26th Annual VA Psychologist Leadership Conference

Dr. Clark [Kaily], thanks for that kind introduction and, more importantly, for dedicating yourself to serving Veterans, for doing so much to help prevent Veteran suicide—our #1 clinical priority. Please tell your father how grateful we all are for his courageous service in Vietnam. I know he’s rightly proud of the work you’re doing at VA—for him and his fellow Vets.

Dr. Mike Martin [Pres., Assoc. of VA Psychology Ldrs], thanks for your leadership of the Association, and your devotion to serving Veterans at VA. Likewise, Dr. Thema Bryant [Pres., APA], Dr. Edgar Villarreal [Chair, Div. 18, VA Section] and everyone representing the Association of VA Psych Leaders, the American Psychological Association, and Division 18—thank you making this 26th Annual Leadership Conference possible, helping VA serve Veterans as well as they have served all of us.

It’s always great to see you—Steve Schwab, Joy Ilem, and Kelly Hruska.

And last, but not least, let me ask all of you who are Veterans to stand, if you’re able, and be recognized. You’re carrying-on a long tradition of Veteran psychologists choosing to serve their fellow Veterans at VA. Veterans serving Veterans—there’s nothing better.

Let me start with a quick story. Down in Louisiana, Mardi Gras had come and gone. In its wake came a deluge of 50,000 COVID cases in and around New Orleans, reportedly spread from a single carrier. At this point, April 2020, New Orleans was leading the nation with COVID infection rates, and people were afraid.

Outside the VA New Orleans screening tent, an elderly Veteran was standing in the hot sun, alone. Understandably, he wouldn’t go into the shaded open-air waiting area for fear of contracting COVID. Well, he did not escape the keen and caring eye of Dr. Ken Jones, the Chief of Psychology Services.

Doc Jones went to the Vet, helped him find shade of a nearby tree. And he listened to him. He heard his concerns, concerns about a cough, meaning that he, like hundreds of other Vets who went to the New Orleans VAMC in those early days, feared he had this mysterious and deadly new disease.

After hearing the Vet, Doc Jones soothed him, and brought the Vet’s providers to him. They wrote him a prescription. And Doc Jones went and got it filled and personally delivered it to the Vet.

But when the Vet left campus, he was still anxious … about his COVID test results. So Doc Jones called him, every day, until the results were in. He was negative. The Vet was so grateful. And he was grateful for the shade and the care and the compassion of Dr. Jones.

Through the course of the pandemic, that same sort of empathetic, compassionate care was delivered by Dr. Jones, by his team, by you and your fellow psychologists hundreds of times, thousands of times across the country. I know you’ve been in the thick of the fight from the very beginning—fighting to keep providing mental health care to the Vets you’re serving, no matter the challenges.

You’ve also been attending to your fellow employees—helping us manage the threat of burnout of our clinicians due to the range of powerful emotions associated with the biggest pandemic in at least a century, helping so many contend with the physical and mental exhaustion of fighting for Vets’ lives and bear the deep pain of unprecedented losses of both patients and loved ones.

Whatever was asked of you, you did it: testing, diagnosing, treating, and vaccinating Veterans—working wherever you were needed, from swabbing stations to ICUs. You treated stress among our nutritionists, custodians, maintenance staff, and others who’ve been risking their lives and the lives of their families to keep serving Veterans. You’ve been helping make sure Vets we care for can access care when and where they need it. And you’ve helped VA deliver more care and more benefits to more Veterans than at any other time in our nation’s history.

All of which is to say, the pandemic has proven time and again the kind of exceptional leaders you are, leaders VA and our Veterans need, right now, perhaps more than ever before to shape the future of VA psychology and, through VA’s future—because of the central role VA has played in modern psychology—the future of psychology itself.

Here’s what I mean. There was an inflection point in VA’s and America’s history nearly 80 years ago. In 1946 General Omar Bradley was leading the newly established, not yet fully staffed Veterans Administration when 16 million troops were being demobilized. There were 670,000 casualties of World War II—many on waiting lists at VA hospitals. Nearly 60% of Vets who could get a bed had serious mental health issues and needed psychological care.

And the quality of care was unacceptable. General Bradley assessed that it was—I quote—“not literally ‘medieval.’ … but it was, and always had been, mediocre.” VA was short on doctors—he estimated VA had about 30% of what was needed, and he couldn’t hire the docs he wanted because of miles of red tape. Meanwhile, the Civil Service was offering him physicians who Bradley described as “the dregs of the medical profession.”

