Deep cutbacks and restructuring at the VA are diminishing care

A worsening provider shortage and efforts to outsource care at the U.S. Department of Veterans Affairs (VA) are undermining the agency’s ability to provide quality health care and mental health care to more than 9 million veterans across the country.

Funding changes are exacerbating an existing provider shortage and putting training and research programs at risk. Meanwhile, care that was long delivered by specially trained, culturally competent VA psychologists is increasingly outsourced to community providers who are not required to be trained in military culture, suicide prevention, lethal means safety, or combat-related trauma.

The VA was established to ensure that those who fight to protect the nation receive low- to no-cost care of the highest quality, long considered a fundamental responsibility of American society, said Joe Plenzler, a U.S. Marine Corps veteran who served as an officer during the wars in Iraq and Afghanistan and advocates to improve veteran care. “It’s part of the social contract,” he said.

A body of research shows that the VA is best equipped to provide that care, said Rodney R. Baker, PhD, the retired mental health director and chief of psychology for the South Texas Veterans Health Care System. But psychologists and other experts predict that these recent and proposed changes will significantly weaken the department, with serious consequences for the physical and mental health of veterans.

“The VA is in real trouble. Unless actions are taken quickly to reverse the trend, its mental health services could easily diminish substantially within 10 to 20 years,” said Russell Lemle, PhD, a clinical psychologist and a senior policy analyst for the Veterans Healthcare Policy Institute, a nonprofit research and policy organization.

In December, the Senate Committee on Veterans’ Affairs ranking member Richard Blumenthal, D-Conn., with support from APA, introduced legislation aimed at reversing some of these trends. The Honor Our Promise to Veterans Act of 2025 would add psychology to the competitive pay category of the Title 38 Code of Federal Regulations, improving pay and benefits for VA psychologists, which could strengthen recruitment and retention efforts. The bill would also expand telework options for certain providers, reduce wait times for veterans seeking mental health care both within and outside the VA, and improve training and accountability for providers outside the VA who are working with veterans.

Diminishing the VA may also deal a setback to the discipline of psychology. The VA’s health care arm, the Veterans Health Administration, is the largest single employer of psychologists in the United States and has provided clinical training for more than half of the field’s practitioners, according to the most recent analyses (Evaluation of the Department of Veterans Affairs Mental Health Services, National Academies Press, 2018opens in new window). It is also the nation’s largest integrated health care system, treating veterans, their families, and some active-duty service members, and it provides a critical opportunity to study interventions and often defines national standards for psychological training and care.

“The VA is a huge player in mental health care in our country and beyond,” said Stephen Long, PhD, a clinical psychologist with 34 years of experience in research, care, and program development who is now retired from the VA. “What happens inside the VA affects what happens outside the VA, which means that everybody who gives or receives psychological care should be concerned right now.”

The model of the VA is to provide high-quality care for life to eligible veterans and their family members, as well as survivors of those killed in the line of duty, by providers who understand military culture and are trained to support this population’s unique needs. Even for those who don’t see combat, military service often involves extended time away from home under stressful conditions where one might fear for their safety and the safety of comrades.

“Whether or not you engage in combat, military life brings a lot of stressors that don’t go away the moment you get your discharge paperwork,” Plenzler said.

After retiring from active duty, veterans may face complex mental and physical challenges that require specialized care. Combat-related post-traumatic stress disorder (PTSD) differs from other forms of PTSD, partly because it can involve prolonged exposure to danger over a period of months or years. Moral injury, or feelings of guilt about actions or inactions that violate one’s core values, may also need to be addressed.

Many veterans have complex PTSD, including some who faced trauma prior to their military experience, Long said. It’s also common for patients to meet criteria for multiple diagnoses, such as depression, panic disorder, and substance use disorder. These challenges can interact with physical health problems, such as traumatic brain injuries from repeated exposure to explosions.

For decades, the VA’s centralized system of research, training, and care was the main provider of specialized support for these complex challenges. That began to shift in 2014, when the Veterans Access, Choice, and Accountability Act broadened veterans’ eligibility for outside care in certain cases, such as when waiting lists or travel times were too long.

But what was intended as a complement to VA services is now becoming the norm rather than the exception, and psychologists and veterans’ policy experts worry that this trend will undermine the VA’s integrated system. Total reimbursement for community care, or care provided outside VA facilities, nearly doubled between 2018 and 2023 and is projected to continue growing rapidly (Kizer, K. W., et al., The Urgent Need to Address VHA Community Care Spending and Access Strategies – Red Team Executive Roundtable Report, 2024opens in new window; Rose, L., & Wagner, T. H., JAMA Health Forum, Vol. 6, No. 9, 2025opens in new window).

While community providers do supply crucial support, many aren’t trained in evidence-based practices for common veteran conditions. These providers operate with minimal oversight from the VA and aren’t required to coordinate the care they provide with the VA (VA Needs Improved Oversight of Behavioral Health Medical Records and Provider Training, U.S. Government Accountability Office, 2025opens in new window).

“This is a unique population,” said Conwell Smith, APA’s deputy chief of military and veteran policy. “Sending veterans out to the community without requiring that mental health care providers understand them is concerning. Veterans should have every expectation that their quality of care is top-notch, regardless of the site of service.”

