Washington Scene

“THE ROAD IS LONG WITH MANY A WINDING TURN….”

            A Critical Ongoing Challenge:  The Veterans Healthcare Policy Institute has recently released its report The Privatization Playbook: Two Decades of Denial, written by senior policy analyst/APA Fellow Russell Lemle and Suzanne Gordon.  This far-reaching investigation documents the ongoing campaign to dismantle the nation’s only public funded, fully integrated national healthcare system and redirect Veterans’ care, and the public money that pays for it, to the private healthcare industry.  The report arrives as the Department of Veterans Affairs (VA) is in the process of awarding ten-year contracts worth up to a combined $1 trillion to giant healthcare insurers.

            From Senator John McCain’s 2008 Presidential campaign through the Choice Act, MISSION Act, and stalled Take Care of America’s Veterans Act, Russell and Suzanne trace the advocacy campaigns, legislative agreements, and ideological groups driving privatization.  They show that at every step, the architects have denied what they were doing.  Fortunately, VA psychologists have been among the most consistent voices for what the evidence shows: VA care is distinctive and its quality metrics match or exceed the private sector’s.  Thus, our dedicated colleagues have been publicly raising the underlying question of whether privatization would really be in the best interests of our nation’s Veterans.

            “The trend is unmistakable,” said Russell.  “Privatization is happening in plain view, and most Veterans don’t realize that their prized system, carefully built to serve them, is already slipping away.  The stakes extend beyond Veterans’ care.  Weakening the VA also threatens its outstanding and cutting-edge medical research, healthcare provider training, and emergency preparedness that serve every American.”  The VA is the largest employer of psychologists and its visionary psychology training programs, including its unique post-doctoral initiatives, have successfully moved psychology into a modern-day, integrative team-based healthcare focus.  The report calls on Congress to protect VA’s critical role in authorizing and coordinating Veterans’ care and guarantee that private-sector care supplements – not replaces – the public system.  [ https://www.veteranspolicy.org/ ].

            A View Tempered By Experience:  Harold Koenig, former U.S. Navy Surgeon General: “I dare say, in the 1990’s, we in Navy Medicine were way ahead of just about every one else when it came to harnessing what this new technology brought us.  Then it stalled.  That’s the way new technologies operate, they grow in spurts.  Now we are on the verge of a tremendous opportunity with what may be coming to us with AI (SI to some).  This time it could be different, the game may be for all the marbles!  So here’s the opportunity to open some fresh new minds and challenge them to think about what could be.

            “Suicide in the Navy: Bring the Care to the Sailor.  A Problem That Demands Perspective.  I have been retired from the Navy for more than 28 years.  That gives me something sometimes missing from policy discussions: Perspective.  I can look back at events and decisions made during my 32 years on active duty and compare them with what is happening today.  One issue that deserves that kind of second look is suicide and mental-health in the Navy.

            “The issue returned to my attention with the recent extended deployment of the USS Abraham Lincoln Carrier Strike Group.  Normal Navy deployments last about six months, with additional time for transit before and after the assignment.  The Lincoln began its deployment in November 2025 and spent 286 days – more than nine months – at sea before making its first full port visit in Thailand in September 2026.  Nearly 5,000 sailors and Marines from the strike group participated in the Thailand visit.  The Navy described it as an opportunity for the crew to ‘rest and recharge.’  That phrase is important.

            “Today the Navy has 11 operational aircraft carriers.  A Nimitz-class carrier has more than 3,000 sailors in the ship’s company, with roughly 2,000 additional personnel in the embarked air wing and staff.  It is essentially a floating city (AirPac).  But it is a floating city that can spend months without seeing land.  During my Navy career, there were more carriers and considerably more opportunities for ships to visit ports around the world.  I remember when there were roughly two carriers in the Mediterranean Sea.  Later, that become one.  Now, there is rarely even one.  That is unfortunate.  The ‘Med’ has many excellent liberty ports.

            “Today, sustained carrier operations more often seem to mean extraordinarily long periods at sea, with fewer opportunities for crews to get off the ship.  The Navy has tried to compensate with activities such as periodic beer nights, work slowdowns and other morale-enhancing events.  Those have value.  But there is no complete substitute for getting off the ship, walking on solid ground, seeing something different and having a few hours when nobody is telling you to do your job.