But General Bradley had a good team, including WWII Veteran Dr. James G. Miller, Chief of the VA’s new Clinical Psychology section. And it was Dr. Miller, your forebear, who determined that to serve Veterans well, the VA needed doctoral-trained clinical psychologists—psychologists with training and experience in delivering clinical services.

So APA shaped its professional psychology accreditation program in response to Dr. Miller’s vision and Vets’ needs, changed the course of psychology in this country, stretching it beyond an academic and research discipline to a clinical, therapeutic practice. So when Veterans needed VA the most—it was a psychologist who catalyzed revolutionary change, not only for Vets, but the entire country.

And here we are today, at another historic inflection point, and America needs VA’s psychologists again. In a big way. It’s your turn.

Post-9/11 Vets are just out of 20 years of war—the most deployed force in our history, coming home with both the visible and the invisible scars of battle and gripped by moral injury reintroduced by the fall of Kabul and the resulting chaos.

This pandemic’s coming to an end, God willing—a once-in-a-century health crisis that jarred loose the health care landscape, leaving us with, according to our Surgeon General, another epidemic of loneliness and isolation, exacerbated by cynical social media and technology companies, and with too little understanding and even less available expertise to treat the resulting mental health disorders.

The country is awash in cheap and prevalent drugs, including fentanyl, increasing the cost of substance use disorder, compounding the challenges already facing too many of our Veterans and their families.

That’s the challenge. And here’s the opportunity.

We’re implementing what can be the largest expansion of Veteran health care and benefits in decades, thanks to President Biden’s new toxic exposure law—the PACT Act. It will bring millions of Vets to VA—many for the first time and, we hope, bring many back to give us another chance.

And we assess that what those heroes will need more than anything is mental health care delivered by first-rate mental health professionals. So America needs VA’s psychologists to keep providing world class care for our Vets and to take inventory of what we’ve learned these last three and a half years that’s been recorded, analyzed, and reported in your peer-reviewed papers. We need to again build the protocols and personnel, drawn from your vision, your expertise, and your experience for the future of VA psychology. I’m talking about a thoroughly Veteran-centric future, that will also serve the rest of America.

There’s no better time than right now to remember—we are better together, especially in the face of adversity and enormous challenges.

Now, we’re not starting from a dead stop, like General Bradley and Dr. Miller did. So much is happening already. You’ve given us predictive modeling for suicide prevention with REACH VET—identifying at-risk Vets so we can get them connected with the specialized care and support they need. MISSION DAYBREAK is bringing innovators to VA to develop suicide prevention solutions that answer the diverse needs of Vets. They’re looking at ways to integrate social determinants of health and social media data that may identify Vets at risk—in real time—and provide actionable insights, actionable intelligence, for suicide prevention. They’re looking at developing machine learning models that can identify never-before-known risk patterns ahead of crisis, by analyzing the data captured in digital devices of Vets after crisis.

You’re designing and fielding virtual tools to support Vets’ mental health care, apps like PTSD Coach, Mindfulness Coach, Insomnia Coach, CBT-I Coach, AIMS for Anger Management, and Beyond MST.  You’re triaging increased demand by deploying time-proven interventions like VA Peer Specialists, facilitating Vets helping Vets. You’re listening to Vets and finding new ways to respond to their needs, to meet them where they are in ways that are truly Veteran centric.

An example. At VA Ozarks up in Fayetteville, Arkansas, Dr. Jeremy Fowler and his team saw how too many Vets struggling with PTSD were engaging in traditional approaches to therapy, and about half were dropping out. Maybe it was a matter of transportation—getting to in-person sessions week after week. Maybe it was competing obligations like childcare, work, or school, and Vets are notorious for putting others first, and themselves last. Sometimes it was simply the length of the treatment or the difficult lag from the start of treatment to the arrival of some relief.

And Jeremy saw how Vets abandoning care was impacting the morale of his fellow clinicians. He talked to his clinicians—and they told him they needed more support to keep Vets coming. His clinicians talked to their Vets, and Vets told them they needed to get through effective treatment, quicker. And, then, Jeremy reached out to our National Center for PTSD and worked with Dr. Cindy Yamokoski. Together, they came up with a solution—the Accelerated PTSD program, based on work piloted at the Cleveland VA.

They took treatments that normally run three to four months and packaged them to run between one to four weeks—shaped the program around what the Vets were missing, and what the clinicians were missing. In the pilot, 80-90% of the Vets stuck with the program until graduation. And today, there are 14 Accelerated PTSD programs at VA facilities across the country.

