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The President's Perspective
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Things Have Taken a Turn for the Surreal at the VA
By Stephen A. Giunta, PhD, LMHC, NCC
AMHCA President, 2014–2015

In Steven Spielberg’s film, “Saving Private Ryan,” Captain John Miller, played by Tom Hanks, when forced to deal with the extraordinary consequences of other people’s decisions, comments to his sergeant, “Things have taken a turn for the surreal.” 

When I consider the recent revelations about the healthcare problems experienced by the nation’s veterans, I am afraid that things have taken a turn for the surreal at the U.S. Department of Veterans Affairs.

The VA has recently been found to have “cooked the books” in an effort to give the impression that all is well when, in fact, 57,000 veterans were denied initial appointments for over 90 days, and some veterans have died in that process. A colleague’s son returned from Iraq with PTSD and he contacted the VA for help. His intake packet was mailed to him at his mother’s house three months after he committed suicide. 

Specific to clinical mental health counselors (CMHCs), we have been treated so poorly by the VA that I cannot help but conclude that a deliberate effort is being made by the VA to restrict CMHCs’ employment in that institution. And the VA has done so at the expense of the welfare of its clients. Collectively, it has placed a higher value on inertia, professional rivalries, and shady performance bonuses than on the needs of our country’s veterans, and it is appalling. 

How Bad Is It for CMHCs at the VA?

A 23-year-old social worker with an abbreviated graduate degree (one in which the senior year of undergraduate work is also credited toward the first year of graduate school), is more likely to get hired at the VA than a 35-year-old veteran with a degree in mental health counseling from a program accredited by CACREP, the Council for Accreditation of Counseling and Related Educational Programs. (At last count, the VA employs a behavioral health workforce of over 23,000, but fewer than 200 are clinical mental health counselors.)

No disrespect is intended toward the non-veteran social worker who is committed to working with veterans. However, practicing mental health professionals know how difficult it is to establish rapport with veterans in need of mental health services unless they are also a veteran. The VA needs to acknowledge this basic clinical reality. 

The camaraderie shared between a client and a mental health professional who is also a veteran is too valuable a resource to be dismissed. One would think that the VA would be seeking out CMHCs with military experience. Yet it would seem that being a veteran carries little weight in the Veterans Health Administration. I repeatedly hear from colleagues, many of them veterans, who face employment obstacles that are capricious at best, if not outright deliberately malicious in nature. In spite of periodically claiming that they are shorthanded and need to hire more mental health professionals, the VA now has one (1) clinical mental health counselor for every 44,000 veterans it serves. 

The social worker may have landed the VA job partly because he or she was first placed there as a graduate student completing a paid internship. CMHC graduate students are not eligible for paid internships at the VA. Further, landing an internship at the VA is ridiculously convoluted for CMHCs compared to social workers or psychologists. 

On one recent occasion—I am not making this up—a student was told that she could only be assigned to an internship slot if she first secured a willing supervisor within the VA. However, she was not allowed to secure a willing supervisor until after she was assigned an internship slot. In the eight years since Congress told the VA that it would hire CMHCs, the VA has yet to establish a formal internship process for our profession.

In the example above, the CMHC graduated from a CACREP-accredited counseling program. If the CMHC graduated from a program that was not CACREP-accredited, forget about ever holding a clinical position at the VA, let alone an unpaid internship. In fact, the VA has so twisted the recommendations of the Institute of Medicine regarding CACREP that it has managed to use it to both effectively demote what few CMHCs were already employed within the VA and simultaneously block access of recent graduates of CACREP-accredited programs.

The VA has adamantly refused to develop a grandfathering process, willfully discarding the full value of seasoned CMHCs already in the VA and needlessly limiting its access to hundreds of extraordinarily talented CMHCs who are interested in employment at the VA. While the need for national academic standards is way overdue in our profession and CACREP seems the logical choice, it is nonsensical to argue that only CACREP-educated counselors are qualified! 

TRICARE, the other major part of the military health system, used the exact same Institute of Medicine recommendation to develop a grandfathering clause to benefit veterans and their families by including CMHCs from programs that were not CACREP-accredited. 

If the VA really cares about our veterans, it will overcome its inertia, set aside professional rivalries, place an emphasis on the clinical appropriateness of veterans counseling veterans, and hire more clinical mental health counselors.

AMHCA Advocates for All Mental Health Counselors

Please know that during my year as president of AMHCA, I will work determinedly to advocate for all clinical mental health counselors. 

The AMHCA board takes to heart our association’s motto—“The only organization working exclusively for the mental health counseling profession.” 

The professional staff at AMHCA works diligently on our behalf behind the scenes and in the halls of Congress. In future articles, I will try to bring their work to light, and I will call on you to help them, because it will take all of us. 

For additional information on AMHCA’s efforts to affect public policy in the VA, visit our website.

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