VA, VISN 20, and NW MIRECC History

VA, VISN 20, and NW MIRECC History

The United States has the most comprehensive system of assistance for Veterans of any nation in the world, with roots that can be traced back to 1636, when the Pilgrims of Plymouth Colony were at war with the Pequot Indians. The Pilgrims passed a law that stated that disabled soldiers would be supported by the colony. The first shots of what would become the war for American independence were fired in April 1775. In June 1775, the Continental Congress created, on paper, a Continental Army and appointed George Washington as Commander. Later, the Continental Congress of 1776 encouraged enlistments during the Revolutionary War, providing pensions to disabled soldiers.

General George Washington established the "Badge of Merit" on August 7, 1782. In its shape and color, the Badge anticipated and inspired the modern Purple Heart. In the early days of the Republic, individual states and communities provided direct medical and hospital care to Veterans. The first hospital for men who made their living at sea was built in Norfolk County, Virginia in the town of Washington. In 1798, President John Adams established U.S. Marine Hospitals with the "Act For the Relief of Sick and Disabled Seamen" and in 1800 the Federal government purchased the Virginia hospital.

In 1811, the U.S. Navy urged Congress to pass legislation to create a Home in Philadel­phia "for destitute Navy sailors and Marines." An interim Naval Hospital opened in the former country mansion of the renowned Pemberton family in Philadelphia. On April 3, 1827 the occasion of the cornerstone laying of the U.S. Naval Asylum was led by Commodore William Bainbridge. Commodore Bainbridge said in his dedicatory speech, "A home will be established for the faithful (sea­man) who has been worn out or maimed in fight­ing the battles of his country. A comfortable harbor will be secured where he may safely moor, and ride out the ebb of life free from cares and storms, by which he has been previously sur­rounded". Established in 1834, the U.S. Naval Asylum was the first federal veterans' retirement facility in America. The United States Naval Home was funded completely by Navy appropriations. In 1889 the name was changed to the U.S. Naval Home and remained in continuous operation until 1976.

The United States Soldiers' Home was authorized by Congress in 1851. The Soldiers Home historically relied upon monthly contributions from active duty Army (and later Air Force) enlisted personnel and warrant officers, fines, and forfeitures collected as a result of disciplinary actions. President Abraham Lincoln loved visiting the Solders’ Home, as did presidents before him. After it grew, he asked to use the cottage for a summer home to escape the humidity and political pressures of DC. All told, Lincoln spent one quarter of his presidency in the cottage including the months when he penned the Emancipation Proclamation.

On March 3, 1865, a month before the Civil War ended, President Abraham Lincoln authorized the first-ever national soldiers’ and sailors’ asylum to provide medical and convalescent care for discharged members of the Union Army and Navy volunteer forces. The asylum was the first of its kind in the world to provide civilian medical care to Veterans of temporary volunteer forces. As the first-ever government institution created specifically for honorably discharged volunteer soldiers, it would later be renamed the National Home for Disabled Volunteer Soldiers (NHDVS). In 1991, Congress merged the U.S. Naval Home with the U.S. Soldiers’ and Airmen’s Home and renamed to Armed Forces Retirement Home (AFRH). President Lincoln's Cottage at the Old Soldiers Home began restoration in 2001 and was open to the public for the first time in history on President's Day in 2008.  

Also in the 19th century, the nation's Veterans assistance program was expanded to include benefits and pensions not only for Veterans, but for their widows and dependents. On March 4, 1865, as the Civil War entered its final weeks, President Abraham Lincoln delivered his second inaugural address from the East Portico of the U.S. Capitol. He ended his address with a stirring call for healing and reconciliation, to which he added a solemn promise to those who had fought to restore the Union, "With malice toward none; with charity for all; with firmness in the right, as God gives us to see the right, let us strive on to finish the work we are in; to bind up the nation’s wounds; to care for him who shall have borne the battle, and for his widow, and his orphan—to do all which may achieve and cherish a just and a lasting peace, among ourselves, and with all nations".

While the U.S. Naval and Soldiers Homes served retired members of the Regular Navy and Army, the federal government did not operate volunteer soldiers' homes until after the Civil War. Two earlier soldiers’ homes, operated by the U.S. Army and Navy for Veterans of the Regular military forces, were very small and housed only up to 300 men each. Following the Civil War, many state Veterans homes were established. From 1866 to 1930, branches of the NHDVS opened throughout the country. The National Homes housed ten of thousands of Veterans. The National Homes were often called “soldiers’ homes” or “military homes.” Each National Home contained a hospital, barracks, dining hall, recreational facilities, and a cemetery. Beginning in late 1800's, National and State Homes opened in Idaho, Oregon, and Washington. The first Soldiers' Home of the Pacific Northwest was located in Orting, Washington. In 1894, the Idaho State Soldiers' Home opened in Boise and the Oregon State Soldiers' Home opened in Roseburg. Later in 1907, the state of Washington passed legislation for the establishment of the Washington Veterans' Home in Retsil.

