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Veterans Administration Suicide Prevention - Trump Admin Fails

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Posted on December 18 2018

in previous entries I’ve drilled down on the most egregious and frankly offensive conduct of our current Commander in Chief. I am unapologetically hard on Trump. And sure I’ll acknowledge I could be softer or gentler but that doesn’t work when you are dealing with a semi-functioning sociopath.

 

See previous entry here and the corresponding twitter thread below, I may or may not have lost my shit. Because I have had it up to my eyeballs with Trump wrapping himself in OUR flag, using OUR Military and using OUR Veterans as a “political talking point” and granted a lot of past presidents have done this, so yes I can admit I’m being slightly hypocritical but for some reason watch Trump do it, it makes me pissed off. 

 

My former twitter account had numerous Government watchdog reports, but sadly that research is now gone. Nonetheless it is a decent time to remind you of the vulgar abuse of Veteran Affairs Secretary Shulkin, arguably this was one of the many factors that lead to Shulkin’s firing...or resignation. Yes the Trump admin argued about that because it’s a distinction that once again puts the Trump Administration’s utter incompetence back in the sunlight.

The February 2018 Veterans Affairs OIG Report. Not only did Shulkin spend nearly $4K on parking...was the parking space fit with a gold leaf car washer? Who SPENDS that much tax payer money on parking for a few days? Then VA Secretary Shulkin and his staff engaged in conduct that can only be described as subterfuge and excuse making. Again this matters because not only did he misuse tax payer funds he instructed his staff to essentially cover it up. All of which is offensive, largely impart the flagrant tawdriness and obfuscation of Agency rules and protocols.

VA’s Chief of Staff Made False Representations to a VA Ethics Official and Altered an Official Record, Resulting in VA Improperly Paying for Dr. Bari’s Air Travel

January 30, 2018 email response to the OIG’s request for an interview, Ms. Gosling identified Secretary Shulkin and his wife as “friends of mine” and stated that she offered the tickets “to thank them for their personal support to me whilst I was CEO Invictus Games Orlando.

OIG also determined that the Europe trip resulted in a misuse of VA resources. While the delegation spent nine full days in Europe, there were only three-and-a-half days of meetings in addition to a reception the evening before the start of the London Summit.

OIG was able to determine that the trip cost VA at least $122,334. However, the OIG could not be more precise because VA’s documentation was inadequate to assess the accuracy and appropriateness of the trip costs. The OIG did identify discrepancies and potential errors that warrant a closer examination by VA auditors

...the $372 in travel agency transaction fees, this change also added $1,733 to lodging costs because VA paid for an early hotel check-in for six rooms, including for Secretary Shulkin and Dr. Bari...

...Simpson’s original roundtrip economy class airfare cost $1,101. However, her ticket was modified so that there was a different connecting city. This change increased the ticket price to $4,041.

Travel records are insufficient to determine what justification, if any, was provided for this increased ticket price.

There was also an inexplicable overpayment to one of the
security personnel of $3,825 for parking and $2,718 for lodging.

 

 Veterans and Suicide...

 

There is zero question that our Veterans deserve the respect and medical care they earned. That should never be a partisan food fight, nor should our Veterans be used as some political token to score points. That said I am trying exceedingly hard to limit my cheap shots at Trump and his (arguably incompetent) Administration. The Government Accountability Office (GAO) late yesterday afternoon  released a detailed report of Veterans and the suicide rate:

 

 

Statistically speaking, nearly 20 Veterans decide to take their lives per day. To give you a better idea of what that means, approximately every 73 minutes a Veteran ends their life. Like many previous Administrations they struggle to grasp the totality of how widespread this issue is and the devastating impact to the Veteran’s family. In late 2010 then President Obama instructed his Administration to address the mental health issue and to focus on suicide prevention.

This 4 Page NIH paper will help you to understand the various interrelated issues, core competencies and deficiencies.  

 

Again every Commander in Chief has struggled to address this growing issue. Some have been more successful, while other administrations have simply dropped the ball. I know for some of you that have followed me on twitter know that periodically I track the various vacancies within the Trump Administration. The reason I occasionally highlight the staffing vacancies is, I often wonder who’s really running the various agencies and is it simply a matter of lack of nominations or Trump merely DGAF. As of late I’m in the later category that Trump DGAF and occasionally it’s a power centralization, but when it comes to our Veterans, my gloves come off.

The GAO recently concluded that the “Suicide Prevention Media Outreach Campaign”

 

VHA officials reported not having leadership available for a period of time to make decisions about the suicide prevention media outreach campaign. GAO found that VHA did not assign key leadership responsibilities or establish clear lines of reporting, and as a result, its ability to oversee the outreach campaign was hindered. Consequently, VHA may not be maximizing its reach with suicide prevention media content to veterans, especially those who are at-risk.

 

Obama Administration 2015 VA Outreach Advertising:

2015, with a suicide prevention paid media budget of more than $4 million, VHA reported that it had placed 58 advertisements online platforms of Google, Bing, and Facebook. They ran 30 billboards, 180 bus advertisements, more than 19,000 radio advertisements, 252 print advertisements, and 39 movie theatre placements in selected
cities across the United States.

