This commentary was written by David McKay, a retired physician from Middlebury, a lifelong Vermonter, a survivor of America’s prodigious health care system, past president of the Vermont Medical Society and the Vermont Psychiatric Association, and a proud veteran of service at the Burlington Lakeside Clinic of the Department of Veterans Affairs.
Hello. My name is Dave. I have been in recovery since 2009. I was addicted. I thought I could control it. Then an old friend who had been in the program for many years invited me to a meeting.
I was skeptical at first. I had heard lots of negative things about the program, all sorts of things about how it didn’t work, horrible things about how it abandoned people who needed it in order to recover. I was skeptical, but at the invitation of an old friend, I went to my first meeting. And that was my first step on the road to recovery from Vermont’s community mental health system.
I spent many years in Vermont’s community mental health system. Hey, it’s the system, so what else have we got? I fully supported its ideals, its purpose, its goals. I did my best to make it work. But there were problems. I didn’t understand them at first. Underfunding. Unresponsiveness. Resistance to change. Incompetent management. Failure of vision and initiative. And the list goes on. Well-intentioned, but ineffective. I was in way over my head but I didn’t realize it.
At that first meeting, I listened to people in the program talk about their own struggles. They spoke frankly about disillusionment with the program, about its weaknesses and failings. But they also spoke with great respect about the good work the program had done for millions of people whose lives literally had been saved because of its existence.
I was not an easy convert. It took time to loosen the knots I had gotten myself tied up in, trying to straighten out all the twists in Vermont’s community mental health care system. I was always looking for that next fix, thinking that if I could score just once more I could turn the corner onto Easy Street.
My old friend just shook his head and tried to show me I was not on a healthy path. Vermont’s community mental health system has always limped along, shunned and even despised by many of Vermont’s other health care providers. Stigma. Disrespect. Denial. Refusal to accept and support mental health as a vital component of an integrated health system. Always the step-child, never the prodigal son.
There is a better path. It is not an easy one. In fact, it can be very muddy. Hard to keep slogging forward. Hard to see your way through the fog. You really have to work for it in order to make it work for you. One day at a time. One step at a time. Recovery is a journey, not a destination.
I came to admit that I was powerless over Vermont’s mental health system, and that I needed to turn my career over to a greater power so I could restore my life to sanity. And that is how I found the VA.
The VA health care system is admittedly flawed and imperfect. And so are we all, all of us are flawed and imperfect. But for all its faults and failings, the VA has come to terms with the essential reality that the mental and emotional well-being of military veterans is integral to caring for their overall health.
The VA places mental health caregivers inside its hospitals and outpatient clinics. They are present and available for immediate consultation with primary care staff. They participate in team meetings to suggest approaches and supportive interventions to engage veterans whose health would benefit from psychological treatment. They offer behavioral treatment for conditions such as chronic pain, substance abuse, diabetes and obesity. They provide training and support for frontline staff, from receptionists to lab techs and nurses to seasoned internists. (And those frontline staff provide training and support for all those administrators and bean counters who think they know how to make the system work.) They are on the spot in case of mental health emergencies or urgent situations. They offer immediate access to wraparound supports such as food, housing and legal services. And of course, they provide specialized mental health care for veterans struggling with mental health conditions. They work together, all under the same roof. It is a kind of “one-stop shopping” that seems disappointingly lacking elsewhere in America’s patchwork health care system.
The program is not perfect, not by any means. It has its quirks and its shortcomings. But it is always open to change and improvement. And it is dedicated to caring for the military veterans who have served our country through the worst of times. Perhaps it could serve as a model for change in a broken system ravaged by greedy drug manufacturers, profiteering insurance companies, Wall Street traders, and a plenitude of other duffers who just want to milk a buck out of the system before it goes down.
I am old and retired now. The problem of health care reform is no longer mine to solve. A new generation needs to step up and figure out what they want to do about it. I don’t need to give a damn what you people decide to do. But, strangely, I still care. And I wish you the best.
Hello. My name is Dave. I have been working on my recovery since I entered the VA program in 2009. Thank you for listening to my story.