearly a third of veterans enrolled in VA health care live in rural areas.

In rural regions, Tester wrote, “losing just one or two providers can have a massive impact on essential access to mental health care and once those providers are gone, it can take years to fill their vacancies and even longer to encourage those patients to return to care.”

Tester acknowledged the VA’s recent progress in improving access to mental health services. But he urged McDonough to press forward.

“More needs to be done,” he wrote, “specifically in rural areas, to keep pace with increased demand and prevent gaps in care that can have dire impacts on veterans and their families.”