            “The strain of those conditions is not theoretical.  When I became an admiral and traded caring for severely ill children for trying to ensure that sailors were well cared for, I was told that on a typical six-month deployment we could expect roughly four significant mental-health ‘casualties’ on each long deployment.  That term covered a wide range of issues.  Often, sailors had to be sent to a shore medical treatment facility for evaluation and processing, frequently leading to separation for unsuitability.

            “For the individual sailor, that was usually the beginning of a very difficult journey.  Many people who left the Navy with mental-health problems did not transition successfully into civilian life.  Some became unemployed, homeless or involved with drugs.  Many died prematurely.  I am not suggesting that every sailor with a mental-health problem should remain in uniform.  Some should not.  Commanders have a responsibility to the individual, the crew and the mission.  But I began to wonder whether we were sometimes treating the location of the problem rather than the problem itself.

            “What Telemedicine Taught Us.  That question came into sharper focus when telemedicine began to develop.  In the early 1990s, we were experimenting with the earliest forms of telemedicine.  One of our first efforts aboard ships was hardly medical at all.  It was social, but it had enormous benefits: We transmitted a photograph of a sailor’s wife and newborn child to the ship.  It was a simple thing, but it mattered.  A new father could see his wife and baby even though he might be thousands of miles away.  The effect on morale was significant, and good morale improves retention.  We soon discovered that telemedicine could do much more.  Dermatology was an obvious application.  Radiology was another major opportunity.  Suddenly, a radiologist could examine an image while the patient was still at sea, thousands of miles away.

            “One day, the Chief of Naval Operations, Admiral Mike Boorda, asked me to show him what we were doing with this ‘telemedicine thing.’  He had heard about it, but he had also heard that satellite transmission was expensive and consumed a great deal of bandwidth.  Was the technology really worth the money?  I took him to the radiology suite at Bethesda.  When we arrived, radiologists and surgeons were examining images while talking with doctors aboard a carrier at sea….  The answer was that the sailor could remain aboard.  The ship did not have to divert.  A medical evacuation was avoided.  The patient did well.  That was the moment when telemedicine became more than an interesting and expensive technology.  It became a new and better way of doing business.  The next question was obvious.  Why couldn’t we do the same thing for mental-health?

            “Bringing Psychiatric Care to the Ship.  A Navy psychiatrist approached me with exactly that idea.  She wanted to try telepsychiatry with sailors aboard an aircraft carrier.  She wanted two television cameras so she could see the sailor’s face and the sailor could see hers.  We obtained them for her.  We established a system that covered an entire six-month Mediterranean deployment.  Normally, we might expect to ‘lose’ several sailors during a deployment because of significant mental-health problems.  With these new tools, the psychiatrist treated several sailors remotely.  None had to leave the ship.  All completed the deployment.

            “From the Navy’s perspective, that represented a savings.  There were no medical evacuations, no disruptions to the ship’s manning and no loss of trained personnel.  But an even larger benefit accrued to the sailors.  They completed their deployment.  They came home with their shipmates.  They earned the right to wear the same ‘cruise jacket’ as everyone else.  That may sound trivial to someone sitting in an office ashore.  It was not trivial to a 20-year-old sailor.

            “Some went on to longer Navy careers and even retirement.  For them, having a mental-health problem did not automatically mean being removed from the team.  The experience gave them a sense of accomplishment and pride in themselves.  For some, it was the first time they had ever felt that kind of personal pride.  That experience convinced me that mental-health care at sea should be thought of differently.  The Navy began embedding clinical psychologists and other mental-health professionals aboard carriers in 1996 in response to concerns about medical evacuations, and the concept subsequently expanded to other communities.  That was progress.

            “Today, telehealth is far more sophisticated than the crude systems we used in the 1990s.  Virtual mental-health care is now an established part of military medicine, including virtual group therapy.  The technology is no longer the limiting factor.  The policy question is what we chose to do with it.