Online Ads, VA produced and published 58 unique ads

Billboards, VA created and published 30 billboards

Radio Ads, the VS created and placed 19,000 ads

Trump Administration 2018 VA Suicide Prevention Advertising:

One very important datapoint is Congress made appropriations to FULLY fund the VA Suicide Prevention Media campaign, the Trump Administration-Veterans Affairs only spent 1% of the budget yielding a jaw dropping and dramatic decrease. The GAO found that because staffing for “decision makers” remained vacant for over nine months, VHA officials said they limited the paid media outreach in fiscal year 2018 to activities that were already in place, including 25 keyword search advertisements, and 20 billboards and 8 radio advertisements in
selected cities across the United States.

Online ads: VA produced 25 ads

Billboards, 20 ads placed

Radio Ads a staggering 8 ads placed, a 99.99% drop

I now refer you to pages 16 thru 18 of the GAO November 2018 report which was added as an addendum to their December 17, 2018 report.

  

Paid media. VHA had a total budget of $17.7 million for its suicide prevention and mental health media outreach for fiscal year 2018, of which $6.2 million was obligated for suicide prevention paid media. As of September 2018, VHA said it had spent $57,000 of its $6.2 million paid media budget

 

The VA acknowledged that staff shortage and contract noncompliance, simply put there was no one there to do the job...in an attempt to address a leaderless VA initiative the VA focused on areas that did not require managerial approval.

VHA officials said they did not have a kick-off meeting between VHA leadership and VHA’s contractor at the beginning of fiscal year 2018—a requirement of the contract—because there was no leadership available to participate in this meeting...officials also reported that suicide prevention leadership was not available for weekly meetings to discuss suicide prevention outreach activities, even after the suicide prevention program obtained an acting director on detail from another agency

VHA officials told us that one of the highest priorities for the suicide prevention program since the beginning of fiscal year 2018 was to establish a national strategy for preventing veteran suicides. The national strategy, issued in June 2018, includes suicide prevention outreach as one of the strategy’s 14 goals.

 

It is important to remember that the House Democrat asked for the GAO to investigate the VA and the VA Suicide Prevention Campaign. In September of 2018 Representative Waltz stared during a VA Suicide Prevention Hearing.

You can read Representative Waltz’s full testimony here.

 

It is infuriating to know that there is a possibility that Justin’s death could have been prevented. It should outrage us all that an entire health care system failed at something so serious and that it claimed to be their highest clinical priority.

VHA needs to be better than this.

However, it can only be better if we all do our jobs - the agency must continue to serve veterans AND we must continue to oversee the agency. Secretary Wilkie implying in his testimony yesterday before the Senate that our constitutional right to oversight is a burden on his ability to implement the VA Mission Act signals a dangerous misunderstanding of the role of Congress. That must be corrected immediately.

 

It is also worth noting that Representative Waltz was the orginal  author of the Clay Hunt Suicide Prevention for American Veterans Act, as such his office asked the GAO to:

GAO was asked to examine VHA's suicide prevention media outreach campaign. The GAO report examines the extent to which VHA:

1) conducts activities for its suicide prevention media outreach campaign, and

2) evaluates the effectiveness of its campaign.

GAO reviewed relevant VHA documents and data on the amount, type, and cost of suicide prevention outreach activities since fiscal year 2013. GAO also reviewed VHA's contract for developing suicide prevention outreach content and interviewed VA and VHA officials. The GAO December 17, 2018 Report States the following:

The primary focus of this campaign since 2010 has been to raise awareness of the Veterans Crisis Line (VCL), VHA's national hotline established in 2007 to provide support to veterans in emotional crisis. GAO found that VHA's suicide prevention media outreach activities declined in recent years due to leadership turnover and reorganization. For example, the amount of suicide prevention content developed by VHA's contractor for social media decreased in fiscal years 2017 and the first 10 months of 2018 after increasing in each of the 4 prior years.

VHA evaluates the effectiveness of its suicide prevention media outreach campaign by collecting data on metrics, such as the number of people that visit the VCL website. However, VHA has not established targets for the majority of these metrics. Officials said they have not established targets because, apart from one industry-wide target they use, they lack meaningful targets for evaluating the campaign. However, VHA could use information about how its metrics performed in the past to develop reasonable and meaningful targets for future performance. Without established targets for its metrics, VHA is missing an opportunity to better evaluate the effectiveness of its suicide prevention media outreach campaign.

 

The GAO’s recommendations, include:

 

Recommendations for Executive Action

  1. Recommendation: The Under Secretary for Health should establish an approach for overseeing its suicide prevention media outreach efforts that includes clear delineation of roles and responsibilities for those in leadership and contract oversight roles, including during periods of staff turnover or program changes. (Recommendation 1)

Agency Affected: Department of Veterans Affairs

Status: Open

Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

  1. Recommendation: The Under Secretary for Health should require officials within the Office of Suicide Prevention and Mental Health to establish targets for the metrics the office uses to evaluate the effectiveness of its suicide prevention media outreach campaign. (Recommendation 2)

Agency Affected: Department of Veterans Affairs

Status: Open

Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updates

 

The bottom line is if you are in crisis, or you know a veteran who is in crisis please call or visit the Veterans Affairs Suicide Prevention resourced Page, found here. It’s okay to reach out for help, Today may be extraordinarily difficult but tomorrow will always be better than today, but you need to here to experience tomorrow. 

 

If you are a Veteran in crisis — or you’re concerned about one — free, confidential support is available 24/7.

Call the Veterans Crisis Line at 1-800-273-8255 and Press 1, send a text message to 838255, or chat online.

 -Spicy Out 

 

 

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