VA hospitals: avenues of opportunity



A VA hospital is a good outlet for a psychologist’s many skills, according to William Unger, Ph.D., chief of the posttraumatic stress disorder (PTSD) department at the Providence, Rhode Island VA medical center (photo by Tom Croke)

By Phyllis Hanlon

The United States founded its first federal facility to offer medical and hospital care for disabled veterans in 1811. In 1917, the government created disability compensation, vocational rehabilitation and insurance programs for active-duty personnel and veterans. By 1930, the Veterans Administration was created, the forerunner to today's Department of Veteran Affairs (VA). As diagnoses evolve, services are expanding and the role of psychologists in veterans' hospitals has become more important in delivering quality mental health care.

According to Antonette Zeiss, Ph.D., deputy chief consultant to mental health services at the VA's Central Office and nationally-recognized lead psychologist, psychologists contribute to the development of holistic health services in a collaborative setting, providing hope for veterans of all ages and their families. "In addition to dealing with mental health problems, psychology plays an important role in behavioral medicine," she says.

David Pilkey, Ph.D., director of the substance abuse day program at the West Haven, Connecticut VA hospital, confesses that his career in the federal system "chose him." Through an internship at the Newington VA facility, he developed a solid background in alcohol and substance abuse studies and now applies his acquired skills and education to the veteran population in fulfillment of his goals to perform clinical work, conduct research into substance abuse issues and offer training.

Although the pace is hectic - the West Haven program offers more than 500 presentations annually, Pilkey emphasizes the rewards of working with the veteran population. "You can see clients rapidly improve. It's rewarding to see patients put their lives back together," he says. "With some problems, it's hard to know if [clients] are making progress. But with tox (toxicology) screens and breathalyzers, you can see improvement and get feedback from these measures. Our program does a good job of giving a good start toward recovery."

Robert Riley, Psy.D., clinical neuropsychologist at the Togus, Maine VA medical center, opted for a position with the VA system because it "fits his lifestyle." He says, "The way the VA is structured, compared to other places, there are more reasonable demands on time. That, combined with the pay and benefits, makes it a good choice."

Riley places great emphasis on the flexibility offered at a VA medical center. "It's not like managed care. There is no approval process and no fighting with HMOs. We are flexible to treat and see veterans as we find most appropriate. This makes the job more meaningful," he says.

In his role as a neuropsychologist, Riley notes that the care a veteran can receive surpasses that which a non-veteran can obtain. "If a person gets a neuropsychological evaluation done, they could pay more than $2,000 in a community hospital," he says. "In a VA hospital, depending on your service connection, these services are automatically available."

When Riley began his career at Togus in 1999, some 15,000 veterans received services from the facility. That number has risen to 35,000 in the last seven years. He points out that World War II and Vietnam veterans are growing older, bringing different health concerns to the forefront. "A large number of issues around diabetes and high blood pressure can impact mental health," he says.

Treatment for these various illnesses closely corresponds to what is used in a community or general hospital. "Some injuries are combat-related but how we treat them is the same way you'd treat the general population," Riley says.

Togus, like many other VA hospitals, offers both internships and post-doctoral fellowships. Riley says, "A VA internship is sought after as is a job at a VA hospital."

Rhode Island features one of the original posttraumatic stress disorder (PTSD) clinics, which attracted William Unger, Ph.D., to the Providence VA medical center where he serves as chief of the department. Focused on general anxiety disorders early in his career, he was awarded a research grant and began working at the Providence facility.

Unger explains that the work at the PTSD clinic involves a series of services that could include individual/couples therapy, case management, cognitive behavioral treatment, drop-in sessions or other types of interventions, designed to respond to episodes or exacerbation of symptoms. He reports that more than 35 groups meet each week, often changing or evolving to meet client needs.

According to Unger, the VA operates a national state-of-the-art technology system that prevents loss of records and important medical information and increases the level of patient care, reducing risks of inappropriate treatment. "This is a wonderful system. It's as good or superior to any system out there," he says. "The VA is leading the charge in technology. Down the line, if someone in Rhode Island goes to Florida, we can access his records. It's a seamless transition."

Unger believes the VA is a good place for psychologists to work, regardless of expertise area. "Psychologists can offer clinical, administrative, research and teaching skills. A VA hospital is a good outlet for all these skills."

For many psychologists, working with the veteran population offers a compelling reason to join the system. Terence Keane, Ph.D., professor and vice chairman of research in the Division of Psychiatry at the Boston University School of Medicine and director of the National Center for PTSD, Behavioral Science Division, has worked for the VA since 1977 and claims they offer "the best mental health services in the country." Within the system of 350 installations and approximately 25 mental health research centers nationwide, the VA covers a range of medical issues from psychology to genetic testing.

Keane compliments the VA for its advances in technology, not only in the area of medical records, but also regarding psychological testing methods. "The VA was the first to go electronic. They developed a comprehensive psychology testing lab," he says. Patients complete tests at a computer terminal and psychologists have immediate access to scores, which facilitates the development of an effective treatment plan.

Training opportunities in the VA excel as well. Keane indicates that when you don't have to "chase a buck," you have a better environment for learning. "You get to protect your time to teach and engage in supervised internships and research," he says.

VA medical centers may greet the eye as standard government-issue buildings. "However, it's what's inside that makes the quality of care so good. In this case, psychology professionals are responsible for providing topnotch healthcare," says Keane.

VA hospitals: avenues of opportunity (May 2006 Issue)

VA hospitals: avenues of opportunity
(May 2006 Issue)