Lack of Confidentiality & the VA
Recently Purple Heart Veteran Mary Dague, a former EOD Tech that suffered extreme injuries, including a double-arm amputation, spoke out about the VA taking away her care-taker allowance. I have also heard from other Veterans who had their disability rating lowered or their care-taker allowance taken away due to the lack of confidentiality in the VA.
In my forensic psychology doctoral program, I learned about the importance of trust and confidentiality in treating mental health. In the civilian world, mental health records are some of the most protected documents there are and require a subpoena to get access to. One of the number one reasons Veterans are not seeking mental health services through the VA is lack of confidentiality. We all know that Veterans are committing suicide at disturbing rates and I believe the VA's lack of confidentiality plays a major role in this.
Another aspect of mental health is trust in your therapist. A patient should not be able to access their therapist's notes. It leads to a lack of trust which leads to an unhealthy patient/therapist relationship. I will never seek mental health treatment through the VA again. Not only did I catch both of my therapists lying to my face, but I also found out what they thought of me in my "confidential" "private" therapy sessions in my medical records. I read a transcript that described the most painful moments of my life and I felt sick when I realized that anyone that worked at the VA could read these. Yes, I understand that anyone that accesses them are flagged and must have a reason to access them, but that isn't the issue! The issue is anyone can!!!! Don't believe me, go look up your medical records on MyHealthVa.Gov. If we can't openly talk to our therapists without fear of repercussions, how will any Veteran heal?
There is an exception to the Privacy Act called the Military Command Exemption for specialized government facilities to include the military (Nelson, 2017). This allows the service member’s health records to be released without their permission to assure mission readiness (Nelson, 2017). The DoD Health Information Privacy Regulation, DoD 6025.18-R, is a guideline for the Military Command Exemption. (Nelson, 2017).
The research found 80% of individuals not seeking help did so because of a lack of confidentiality and the fear of negative reactions from their command (Ho et al., 2018). Many military members are seeking help from outside sources such as faith-based organizations and non-medical counseling services (MFLCs) (Ho et al., 2018). Even though there are services offered, there is still a fear of being found out and many service members are not getting the help they need (Ho et al., 2018). The following study was conducted to learn more about the reasons Veterans don’t seek treatment.
Cheney, Koenig, Miller, Zamora, Wright, Stanley, and Pyne (2018) conducted a mixed-methods study to discover the reasons why Veterans weren’t using mental health services through the VA. 66 Veterans that had experience with being treated for mental health at the VA participated (n=40). The majority were male (n=50), white (n=40), 24 were diagnosed with PTSD, 28 with depression, and 40 alcohol dependency. Results found five main reasons why they didn’t seek further treatment:
1. Worry about what others think: Keywords such as stigma, vulnerability, and lack of trust with the VA were brought up. The participants stated that they didn’t want to be labeled “crazy” or “in therapy”. They admitted going to therapy made them feel weak and a failure. They confessed having a lack of trust in their therapist and that the therapist could not relate to what they were going through because they had never experienced what it was like to be in the military.
2. Financial, personal, and physical obstacles: Taking off work to attend therapy created a financial burden. Many VA treatment facilities were a long distance away often making it difficult for Veterans with physical disabilities to get to and questions about taking off work created personal strains.
3. Lack of confidence in the VA: The participants stated that they had issues with long wait times, what they viewed as unqualified staff, cancelations, lack of flexibility, and lack of appointment times during off working hours.
4. Navigating VA benefits: Lack of knowing what services were available to them, difficult paperwork, and the overall feeling that the VA wanted to save money by making it more difficult to get treatment.
5. Lack of confidentiality: This was the main concern for the participants. They expressed fear of losing security clearances, losing disability or special caretaker allowance, and job loss or job rejections due to their being lack of confidentiality in the VA (Cheney et al., 2018).
Cheney, A. M., Koenig, C. J., Miller, C. J., Zamora, K., Wright, P., Stanley, R., & Pyne, J. M. (2018). Veteran-centered barriers to VA mental healthcare services use. BMC health services research, 18(1), 591.
Ho, T. E., Hesse, C. M., Osborn, M. M., Schneider, K. G., Smischney, T. M., Carlisle, B. L., & Shechter, O. G. (2018). Mental Health and Help-Seeking in the US Military: Survey and Focus Group Findings (No. PERSEREC-TR-18-10, OPA-2018-048). Defense Personnel and Security Research Center Seaside United States.
Nelson, H. A. (2017). MILITARY COMMAND EXCEPTION: BALANCING MEDICAL CONFIDENTIALITY WITH MISSION READINESS (Doctoral dissertation, AIR UNIVERSITY).