Not exactly an ad for VA PTSD treatment / suicide prevention

Government health care -- Why did you think it would be good? Because of the bang up job governments do with education?

NYT

"After the eighth suicide in the battalion, in 2013, Mr. Bojorquez decided he needed professional help and made an appointment at the veterans hospital in Phoenix.

He sat down with a therapist, a young woman. After listening for a few minutes, she told him that she knew he was hurting, but that he would just have to get over the deaths of his friends. He should treat it, he recalled her saying, “like a bad breakup with a girl.”

The comment caught him like a hook. Guys he knew had been blown to pieces and burned to death. One came home with shrapnel in his face from a friend’s skull. Now they were killing themselves at an alarming rate. And the therapist wanted him to get over it like a breakup?

Mr. Bojorquez shot out of his seat and began yelling. “What are you talking about?” he said. “This isn’t something you just get over.”

He had tried getting help at the V.A. once before, right after Mr. Markel’s funeral, and had walked out when he realized the counselor had not read his file. Now he was angry that he had returned. With each visit, it appeared to him that the professionals trained to make sense of what he was feeling understood it less than he did.

He threw a chair across the room and stomped out, vowing again never to go back to the V.A.

In recent years, suicide prevention efforts by the Department of Veterans Affairs have focused on encouraging veterans to go to its hospitals for help, but a bigger problem could be keeping them there.

In interviews, many Marines from the battalion said they received effective care at the V.A. But many others said they had quit the treatment because of what they considered long waits, ineffective therapists and doctors’ overreliance on drugs.

Six of the 13 Marines from the battalion who committed suicide had tried and then given up on V.A. treatment, discouraged by the bureaucracy and poor results, according to friends and relatives.

A 2014 study of 204,000 veterans, in The Journal of the American Psychiatric Association, found nearly two-thirds of Iraq and Afghanistan veterans stopped Veterans Affairs therapy for PTSD within a year, before completing the treatment. A smaller study from the same year found about 90 percent dropped out of therapy.

The therapies, considered by the department to be the gold standard of evidence-based treatments, rely on having patients repeatedly revisit traumatic memories — remembrances that seem to cause many to quit. Evaluations of the effectiveness of the programs often do not account for the large number of patients who find the process disturbing and drop out.

Dr. Kudler of the Department of Veterans Affairs said data showed that 28 percent of patients drop out of PTSD therapy, but that most veterans stay in treatment and report improvements.

He added that dropout is an issue in all mental health care, not just among veterans, and that the department was constantly trying to provide alternative types of therapy, like meditation."