Getting treatment for post-traumatic stress disorder can be an arduous process for veterans who regularly must deal with administrative and medical delays, health care professionals say.
But those delays did not apply to Aaron Alexis, the gunman in Monday's deadly shooting spree at the Washington Navy Yard, according to the Department of Veterans Affairs.
Alexis, who reportedly had PTSD after witnessing the 9/11 terrorist attacks in New York, enrolled in the VA system one month after he left the Navy Reserve in January 2011.
But he "never sought an appointment from a mental health specialist, and had previously either canceled or failed to show up for primary care appointments and claims evaluations examinations he had scheduled at VA Medical Centers," the VA said in a statement.
Late last month, Alexis showed up a VA emergency medical center in Providence, R.I., and another in Washington, D.C., seeking medication for insomnia. After medical exams at both centers, he was given small doses of medication and told to follow up with primary care providers.
"On both occasions, Mr. Alexis was alert and oriented, and was asked by VA doctors if he was struggling with anxiety or depression, or had thoughts about harming himself or others, which he denied," the VA statement said.
Weeks earlier, Alexis had called Newport, R.I., police to a hotel where he was staying and told them that voices were speaking to him through the wall, floor and ceiling, that three people were following him and keeping him awake with microwave vibrations, and that he had left two other hotels because of that. He also denied any history of mental illness.
Jason Hansman, senior program manager for health at the Iraq and Afghanistan Veterans of America, said there is "a huge stigma around mental health. People don't want to self-identify as having an issue."
About 7 percent of people in the U.S. and 11 percent to 20 percent of veterans from Iraq and Afghanistan suffer from PTSD, health care professionals say.
Mr. Hansman said that veterans returning from war may not even recognize they have an issue, or don't know where to go for help.
Alexis, however, was never deployed to a war zone.
Of the 2.5 million troops who have deployed since 9/11, only 1.7 million are eligible for VA care, and only half of those will seek care, said J.B. Moore, military and veterans policy and support manager for the National Alliance on Mental Illness. A little more than half are diagnosed with mental health issues like PTSD and depression.
"That's not everyone who may need mental health care," Ms. Moore said. "Every step of the way you are losing people that could be getting help."
One complication in receiving care is the wait between when a veteran enrolls and the initial evaluation — which varies with how busy the VA facility is, Mr. Hansman said.
"It could happen within a couple of days, weeks or months," he said. If a mental health issue is identified, the veteran will be scheduled to meet with a therapist, which could take additional days and weeks to set up.
Getting into the system, and into a routine with a therapist and receiving consistent care takes time is the hardest part, especially for reservists in rural areas or veterans who move around, Mr. Hansman said.
"If you're waiting over two to three weeks for care that's been promised, then there's some sort of breakdown in the system," he said. "There's still this gap between what the VA provides and what is actually needed."
The VA operates 153 hospitals, 956 outpatient facilities and 232 smaller clinics nationwide.
Kristina Kaufmann, executive director of Code of Support, a military advocacy group, worries that the Navy Yard shooting will make it even harder for veterans to come forward and seek mental health care.
"These things can impede and serve as a barrier to service members who are dealing with mental health issues — just in trying to convince them to go get help and that they are nothing like this guy and they are not crazy," Ms. Kaufmann said.
"The narrative of this country is starting to fly back to what it was after Vietnam, which is 'crazy veteran,'" she said. "This guy seems to have deep psychological problems that were pre-existing. — 99.9 percent of veterans are not going around shooting people."
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