Seven years ago, the U.S. Department of Veterans Affairs rejected allegations by media outlets and watchdog organizations that America faced a suicide epidemic among former military personnel.
The VA claimed just 790 veterans under department care had taken their own lives that year. Yet, by reviewing available public records since 2005, CBS News uncovered 6,256 suicides.
As VA officials publicly disputed the network's data, Dr. Ira Katz, the top mental-health officer, was sending internal e-mails titled "Not for the CBS Interview Request."
"Shh!" Katz wrote in one message. "Our suicide prevention coordinators are identifying about 1,000 suicide attempts per month among veterans we see in our medical facilities."
When the e-mails were disclosed, confirming the CBS findings, some members of Congress called for Katz's resignation or termination.
Today, Katz remains at VA headquarters as acting director of mental health operations. In a phone interview with The Arizona Republic, he and Caitlin Thompson, deputy director for suicide prevention, said veterans' mental-health care is a national success story that merits a B+ if graded on a curve against other programs. Katz said recent data indicate the suicide rate is increasing among men in the general U.S. population but is stable among VA patients. "We're doing relatively well by fighting this trend," he added.
An official Veterans Affairs statement to The Republic supplemented that point: "Getting help from VA does make a positive difference, and treatment does work. VA's basic strategy for suicide prevention requires ready access to high quality mental health ... services supplemented by programs designed to help individuals and families engage in care."
The positive evaluations come despite VA findings that the number of veteran suicides began rising in 2007. They also come amid confusion over just how many veterans are taking their own lives.
A fact sheet published by the VA's Suicide Prevention Program in 2012 reported 18 veteran suicides daily, while a "Suicide Data Report" issued by the same program in the same year put the number at 22. In 2013, the VA and Defense Department published a clinical-practice guide saying 18 to 22 die daily.
Even the higher number is suspect. Craig Northacker of Vets-Help.org said death records do not capture the real tally of veterans' suicides, which he estimates at 30 to 35 daily.
Thompson acknowledged the data dilemma: "Numbers of suicides are just very, very difficult to get, period."
But other evidence hints at the magnitude of the crisis. As of June 2012, the national VA Suicide Prevention Line was getting roughly 17,000 calls per month — up more than 17 percent from 2009. Four out of five were veterans seeking help, nearly one-third of them contemplating suicide.
The B+ grade from Katz also seems to clash with criticism from Congress, watchdog organizations and whistle-blowers who say VA mental-health programs are beleaguered by delays in care, dishonest record-keeping and staffing shortages.
Recent investigations by the VA offices of inspector general and special counsel exposed a nationwide patchwork of mismanagement and treatment breakdowns:
• In Georgia last year, the inspector general said 16 veterans who were sidetracked in the appointment system had attempted suicide while awaiting mental-health care.
• In St. Louis, Chief of Psychiatry Dr. Jose Mathews discovered that doctors on his staff were seeing just six veterans a day — spending only 3½ hours in patient contact per shift. Mathews testified in a House hearing that veterans became so frustrated with VA mental-health care they quit after one or two visits. When Mathews tried to enact reforms, he was investigated, bullied and removed from his job.
• At the VA hospital in Brockton, Mass., an Office of Special Counsel report said one patient went eight years without a psychiatric evaluation and another went seven years without a single note in his chart.
In 2012, according to an inspector general's report, seven of 10 VA mental-health workers said they were short-staffed. The problem: low pay, undesirable work conditions and a national shortage of mental-health professionals.
At the same time, veterans report abysmal satisfaction rates. When the American Legion surveyed members recently, 59 percent said they felt "no improvement" or were "feeling worse" after going to the VA for treatment of traumatic brain injuries and post-traumatic stress disorder. Thirty percent terminated treatment early.
A survey by the Iraq and Afghanistan Veterans Association released last month says more than half the respondents have a mental-health injury and 31 percent have considered taking their own lives. Nearly half said the VA is doing a "bad job" with mental-health services, and two-thirds indicated scheduling "challenges."
Such findings seemingly conflict with the VA's own survey last year, which said mental-health patients "strongly agree" they receive timely, effective and respectful care.
A March poll by the Washington Post and Kaiser Family Foundation found that more than half of post-9/11 vets know a service member or veteran who committed suicide or attempted to do so.
Suicides also have been prominent in the nearly $200 million worth of wrongful-death settlements paid by the VA during the past decade. One case documented by the Center for Investigative Reporting involved a Marine veteran who hanged himself with a garden hose after being turned away from a VA psychiatric-care clinic. Another was filed by a widow whose veteran husband shot himself after a disability claim for PTSD was turned down.
From 2005 to 2013, meanwhile, the number of veterans receiving mental-health care increased 63 percent. More than half of those who served in Iraq and Afghanistan have sought treatment.
Still, it may be difficult to blame a lack of funding for shortcomings. In 2001, the Veterans Health Administration, the VA's medical branch, spent just over $2 billion on mental-health programs. As of this year, that amount had more than tripled to $7 billion.
VA officials did not provide staffing ratios for mental-health care. But a 2014 department report says nearly 9 percent of the budgeted positions are vacant, and most hospitals would have to add even more positions to properly serve veterans.
Under heat from veterans' advocates and Congress, the VA has pressed to improve service. The department created a suicide red-flag system, financed research, opened a national crisis line and developed education programs. In 2012, President Barack Obama launched a campaign to fill the shortage of psychiatrists and social workers at VA hospitals nationwide. Since then, 2,752 mental-health workers have been added, raising the total from 18,383 to 21,135.
Amid a nationwide shortage of psychiatrists, the VA has increased pay and is offering recruitment and retention incentives.
During a July hearing of the House Committee on Veterans' Affairs, Rep. Mike Michaud, D-Maine, noted that the VA's spending on mental health has doubled since 2007. "But it's not working," he added. "We have to figure out why."
Rep. Jeff Miller, R-Fla., the committee chairman, said overall suicide rates among vets may be stable, but deaths among those veterans ages 18 to 24 skyrocketed 70 percent during the past three years.
During the July hearing, Miller interrogated Maureen McCarthy, deputy chief of patient-care services for the Veterans Health Administration, about her agency's mental-health data.
"Would you bet your life on any number that somebody (from VA) gives you is a truthful number? Because we just had a panel of witnesses who've lost their children. They lost their lives," Miller said. "Now I'm asking you, would you bet your life that the information that people are telling you is truthful?"
McCarthy responded, "Sir, I would not. I would not bet my life."
Rep. Ann Kirkpatrick, D-Ariz., anguished while addressing families of suicide victims at the hearing. "Your testimony is heartbreaking," she told them, "and I can barely hold back my tears."
As a result of the controversy and criticism, Katz said, VA administrators are reviewing psychiatric-appointment protocols, patient ratios, productivity and private-care options. Even a B+ department can improve, Katz said, and he urged disenchanted veterans to reconsider VA mental-health services.
"We hope they would give us another chance, and we hope we would rise to the occasion," he said.
Wagner also writes for The Arizona Republic.