Research shows that veterans who access care at the VA fare better than those treated in the private sector. They have lower suicide rates and better outcomes for most major physical and mental health needs (Ramchand, R, & Montoya, T., RAND, May 22, 2025opens in new window; Shekelle, P., et al., VA versus Non-VA Quality of Care: A Living Systematic Review, VA Office of Research and Development, 2024opens in new window; Recent Peer-Reviewed Studies Comparing VA to Non-VA Healthcare Cost, 30-Day Mortality and Care Outcomes, Veterans Healthcare Policy Institute, 2025opens in new window).

“If you’re trained at the VA, you learn something important about veteran mental health care that you’ll never get if you’re trained someplace else,” said Baker, who treated veterans and trained psychology interns at the VA for more than 40 years.

For example, community providers may not know how to collect and incorporate information about a patient’s military history, Baker said, including details about branch, role, deployments, combat exposure, injuries, military sexual trauma, and unit culture. They may also lack expertise in navigating the transition between military and veteran life, now considered a critical adjustment period.

“One of our biggest fears is that veterans will just be left out in the system on their own, without the touch point that brings in cultural competency,” said Kyleanne Hunter, PhD, CEO of the nonprofit Iraq and Afghanistan Veterans of Americaopens in new window and a veteran of the U.S. Marine Corps.

Psychology and the VA are deeply intertwined. After World War II, VA health centers were established alongside medical schools, creating a vital training pipeline for both physicians and psychologists that stands today.

A 2015 analysis found that more than half of psychologists completed some clinical training, such as an internship or postdoctoral fellowship, at the VA (Evaluation of the Department of Veterans Affairs Mental Health Services, National Academies Press, 2018opens in new window). For years, it was among the most desirable employers for psychologists, Lemle said.

Data indicate that the administrative changes and funding cuts that are impacting veterans’ care delivery are driving a net loss of providers. In the latest monthly VA workforce report, released in September, just 62% of departing psychologists said they would recommend working at the VA—the lowest satisfaction rate of all professions surveyed (VA Workforce Dashboard, No. 29, September 2025opens in new window). Reasons cited included lack of trust in senior leaders, policy or technological barriers to work, job stress, and personal or family matters.

Throughout 2025, VA reports also show a monthly decline in psychologists employed by the organization, with 57% of medical centers reporting a shortage (OIG Determination of Veterans Health Administration’s Severe Occupational Staffing Shortages Fiscal Year 2025opens in new window, VA Office of Inspector General, 2025). The VA has now announced it will cut a total of 30,000 jobsopens in new window this year across the organization and impose caps on staff at every medical center.

“This approach locks in permanent VA understaffing just as demand for mental health services is projected to continue growing through 2030,” Lemle said. “The private sector can’t fill this gap either—over a third of Americans live in areas already facing mental health professional shortages. That’s not taking care of our veterans.”

Federal return-to-office mandates have further strained the VA psychology workforce. Providers who once worked partly or fully from home, providing telehealth sessions, are now mostly barred from doing so. The change in regulations forced some psychologists to end their employment rather than commute long distances to perform the exact same work.

Encouragingly, the VA will begin an internship match program in 2026, ensuring that vital opportunities for psychological training remain open to students.

The VA’s cuts put clinical care, training, and workforce issues in the spotlight, but the risk to research should not be ignored. As the nation’s largest integrated care organization, the VA offers a sizable study population with rich data that can be used to improve health care and mental health care for all Americans, a setup difficult to replicate, Smith said. Key advances in psychology—such as understanding post-traumatic stress, trauma-informed treatments, suicide prevention, integrated care, and telemental health delivery—can be traced back to the VA.

“The cuts to research development will affect more than just the staff in those departments,” said Kathleen McNamara, PhD, a clinical psychologist who worked at the VA as a provider, trainer, and administrator for more than 30 years. “This is about providing the best care possible—and these researchers are asking the right questions to better understand the needs of a new generation of veterans.”

For example: How do psychological and physical combat trauma impact the aging process, particularly for women as they enter menopause and perimenopause?

“Women are the fastest growing group of veterans, yet there’s very little research on menopause and its impact on conditions like complex PTSD and brain injuries,” Hunter said. “These are the types of research questions that are so critical for us to keep asking.”

Given the VA’s pivotal role in the field, psychologists of all stripes must rally to protect its future, Smith said. Because the Hatch Actopens in new window limits how federal employees can engage in advocacy, VA psychologists do not always have the ability to speak out about these issues—making support from those outside the organization crucial.

“If general psychology advocates for the VA, that can make a big difference,” McNamara said.

One way to show support is by joining the Psychology Advocacy Network run by APA Services to stay informed about advocacy campaigns on veterans’ issues and other topics.

Psychologists and veterans alike can also raise their voices on these issues by calling their member of Congress.

“Time is of the essence. If you care about the long-term viability of the VA, call your elected officials and express your displeasure about how budget changes are affecting VA facilities and demand that the organization be funded appropriately,” Plenzler said.

Advocating for the VA now can help fulfill the social contract with those who have fought to protect this country.

“How we treat our veterans tells us a lot about who we are,” Baker said. “The question is: Are we going to step up and provide the best care available for those who risked their lives for our country?”