This veteran’s personal experience tells us a lot about the VA’s problems

Mike Scotti served as a U.S. Marine in Afghanistan and Iraq. Since then, he’s become an outspoken advocate on veteran issues. His book, The Blue Cascade: A Memoir of Life After War, covers the all-too-common mental health issues that shadow veterans after they leave war zones. He also recently wrote a column for The New York Times, in which he discussed the ongoing Veterans Affairs scandal. I reached out to Scotti by phone to discuss these issues. This interview has been edited for length and clarity.

German Lopez: What’s been your personal experience with the VA?

Mike Scotti: When I first signed up for my VA medical care, they got my social security number wrong in the system — and that’s how they identify you. My first interaction, they got it wrong. I’ve gotten letters in the mail that I have an appointment scheduled that come after the time of the appointment. These are small things, but they’re indications of a much larger problem.

I had Vietnam veterans tell me when I first got out to stay away from the VA because it’s a disaster. They told me that if I can, I should go somewhere else. I’m hearing this firsthand from guys who have been around for a long time. That actually kept me away.

I finally did enter the VA system for general health care in Miami. Like I said, it was a mess from the beginning. But once I got in, my primary care doctor was a great guy — he’s a really great doctor.

The system is choking under its own bureaucracy. With point A being the veteran and point B being that really good doctor, mental health provider, and counselor, it’s a really long distance between point A and point B. That’s the problem.

GL: You bring up these problems, but at the same time there are surveys out there that veterans actually like the care they get at the VA. One of the things I’ve heard is that veterans might like the quality of the care they receive, but it takes too long to actually get that care. What do you make of this discrepancy?

MS: First, the surveys are from the VA. Who knows what happens there? If they can lie about one type of number, they can lie about different types of numbers.

Second, I can say that the quality of the care that I’ve received has been good. But everything else around it has been a disaster. Almost every administrative step along the way has been a disaster.

If you’ve got an infection on your foot, you need to get in there. If you have suicidal thoughts or PTSD, you need to get in there. You can’t wait three months for an appointment. It shouldn’t work that way.

Yeah, the quality — the one-on-one care I’ve received — has been good. But because everything else is so messed up, it wrecks the whole experience.

That’s especially true for mental health. You’re already raw when you go in there. You’re already committing a brave act by admitting that you need help and deciding to go the VA to get mental health treatment, and it’s not a good thing when it doesn’t come together the way it should. You can decide that day you’re going to get help, but four months from now you might say, “Forget it. I’m not going to do it.”

GL: Could you describe your experience with mental health issues at the VA?

MS: It parallels with what we’ve talked about with the quality of care. The quality of care of the providers that I’ve interacted with has been good, has been top-notch. I haven’t been through the major programs, but I have spoken with people there, and the VA has done an excellent job.

Unfortunately, it was in January when I went and signed up for an appointment. I didn’t get to see anybody until March.

GL: Are you worried that if someone with, say, suicidal thoughts isn’t treated, it could lead them to kill themselves before they get into the VA?
MS: Exactly.

Now, if you go in there and say, “I’m going to kill myself,” obviously things work differently. They have a fast track for that kind of problem. So if you say you’re going to kill yourself, that sets into motion a chain of events that are outside of everyone’s control — there are things that have to be done.

But if you go in there and say you’re having problems but you don’t say you’re going to kill yourself, you could still be thinking about it, messed up, and struggling. But if you don’t specifically tell them, no one sits you down and asks you what’s wrong. So you sign up, then you wait two months to see a primary care doctor, and then the primary care doctor or nurse says, “Oh, you’re mental health.” Then you go speak to a counselor and they make the determination.

Once you’re in the system and if you land on the right person who’s going to take the initiative, you can go that route. But, like I said before, it’s such a long distance from point A to point B — it could take months.

But, without question, the opportunity exists for someone who’s struggling to get his mental health care delayed for so long that he takes his own life.

GL: So what do you think should come out of this scandal, given your personal experience?

MS: We really need to root out any of the managers, and anyone who’s closely related to this thing needs to be fired. I know there’s some legislation that makes it easier for people to be fired. They should all be fired. People should be sent to jail if they were messing with the numbers.

Looking at the underlying problems, the way the incentives system works is obviously not working. Instead of fixing the problems, people are lazy. They don’t want to do the hard stuff and change the organization. They want to cheat, and they want to steal.

The organization needs a cultural change, which is really, really hard to do. The problem starts from the top-down. To show people they’re going to be held accountable, you need to create an organization that’s filled with integrity.

I saw some veteran groups are worried about privatization and have been going back and forth that. If there’s overflow now and some people need to go private, then absolutely send it private. But I think there’s things you can do in parallel to that to fix the systems in the VA.

Changing bureaucracy is hard, but it’s not impossible. Bureaucracies are made up of people and procedures. If you change or get rid of the people and change the procedures, you’ll change the organization.

Just because [VA Secretary Eric] Shinseki was a general, it doesn’t mean he’s a good leader. There are good and bad generals. Not every general is good. I just don’t understand why he hasn’t been fired. You can’t argue he didn’t know about it. The scheduling problems came out at least two years ago, and it’s still happening now. That means Shinseki is a completely incompetent leader. He needs to be removed.