Say never to the ‘Never Again Act’

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​In a very well-intentioned but misguided attempt to serve the nation’s veterans, Rep. Dave Loebsack (D-Iowa) has introduced a bill called the Never Again Act that could seriously compromise the health of the veterans he is trying to protect. Loebsack’s bill, H.R. 6108 would allow any veteran who asks for it to be automatically admitted to an inpatient psychiatric unit at a Veterans Health Administration Hospital, even if clinicians determine that the admission is unwarranted. If VHA inpatient psych beds are full, veterans would be admitted to a private or public sector psychiatric hospital, with the VHA paying the bill.

​The bill was prompted by the tragic death of veteran Sergeant Brandon Ketchum who shot himself after he reportedly asked to be admitted to a psychiatric unit at the Iowa City VA Medical Center. Although the details surrounding Ketchum’s case are not yet certain, what should crystal clear to legislators in Washington is that The Never Again Act, like the Veterans Choice Act that preceded it, is a poorly thought out solution to a very complex problem.

​{mosads}Allowing veterans to determine whether they are hospitalized is not the answer to this vexing problem. Our entire medical system depends on the idea that educated and skilled clinicians evaluate patients and determine what is safe and needed for their care. Encouraging and supporting veterans to seek care when they are suicidal is very important. Collaborative decision-making should be (and, at the VHA, typically is) the norm. The first choice should always be to treat. But to allow patients the prerogative to overrule clinicians and have themselves admitted would set a precedent that would upend our entire system of medical care.

​Under the new model of care proposed by the Never Again Act, veterans who most need inpatient psychiatric services might be the last to get them. That’s because veterans who want a bed would only have to claim that they are suicidal to have the right to be admitted. For example, savvy homeless veterans who understandably want a bed for the night could say they are suicidal and be admitted. If this happened too often it would leave no beds for truly suicidal veterans in need of hospitalization.

​The proposed act also fails to consider the acute shortage of inpatient psychiatric hospital beds in both the private and public sector. Over the last half century, America has had fewer and fewer inpatient psychiatric beds. According to a report by the Treatment Advocacy Center, “between 2005 and 2010 state psychiatric beds decreased by 14%, with per capita state psychiatric bed population plunging to 1850 levels.” The Organization of Economic Cooperation and Development (OECD) reports that, among the 39 OECD countries, the U.S. is one of the three lowest ranking when it comes to the number of psychiatric hospital beds per 1,000 population. Without allocating huge sums of money to remedy a serious social problem, this proposed legislation would channel veterans into a system that does not have the capacity to serve their needs.

This legislation also threatens to add unacceptable financial strain to the VHA healthcare system. This bill comes with no additional funding to help the VHA pay for the most costly form of mental health treatment. Without that funding, the VHA would be saddled with enormous costs for expensive, and sometimes unnecessary, hospitalization both inside the VHA and in the private or public sector.  

The Association of VA Psychologist Leaders has proposed alternative remedies to address the kinds of problems that may have led to Sergeant Ketchum’s death. These include increasing inpatient psychiatric care capacity, increasing what are known as step-down psychiatric programs for veterans who are in trouble but don’t require hospitalization and promoting programs to counsel veterans in crisis about temporarily storing their firearms more safely. If Congress really wants to protect the nation’s veterans, it’s time to stop legislating by anecdote and consider workable remedies to the veteran suicide problem.

Suzanne Gordon is a healthcare journalist who is writing a book on the VA healthcare system.

The views expressed by authors are their own and not the views of The Hill.


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