VA Under Pressure to Improve Mental Health Treatment Access
Xiomara A. Sosa, XAS Founder
Yesterday, the U.S. Department of Veterans Affairs (the VA) announced that it was adding Mental Health Counselors and Marriage and Family Therapists to its workforce as part of the hiring of an additional 1,900 mental health staff nationwide that VA announced last week. Included in the announcement was this quote from VA Secretary Eric K. Shinseki, “The addition of these two mental health professions is an important part of VA’s mission to expand access to mental health services”. The American Counseling Association agrees with that statement, but it looks upon this announcement with a great deal of caution; to date, the VA has hired only a handful of LPCs. The VA’s failure to adequately provide mental health care to veterans–highlighted by a new report from the VA Inspector General’s office–was the focus of a hearing held yesterday by the Senate Committee on Veterans Affairs, and at the hearing, Senator Jerry Moran (R-KS) told the VA that among other steps, he wanted to see the VA begin hiring more licensed professional counselors.
Over six years ago, Congress passed the “Veterans Benefits, Healthcare, and Information Technology Act of 2006” (P.L. 109-461) which recognized Licensed Professional Mental Health Counselors (LPMHCs) to work and provide treatment to veterans in the VA as full-fledged mental health clinicians. Over a year and a half ago, the VA adopted an occupational standard for the hiring of LPMHCs.
From the perspective of counselors, very little has happened since the law was enacted and the standards were adopted. ACA has not seen any evidence that the VA is hiring significant numbers of LPMHCs at VA facilities. A review of the job postings on USAjobs.gov for this calendar year shows that, on average, fewer than 1 (one) LPMHC position is advertised in a given week, while dozens of clinical social workers positions are advertised. LPCs meet education, training, examination, experience, and ethical requirements on par with those of clinical social workers. Veterans clearly need better access to mental health treatment–as shown by the recent report by the VA Office of the Inspector General on waiting times for initial mental health evaluations–and there are thousands upon thousands of fully-licensed counselors ready and willing to help provide urgently needed care. Many of these counselors are veterans themselves, and yet they cannot find work with the VA providing services to their fellow veterans.
The VA’s recent statement regarding the hiring of counselors gives us hope. However, other statements by the VA made just last week–indicating that they do not see a “national need” to establish traineeship positions for LPMCs, and implying that they do not consider LPMHCs to be mental health clinicians–give cause for skepticism. Ultimately, actions speak louder than words. ACA will continue working with Congress, other concerned organizations, and veterans service organizations to ensure that the VA finally begins recognizing the counseling profession.
ACA is continuing to collect anecdotal evidence of counselors’ experience in attempting to find mental health clinician positions at VA facilities. Please share any experiences you have on this issue with Art Terrazas of ACA’s public policy staff, at email@example.com.
You can read the VA’s press release by clicking here.
Mental Health Issues Among Gay, Lesbian, Bisexual, Transgender People
Xiomara A. Sosa, XAS Founder
According to the National Institute on Mental Health, an estimated 26% of adults 18 and older, or 1 in 4 Americans, experience a mental health issue in a given year.1 Just like everyone else, gay, lesbian, bisexual, and transgender (GLBT) people also experience mental health issue.
First and foremost, however, we must remember that being gay, lesbian, bisexual, or transgender is not a mental illnss in and of itself. Just because someone is GLBT doesn’t automatically mean that they will experience a mental illness. According to the American Psychological Association: “Homosexuality per se implies no impairment in judgment, stability, reliability, or general social and vocational capabilities. Further, the American Psychological Association urges all mental health professionals to take the lead in removing the stigma of mental illness that has long been associated with homosexual orientations.” 2 However, GLBT people may face unique risks to their mental health and well-being, which mental health providers should be aware of.
Most research suggests that GLBT people are likely to be at higher risk for depression, anxiety, and substance use disorders.3-5 One study found that GLB groups are about two-and-one-half times more likely than heterosexual men and women to have had a mental health disorder, such as those related to mood, anxiety, or substance use, in their lifetime.4 In a national study comparing GLB and heterosexual groups, researchers found that gay and bisexual men were more likely to report major depression and panic disorder in the previous twelve month period. Lesbian and bisexual women were more than three times as likely to have experienced generalized anxiety disorder.5
The reason for these disparities is most likely related to the societal stigma and resulting prejudice and discrimination that GLBT face on a regular basis, from society at large, but also from family members, peers, co-workers and classmates.
In terms of more serious mental illnesses, such as those that are long-term and require hospitalization or in-patient care, unfortunately we don’t know very much. However, of the approximately 18 million people with serious mental illness, a reasonable estimate suggests that about 720,000 are gay, lesbian, bisexual, or transgender.6
In one of the few studies of serious or major mental illness among GLBT people, researchers found that LGB men were less likely to report psychotic disorders, such as schizophrenia, but more likely to report mood disorders, such as depression and bi-polar disorders. They found no differences between GLBT and heterosexual women.7
A note on terminology: The term “GLBT” is commonly used as shorthand for the gay, lesbian, bisexual, and transgender community. It is important to note that while these groups may share some similarities, they are by no means identical in terms of their mental health issues, concerns, or needs.While the terms lesbian, gay, and bisexual (and heterosexual) refer to someone’s sexual orientation, transgender is a term related to gender identity, or someone’s sense of being a man or woman, boy or girl. Transgender people are heterosexual, gay, lesbian, and bisexual. The term gay typically refers to a man who is romantically and emotionally attracted to other men. Lesbian (or gay woman) refers to a woman who is romantically and emotionally attracted to other women. Bisexual refers to someone who is romantically and emotionally attracted to men and women. Being bisexual does not necessarily mean someone is involved in multiple relationships at once. Some men and women may engage in same-sex behavior yet still identify as heterosexual, and some lesbian or gay people may have sexual relationships with people of the other sex. It is important not to make assumptions or judge people when it comes to sexual orientation and gender identity. Finally, GLBT people are just as diverse as everyone else! We are old, young, rich, poor, parents, children, friends, co-workers, Latino, African American, and on and on. Just like people with mental illness, GLBT people are everywhere and in every community!
by Wendy B. Bostwick, PhD, MPH