Iowa City VA works to expand mental health services and close gaps | Lee-fil

Tom Barton Gazette Des Moines Office

IOWA CITY — Six years after the suicide of a Davenport veteran sparked national attention and calls from members of Congress for an investigation after he was denied inpatient psychiatric care, the IOWA Medical Center Iowa City Veterans Administration is planning a major expansion.

“Over the past few years, mental health – both military and civilian – has been recognized as a gap in our medical treatment of individuals, whether veterans or civilians,” said Heath Streck, associate director of operations, following a 9/11 flag-raising ceremony Friday at the Iowa City VA Health Care System.

Streck, however, pointed out that several mental health initiatives and funding recently approved by Congress will “facilitate improved infrastructure” and the hiring of additional mental health professionals and social workers “to help deal with workload and increased needs.

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President Joe Biden in June signed Sgt. Ketchum Rural Veterans Mental Health Act. Legislation was named for Sgt. Brandon Ketchum.

The 33-year-old served in Iraq and Afghanistan and battled post-traumatic stress disorder and substance abuse after serving in the US Marines and Iowa National Guard. He died by suicide in 2016 after being denied inpatient psychiatric care at the Iowa City Veterans Administration Medical Center.

The new law, supported by the Iowa congressional delegation, will establish three new Department of Veterans Affairs (VA) Rural Access Network for Growth (RANGE) Program Centers, which provide a small team of specialists to meet the needs of rural veterans with serious mental disorders. health and daily life problems.

It also demands that the Government Accountability Office conduct a study and report on whether the VA has sufficient resources to serve rural veterans who need more intensive mental health care than traditional outpatient therapy.

The VA’s Office of Inspector General concluded in a report that while VA staff were not directly responsible for how Ketchum was treated by hospital staff, the system could be improved.

“The psychiatrist’s decision not to admit the patient was in practice acceptable based on the information available to him at the time,” the report said. “However, had the admitting psychiatrist been aware of the extent of the patient’s psychosocial struggles… the psychiatrist might have decided to admit the patient. Furthermore, the psychiatrist made a good faith effort to re-engage the patient after he abruptly left the session.

Streck and Jamie Johnson, public affairs manager, said the Iowa City-based VA health system is developing a medical-psychological unit and plans to develop a community living center in addition to a treatment program. residential rehabilitation to fill gaps and meet demand .

The VA health care system in Iowa City serves veterans and their families in eastern Iowa and western Illinois. About 35-40% are enrolled in the VA and receive treatment.

And demand for inpatient mental health care is expected to grow 6.2% by fiscal year 2029, according to a VA Market Recommendation Report for Eastern Iowa.

Long-term care demand is expected to increase by 64.9% by FY2029, the report said.

Johnson said the demand is primarily driven by the health system’s vastly aging patient population, which lives primarily in rural areas.

“There’s a huge number of veterans out there who just aren’t looking for the services that we would really like to have to come see us,” he said. “There are things we are doing to improve services, or expand services and offerings, to veterans who might fall into this category.”

The Biden administration announced plans in March to reposition the nation’s veterans’ health care system to conform to emerging patient needs in the coming years, which includes recommendations to build a new rehabilitation and residential treatment program. of 30 beds to provide mental health services and a partnership to expand long-term care services in a new community living centre.

Johnson, the public affairs officer for Iowa City VA, said both projects were planned before the report was released. He also noted that the recommendations still need to be approved by Congress and Biden early next year.

The VA will likely need to identify a new site to build a stand-alone VA nursing home for dementia and post-surgical care, as its Iowa City campus is small and landlocked, with a highway on one side and the campus in the University of Iowa on the other.

If the proposal is approved, Johnson said he expects the VA to seek to acquire land or partner with another organization in 2024 to lease a site to expand long-term care services.

“It’s in the preliminary stages, and it’s going to be a bit further out,” Johnson said.

Residential rehabilitation treatment program

Currently, Iowa City VA patients must travel to St. Cloud, Minnesota, or Des Moines to receive treatment under a rehabilitation and treatment program, which sometimes prevents veterans from engaging in hospital-based treatment programs, due to distance, transportation requirements and separation from family and local support networks, Johnson said.

“We will be able to offer extended residential treatment locally without having to transport our patients to other VAs,” he said. “Programming is group-based and aims to help patients manage chronic conditions, including depression (post-traumatic stress disorder), substance use disorders, and other such conditions. Often, patients need weeks or even months to regain function and be able to recover as best they can. So having a PRTR here will allow us to provide that longer term care to our acute care unit.

Hospital Medical Psychiatry Unit

While the Iowa City VA health care system already has an inpatient mental health unit, its new medical-psychological unit will add 10 beds for veterans who have an acute medical condition combined with mental health issues. underlying mental health.

Johnson said a new inpatient unit — which would be housed in converted administrative offices at the VA hospital — is already being designed and expects it to be ready for use in 2024.

It would only be the second such unit in the VA health care system nationwide, he said.

“Staff would be specially trained to treat combination illnesses, such as substance abuse, depression and PTSD, and would serve as a training site for the University of Iowa’s internal medicine and psychiatry program, where the physician resident will be trained in both specialties,” Johnson said. “Our population of veterans is aging, and that aging population also suffers from diseases associated with aging, such as mood disorders (and) dementia – things that can lead to hospitalization.”

He noted that many area hospitals have closed or reduced enumeration of their inpatient psychiatry units, resulting in more veterans seeking care within the VA due to a shortage of beds.

“These things will help us close those gaps for veterans,” Johnson said.

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