DAVID GREENE, HOST:
All right. U.S. combat veterans dealing with post-traumatic stress or depression often turn to Vet Centers. These are clinics run by the federal government. Now some of the counselors at those centers say they are dealing with stress themselves because of the number of cases they've been asked to take on. New Hampshire Public Radio's Peter Biello has more.
PETER BIELLO, BYLINE: Ted Blickwedel is a 63-year-old Marine Corps veteran living in Smithfield, R.I. And recently, when he was working as a clinical social worker at his local Vet Center, he began to think about suicide.
TED BLICKWEDEL: You know, I didn't sit around and ruminate about how I'm going to go about taking my own life or anything. But nonetheless, it was just that sense of I just don't want to be here anymore.
BIELLO: Blickwedel says he felt a rising sense of hopelessness about his job. It began a couple of years ago, when the Department of Veterans Affairs changed the way it measured counselor productivity. Instead of asking counselors to track what percentage of their time they spend with clients, the VA asked counselors to meet a minimum headcount. Blickwedel says that's when his focus began to shift.
BLICKWEDEL: I would be in session trying to engage somebody but being more worried about, you know, getting them out the door so they can do notes and get the next person in on the hour every hour.
BIELLO: Blickwedel says if a veteran with PTSD needed an extra-long session. He'd spend extra time with him and see fewer clients. That would have consequences. The VA wants counselors to have 25 visits each week to be, quote, "fully successful." The VA says that should take about 17 hours. The problem is that even by the VA's own analysis, the average visit takes 77 minutes. That's 32 hours.
BLICKWEDEL: That doesn't leave adequate time to get all of your other administrative duties done with your progress notes, your treatment plans, your assessments, with staffing, consultation, with other providers that are working with the veteran.
BIELLO: Many of the dozen Vet Center employees interviewed for this story worked extra hours, often without compensation to keep up. Some say they went on medication to manage the stress, others lost weight. And when they suffered, they say, so did services. Mike Fisher leads the VA's Vet Centers.
MIKE FISHER: When we talk about accounting for 25 encounters in a week, I think that's reasonable given that the vast majority of our staff are already doing that.
BIELLO: He says those who don't make the numbers simply have to create a plan to boost them.
FISHER: That plan can include increased outreach. It could include I'm going to try as a clinician this one type of group. There's complete flexibility in that.
BIELLO: Group sessions can give your visit count a boost since each member of the group is counted individually. But getting enough groups can be tricky says Rick Stouffer, a Vet Center counselor from Knoxville, Tenn.
RICK STOUFFER: It would be nice to have a full caseload of clients, but I have no control over how many clients I have.
BIELLO: He says sometimes clients don't show up for appointments, which can hurt productivity. Demand for Vet Center services varies by location. Some are simply busier than others, but the standards are mostly uniform. There has been no formal survey of how Vet Center social workers feel about these requirements. Ted Blickwedel tried to conduct one by email. The VA told him to stop, and when he didn't, they cut off his email access. The VA says he was using email in an unprofessional manner. Now Blickwedel is retiring over these requirements, which he says need to be reduced to a reasonable level.
BLICKWEDEL: That's No. 1. No. 2, there needs to be more hiring at higher echelons of people in managerial leadership positions that have clinical backgrounds so they can make common-sense clinical decisions.
BIELLO: And only then, Blickwedel says, can Vet Center employees stop worrying about metrics and focus more on their clients. For NPR News, I'm Peter Biello in Smithfield, R.I.
(SOUNDBITE OF THE LIMINANAS' "UGLY DEATH")