Newspapers and media outlets are carrying daily revelations of serious shortcomings in the Veterans Affairs healthcare system. Those who have served our country, with honor and sacrifice, are receiving far less than their due for their medical and psychological needs. In 2010 and 2011, I provided resilience training to VA combat crisis treatment teams in the VISN 3 network—case managers, nurses, social workers, psychologists, suicide prevention coordinators, and other staff in eighteen medical facilities in the New York and New Jersey area. My firsthand experience with the VA system during this year-long contract, combined with experiences of my patients and friends, matches and confirms much of the recent reporting. Unfortunately, I’m not surprised at the level of bureaucratic dysfunction in our Department of Veterans Affairs.

Bureaucracy can have its own brand of trauma. Certainly, the VA treatment teams I worked with named “the bureaucracy” as their number one source of trauma on the job. Considering that these health professionals served a high-needs, often highly-traumatized population of Iraq and Afghanistan war veterans, this was a disturbing finding.

Bureaucracies, by nature, are hierarchies. Each level of the hierarchy possesses a level of power and authority over those levels below it. These positions of authority are proscribed, and by that I mean that the authority belongs by definition to the job position, not the person. The organizational chart dictates who has power and control over whom. When people who are natural authorities—skilled, mature, capable leaders in their fields—are also those with the proscribed authority, all can go well in a bureaucracy. When less-qualified professionals take positions of control, mistakes and abuse can follow. Poor leaders with proscribed authority can be capable of cutting corners ethically, making unreasonable or impossible demands on front-line staff, and creating both dangerous and even toxic work cultures and deficiencies in delivery of services.

This is what we’re seeing now at the VA. My heart breaks to witness it. Corruption has crept into a system that some of our finest men and women depend upon for their very health and well-being.

While working with the VISN 3 treatment teams, I found many highly dedicated, skilled, and compassionate professionals providing care to the best of their abilities, within some significant constraints of time and resources. As caregivers, they worked long hours, often donating their personal time to meet the needs of veterans and their extended families in ways the VA system couldn’t or wouldn’t provide. Pressure from above to meet quotas and keep up with voluminous paperwork were actual sources of trauma for them. While some already knew effective self-care techniques to stay resilient, too many of them were also close to burning out.

Losing effectiveness of the job and watching their home life deteriorate was the last thing these health professionals wanted to have happen to them. They wanted to continue serving in a calling they loved and were committed to. I think of them now—how hard they worked and how much they cared—and hope that real reform in the vast bureaucracy of our Veterans Affairs will happen soon. Veterans, and their caregivers, deserve better.