Momentum’s growing. Vets who’ve been suffering for decades are getting access like they never have before, and learning that their PTSD is treatable. A post-9/11 Marine Corps Vet named Justin had been suffering debilitating PTSD symptoms after multiple deployments with special forces teams. After being medically discharged because of his PTSD, he had no direction, no goals. He was always filled with anxiety. He was always thinking of threats, always mentally poised for disaster to strike. He said, “I didn’t know anything other than how to prepare for combat, to go to combat, and make sure everyone’s safe.” He spent years drinking , losing himself, as he put it.

Now, routine therapy made some of the symptoms tolerable, but he felt like he’d reached a stalemate. Then he found his way to the Accelerated PTSD program in Fayetteville. It changed his life. He said, “No one’s ever made me think about things, see things differently. Dr. Fowler did.”

That’s just a single example of so many innovative movements happening right now. But it’s exactly the kind of agility and creativity we need to answer the needs of Vets today, and in the future.

Now, before we get to questions, let me ask for your help on a few things.

First, the innovations on technology are important, but I have an inkling that there will be no replacing your core expertise—your human touch with our Veterans. So we need to ensure access, and in three, key ways: crisis access, initial access, and sustained access.

Consider a Veteran with a partial ACL tear who needs physical therapy two times a week for eight weeks total. A one-time appointment and follow-up in 3 months would be insufficient. Yeah, scheduling for this type of follow-up is challenging, but when we provide initial or crisis access, without sustained access, we’re not providing quality, evidence-based care. 

Access without quality is meaningless. We must have both—access and quality to move the needle in mental health treatment. So, how can we ensure not only access initially in our system, but also sustained access to treatment that works? 

Second, we need you thinking big. And we need you to think urgently, just like in 1946. Over the course of the conference and when you get home, spend some time thinking about—and talking about—what you can do right this very moment to make a change for Veterans you and your teams are serving back home. How can you improve access? What new group treatment could you deploy? How can you help your medical colleagues with enhanced pain management that can mean a suicide averted? Think about, as Dr. Martin urges, how we can “impact the care of many, many Veterans, rather than just one Veteran at a time.”

Third, I need your help on retaining our great mental health care providers—both those who’ve been with us for decades, and those just coming on board. VHA’s hiring at a record pace, and we’re growing your mental health workforce across nearly all of the occupational series—that’s in spite of the nationwide shortages in nearly all mental health disciplines. And once we bring on great new mental health professionals, we have to retain them.

That’s where I really want to ask for your help. Doc Villarreal remembers how his colleagues have played such a meaningful role in shaping and supporting his VA career. In that spirit, as new team members come on board, put your arms around them, welcome them, teach them, train them, inspire them. Make sure they know what I know, what I have no doubt about—that they’re joining the best workforce in federal government, with the best mission of any organization in this country.

Inspire them, just like you inspire me every day.

Fourth, tomorrow’s the first day of PRIDE Month. For all of us at VA, that means celebrating more than one million lesbian, gay, and bisexual Vets and employees. I’m reminded of a Vietnam-era Vet named Matt who came out to his VA doc up in Wisconsin several years ago. The doctor smiled, gave him a big hug, and said—“At VA, Matthew, we love everybody.”

That’s important, for so many reasons. We still have a lot of work to do to better understand the needs and expectations of our LGBTQ+ Vets and employees. So I’m asking you all to really help lead that, to be the sparks that light the fires of change.

Your reach is wide … let’s make it even wider.

And, a final word. Listen, I don’t know what mental health care delivery will look like in five years, in 10 years, in 20 years. But here’s what I do know. You’re the people with vision. You’re the ones who are going to shape it. You’re the ones—and I’m speaking to our APA partners who’ve been with us for so long, as well—you’re the people who are going to transform mental health care delivery for Veterans once again.

It strikes me—after the end of the Afghan war, the longest in our country’s history, after the end of the isolation of the epidemic and the associated loneliness and fear on top of it, as we wrestle with substance use disorder and the prevalence of cheap, prevalent and deadly drugs—it strikes me that the main thing this country needs is, well, it’s you.

Everywhere I look, that’s what I see, a need for more of you to help us—not just to answer questions, but to even know what the right questions are in the first place.

I know Dr. Miller would have high expectations of you. He would be so proud of you. I know I am.

Thank you. God bless all of you, our Veterans, their families, caregivers, and survivors. And may we always give them, our very best.

The floor’s yours.