New York Times On VA's Changing Culture

The V.A. Tries to Get Beyond Its Culture of No

By LAWRENCE DOWNES

The Veterans Affairs Department says that it is not only making strides in treating post-traumatic stress disorder and brain injuries and in preventing suicides, but is also upending its reputation for bureaucratic delays and unresponsiveness.

It is easy to be skeptical. But then there is this: a small wing of a V.A. hospital in Canandaigua, N.Y., where a staff of about 120 runs a national phone and Internet chat service for veterans in crisis. Its mission is to connect veterans to help as quickly and efficiently as possible. One online-chat counselor, Laurie Courtney, told me proudly that this was "the new V.A." She and three colleagues, in a brightly lighted room with barely enough space for their computers, chairs, coats and handbags, handle online conversations all day. Dozens of others staff the phone lines.

Their work has the relentlessness of battlefield medicine, with pleas for help coming from all sides. One Vietnam veteran has struggled with survivor's guilt for 43 years. Another has lost his job and his marriage, and agrees to try V.A.-sponsored therapy, "if it will stop these dreams." Transcripts of the chats, redacted for privacy, show counselors using gentle questions and encouragement: "How can I help you?" "It sounds like you have some good friends." "Thank you for your service." "I'm going to have someone call you right now."

The counselors aren't therapists or case managers; they just tell people where and how to get care and then follow up if they can. They can't always know if a person really is in crisis or is even a veteran. But they say that dealing with the occasional pranksters and harassers is a necessary part of a program that tries to be radically open and welcoming. That, for the V.A., would be a sea change.

There are now two million veterans of the wars in Iraq and Afghanistan, a small but growing portion of the total veteran population of 23 million. Not all saw combat; not all bear physical or psychological scars. Those who do pose a challenge this nation is only beginning to confront.

In May, a federal court blisteringly criticized the V.A. for "unchecked incompetence" in failing to provide mental health care to veterans. The judges cited backlogs of hundreds of thousands of benefits claims and the lack of suicide-prevention experts in hundreds of outpatient clinics. Veterans can wait months for treatment and years to have their disability claims processed.

The Veterans Outreach Center in Rochester, barely a half-hour from the Canandaigua V.A., is another part of the solution. The independent program offers job training, art therapy and other services, and houses troubled vets with rap sheets and addictions. Its director, James McDonough, a retired Army colonel, praises the V.A. for having skilled professionals and expert care, but says it needs to do a much better job of working with community-based programs like his to broaden and strengthen the web of care.

Stacy Fogarty, 24, runs the center's peer mentoring program. While in the Air Force, she served in a field hospital north of Baghdad. Her job was in supply, but when casualties poured in, everybody was on call. Her worst memory: bringing in one soldier on a stretcher. At first she wasn't sure what she was looking at. Then she realized: this was a man, face down, helmet straps pinching back his ears. He was a head and a torso. She stood by his bedside, curtains drawn. When the doctor pronounced the time of death, she was stricken.

Ms. Fogarty, who suffers from post-traumatic stress disorder, tinnitus and asthma, considers herself lucky: She has her life, her limbs, a job, the ability to carry on. She is also a reminder of how much more the V.A. must do to educate veterans about their benefits and available services.

A few months after she came home she decided she missed the camaraderie of the military. She Googled "volunteer," and found the outreach center and her calling. Only there did she learn from other veterans that the V.A. could help her, too.

"If I didn't stumble my way into here," she said, she wouldn't have health insurance and would still be struggling. Ms. Fogarty says that as a proud member of what she calls an overlooked minority, she is glad to be helping veterans look out for one another.

After resisting, she said, she looked up the name of the dead soldier in Iraq. He had a wife and a child. And he had a brother serving in Afghanistan. She found that soldier on Facebook, and told him she had been there when his brother died. She thinks of him every day.