Bridging the Gap

BY Kenneth Harbert and Thomas Zampieri

The United States is facing a mental health crisis affecting people of all ages — but nowhere is the need more urgent than in the veterans’ community. This raises a critical question: How can we ensure that the VA’s Veterans Health Administration, the nation’s largest integrated health care system, has the providers necessary to meet this growing demand?

The challenge is clear. In September 2024, the VHA’s Inspector General found that 66 of the VHA’s 140 healthcare centers experienced severe shortages of psychiatric providers. At the same time, a Government Accountability Office report revealed a staggering 90 percent increase in the number of veterans receiving mental health care between 2006 and 2019, with outpatient mental health care projected to rise by an additional 32 percent over the next decade.

With provider shortages already stretching the system and demand increasing, why has the VHA not expanded the role of Physician Assistants in mental health care since 2015? Could empowering these skilled professionals be a key to improving access and ensuring veterans get the care they need?

Addressing this challenge isn’t just about numbers — it’s about lives. The time to act is now.

Bryce Hodges/U.S. Marine Corps

Long wait times for mental health care are a growing challenge at civilian and VHA facilities. This issue is complicated by potential large-scale personnel cuts at the VA and a persistent shortage of mental health resources in underserved urban and rural communities. According to the American Psychiatric Association, the U.S. has a shortfall of about 13,800 psychiatrists — a gap that is expected to widen in the years ahead.

But there is a solution within reach. Physician Assistants are highly trained, ready, and eager to step in to help the VHA provide sustainable mental health care, especially in rural Community-Based Outpatient Clinics and VA Medical Centers where access is often limited.

The VHA has long been a trusted provider of care for veterans. With the enactment of the PACT Act two years ago, an additional 800,000 veterans have enrolled in VHA services for medical and mental health care. However, delivering this level of care requires a robust provider network — one that is currently stretched too thinly. There simply aren’t enough mental health professionals to effectively identify and treat those in need.

As enrollment surges, chronic staffing shortages persist, and new personnel cuts loom, the strain on mental health services at Vet Centers, VHA hospitals, and CBOCs continues to grow. Now more than ever, we must find solutions to ensure that every veteran who seeks care receives the support they deserve. Expanding the role of Physician Assistants could be a key step in bridging this gap.

Jennifer Scales/Columbia VAHCS

Studies consistently show that veterans experience higher rates of mental health disorders, such as anxiety, depression, and substance abuse, compared to the general population. Given that situation, timely and effective access to VHA mental health is not just important – it is a matter of life and death.

For more than 50 years, Physician Assistants have played a vital role in supporting the VHA’s mission. In fact, the PA profession itself was born from the dedication and service of veterans. One of the few positive outcomes of the Vietnam War was the creation of a new healthcare profession, one that started with veterans.

The PA profession was established in 1967 at Duke University Medical Center, spearheaded by Dr. Eugene Stead, who trained three Vietnam War Navy corpsmen to address a growing need for skilled healthcare providers. Around the same time, Dr. Richard Smith launched a similar program at the University of Washington Medical Center, training Vietnam War Special Forces medics and Navy corpsmen to serve in areas with limited medical resources.

These pioneering PAs went on to deliver essential care and many found lifelong careers in the VA healthcare system. Many PAs trained in VHA hospitals dedicated their professional lives to serving veterans and continued their advocacy long after retirement — and some became founding members of Vietnam Veterans of America.

As the demand for mental health care continues to grow, the question remains: Why not build upon this proven history and expand the role of PAs in mental health services today? By doing so, we can honor this legacy while ensuring that every veteran has access to the care they deserve.

Before starting an entry-level PA graduate medical education program, prospective students must have hands-on patient care experience as medics, corpsmen, nurses, mental health counselors, paramedics, EMTs, surgical technicians, medical assistants, or clinical social workers. This ensures that PA students bring real-world medical experience into their training.

PA graduate programs are rigorous, offering a master’s degree upon completion of 125 credit hours in clinical medicine, behavioral health, and professional practice. With more than 300 accredited programs nationwide, PA graduates are trained to assess, diagnose, develop and manage treatment plans, and prescribe medications.