            “The Human Cost of Suicide.  During my career, I had to deal with several very serious mental-health events.  As a young general medical officer in Sasebo, Japan, I tried unsuccessfully to save a sailor who had obtained a loaded pistol and shot himself.  Later, also in Sasebo, I worked with the Catholic chaplain to talk another angry serviceman out of using weapons he had obtained against himself or others.  We were successful, but his future remains a mystery.

            “In 1987, while I was commanding officer of the Naval Medical Center, San Diego, a severely depressed sailor jumped from the third floor of a hospital building to his death.  A similar event occurred while I was Surgeon General, when a recently discharged mental-health patient dove to his death from the top floor of the hospital parking garage,  Later, the wife of one of our Bethesda physicians, who was suffering from postpartum depression, died by suicide after jumping from a bridge into the sea.  She left her baby in the care of her husband.  A final tragic case occurred after I retired, when a highly accomplished physician – the son of a close friend and neighbor and the father of three – suddenly chose to end his life.  Each of these memories has stayed with me for the rest of my life.  It is a great deal of emotional baggage to carry.  Suicide does not affect only the person who dies.  At the Pentagon, I was attending a senior Navy leadership meeting when we heard a gunshot from a nearby restroom.   A Marine guard assigned to the building had died by suicide.

            “The most memorable experience of my career occurred shortly afterward.  Admiral Boorda had been in that meeting and heard the shot.  He asked me to prepare a briefing for him on suicide in the Navy and Marine Corps.  My staff prepared a polished briefing with slides and statistics.  I arrived expecting to give him the presentation.  Instead, he dismissed his aide and told me he just wanted to talk.  We talked for approximately 45 minutes.  He was not interested in the slide deck.  He wanted to discuss suicide in general.  That seemed logical to me, considering what had recently happened to the young Marine.

            “At that time, I remember that the Navy was averaging roughly a dozen suicides a year, according to the figures available to us.  The numbers are much higher today.  Current Navy data show 68 active-component suicides in 2023, compared with 41 in 2013.  The number of people serving in the Navy today is also considerably lower than it was in the mid-1990s.  Two days after our conversation, Admiral Boorda died by suicide.  The irony remains with me.  The Navy’s senior leader had just asked me to discuss suicide prevention.  He had been concerned enough about the problem to bring me into his office for a personal conversation.  Two days later, he was dead.  I have never forgotten that.  These experiences make it impossible for me to regard suicide statistics as merely numbers on a chart.  They are people.  They are families.  They are shipmates.  They are empty chairs at dinner.  And sometimes they are preventable.

            “A Policy Choice.  Nor have I forgotten what telemedicine taught me.  We should not assume that the answer to a sailor in psychological distress is automatically to remove the sailor from the ship.  Sometimes that is necessary.  But sometimes the answer may be to bring the specialist to the sailor.  That principle should guide Navy policy as deployments grow longer and opportunities for port visits become fewer.

“The Navy and the Uniformed Services University should examine the mental-health experience of sailors on extended deployments, particularly aboard aircraft carriers.  We should study the number of mental-health encounters, suicide attempts, medical evacuations, separations and successful treatments conducted aboard ship.  We should compare ships with embedded mental-health providers and robust telemedicine capabilities with those without them.  We should also examine deployment length and opportunities for genuine rest.  A five-day port visit after hundreds of days at sea is welcome, but it also tells us something about the extraordinary demands we are placing on today’s crews.

            “The Navy’s mission come first.  I understand that, I spent 32 years in uniform.  But the mission is accomplished by people.  When we ask sailors to remain at sea for months at a time, we have an obligation to give them the medical, psychological and human support necessary to remain healthy enough to do the job.  We learned how to transmit an X-ray across an ocean.  We learned how to put a radiologist in a hospital ashore into the examination room of a ship at sea.  We learned how to treat a sailor’s skin disease from thousands of miles away.  We learned that a sailor could receive psychiatric care without leaving the ship.  The technology has only improved.  Perhaps it is time for Navy policy to catch up with what we already learned more than 30 years ago.  When the sailor cannot get to the doctor, bring the doctor to the sailor.  And when possible, do not just save the sailor’s life.  Save the sailor’s place in the crew.”  “He ain’t heavy, he’s my brother” (The Hollies. He ain’t heavy, He’s my bother).  Aloha,

Pat DeLeon, former APA President – Division 29 – October, 2026