Each program includes 2,000 hours of supervised clinical experience in family medicine, internal medicine, surgery, emergency medicine, pediatrics, behavioral and mental health, and women’s health.

Mental and behavioral health are key components of PA training, with curricula covering initial patient assessments, treatment planning, medication management, and therapeutic interventions. Students also engage in family and individual counseling, as well as patient education — further reinforcing their ability to address mental health concerns in a clinical setting.

Despite this extensive training, mental health remains an underutilized specialty for PAs. Of the nearly 170,000 nationally certified graduate PAs, fewer than 3 percent work in mental health. However, for those who wish to specialize, additional pathways exist. PAs can obtain a Certification of Additional Qualifications (CAQ) in Psychiatry, which requires 2,000 hours of clinical experience in mental health.

PAs specializing in mental health already play a critical role. They conduct initial evaluations, diagnose mental health disorders, manage medication regimens, and collaborate on psychotherapy treatments for substance use disorders, crisis intervention, suicide prevention, and risk assessment. PAs serve on Military Crisis Teams, Medical Reserve Corps, Disaster Medical Assistance Teams, Crisis Response Teams, and Disaster Response Teams. They work in clinical forensic psychology, child, adolescent, and family psychiatry, and clinical neuropsychology, providing care for veterans and active-duty military personnel experiencing anxiety, depression, PTSD, traumatic brain injuries, and other stress-related disorders.

Yet, despite their qualifications, PAs are still not recognized as mental health practitioners within the VHA system. At a time when the need for mental health services has never been greater, why is this highly trained, readily available workforce being overlooked?

Despite the growing demand for VHA mental health services, several legislative, policy-based, and cultural barriers continue to block the elevation of PAs into key mental health roles.

Take the STRONG Veterans Act of 2022, for example. That law was designed to add 250 positions for additional training in mental health disciplines. However, PAs were overlooked as potential candidates, despite their extensive medical and mental health training.

Similarly, VHA’s Mental Health Directive 1165, which defines core mental health professions in the system, fails to recognize PAs, even though 287 PAs were already working in mental health roles within VA facilities.

Perhaps even more concerning, a VHA directive prohibits PAs from screening new veterans who request or are referred for mental health services—even though this is standard practice for PAs and NPs in civilian healthcare systems. Furthermore, the VHA’s Mental Health Suicide Prevention Office has excluded PAs from its policies and directives since 2015—even though many VHA PAs held these responsibilities while serving in the military.

VA medical recruiters and the Veterans Integrated Service Network do not consider PAs for vacancies in Community-Based Outpatient Clinics—not just for mental health roles, but even for essential primary care positions.

At a time when mental health provider shortages are at crisis levels, veterans are waiting for care, and burnout among existing providers is rampant, these exclusions are not just bureaucratic oversights—they are barriers to real solutions.

We believe that Vietnam Veterans of America should strongly advocate for the inclusion of Physician Assistants in a national strategic plan for recruiting, training, and utilizing healthcare professionals in the VA.

We urge the VA Under Secretary of Health and Congress to take action by enacting legislation that prioritizes PA recruitment, expands scholarship opportunities for PAs, and ensures that PAs are included in dual-position announcements for VHA vacancies.

Additionally, VHA must expand PA clinical residencies and develop a national recruitment strategy to ensure that PAs continue to play a vital role in veteran healthcare.

Beyond recruitment, PAs must be granted parity with Nurse Practitioners— particularly in Community-Based Outpatient Clinics, VA Medical Centers, Vet Centers, and Crisis Response Teams.

Finally, Veterans Integrated Service Network managers must develop a stronger understanding of PA graduate medical education programs and ongoing professional requirements.

It’s time for the VA to break down outdated barriers, modernize its approach, and fully integrate PAs into the veteran healthcare system. The solution is here — let’s take action.

Kenneth Harbert, PhD, is Vice Chair of VVA’s PTSD and Substance Abuse Committee; Thomas Zamiperi, PhD, is Past President of the Blinded Veterans Association. Both are VVA life members.

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