As the U.S. entered World War I in 1917, Congress established a new system of Veterans benefits, including programs for disability compensation, insurance for service personnel and Veterans, and vocational rehabilitation for the disabled. In 1918, Congress tasked two Treasury agencies - the Bureau of War Risk Insurance and Public Health Service - with operating hospitals specifically for returning World War I Veterans. They leased hundreds of private hospitals and hotels for the rush of returning injured war Veterans and began a program of building new hospitals. Native Americans who served in World War I were authorized, for the first time in history, to apply for American citizenship due to a law enacted on November 6, 1919, making them eligible for full Veterans benefits, including health care. World War I was the first fully mechanized war, and as a result, soldiers who were exposed to mustard gas and other chemicals and fumes required specialized care after the war. Tuberculosis and Neuropsychiatric hospitals opened to accommodate Veterans with respiratory or mental health problems. 

In April of 1921, a Presidential committee recommended consolidating the Bureau of War Risk Insurance, Federal Board of Vocational Education, and Public Health Service into an independent federal agency led by an executive who reported directly to the president. Congress took up the committee’s proposal and by summer passed Public Law 67-47, popularly known as the Sweet Act after the name of the legislator who introduced it, establishing the Veterans Bureau. President Warren G. Harding signed Public Law 67-47 establishing the Veterans Bureau by merging the three World War I Veterans programs. In November 1921, a Veterans hospital was opened in Portland, Oregon by U.S. Marine Hospital Service (USMHS).

Public Health Service hospitals serving Veterans were assigned to the new Veterans’ Bureau. A majority of existing VA hospitals and medical centers began as National Home, Public Health Service, U.S. Marine Hospitals, or Veterans Bureau Hospitals. In Washington, there were U.S. Marine Hospitals located in Seattle, Port Townsend/Port Angeles, and Knappton Cove. Originally part of Fort Walla Walla, which dates back to the early 1800s, land was transferred to the then U.S. Veterans Bureau in 1921 for a hospital in the Walla Walla area. On Veterans Day 1996, VA Walla Walla Medical Center was renamed Jonathan M. Wainwright Memorial VA Medial Center. Wainwright was born on Fort Walla Walla grounds August 23, 1883; he was a WWII Prisoner of War (POW) from 1942 to 1945. Wainwright received numerous medals, including the Medal of Honor September 10, 1945, which was presented to him by President Harry S. Truman. In 1922, Henry Ford provided 50 Model T Fords to help the Disabled American Veterans of the World War (DAVWW) to attend the organization’s second national convention. No one knew it at that time, but this was to be the beginning of a strong, dedicated partnership between the DAV and the Ford Motor Company. DAV operates a fleet of vehicles around the country to provide free transportation to VA medical facilities for injured and ill veterans. With rides coordinated by DAV Hospital Service Coordinators around the country, the DAV Transportation Network is staffed by volunteers.

The first hospital for Veterans in Portland was opened by the U.S. Public Health Service in November 1921. In January 1926, Charles Samuel ("Sam") Jackson, publisher of The Oregon Journal, deeded 25 acres of land in Portland to the United States Veterans Bureau. Initial site preparation for a Veterans hospital started on Feb. 3, 1927, with construction commencing one year later. The first 13 buildings were activated in December 1928 and formally dedicated later in 1929. The only remaining original building of Portland VA Medical Center (PVAMC) is building #16, built in 1932.

The American Lake campus opened in 1923 as the 94th Veterans Hospital to be built by the War Department for the provision of care to World War I Veterans. The Secretary of the Army authorized, under a revocable license, the Veteran Bureau's use of 377 acres of the 87,000 acre Fort Lewis property. Dedicated in 1924 the American Lake VA Medical Center was chartered with a single mission - Neuropsychiatric treatment. On March 15, 1924, the first 50 patients were admitted to the hospital, by transfer, from Western State Hospital at Fort Steilacoom. The first research program was established in 1925 and the Veteran’s Bureau began conducting the first hospital-based medical studies. The construction of VA's first facilities for women Veterans were constructed at American Lake VA in 1948. The American Lake Veterans Golf Course, was added after World War II.

In October 1927, after Word War I, General Charles Summerall proposed that Congress revive the "Badge of Military Merit." In January, 1928, the Army’s Office of The Adjutant General was instructed to file the materials concerning the proposed medal. Among those materials was a rough drawing of a circular medal disc with a concave center on which a raised heart was visible. Engraved on the back of the medal was "For Military Merit." Also in 1928, admission to the National Homes was extended to women, National Guard, and militia Veterans. In 1929, U.S. Army General Frank T. Hines, VA’s longest-tenured leader, suggested consolidation and coordination of all veterans activities into one agency. By 1929, the National Homes had grown to 11 institutions that spanned the country. The second consolidation of federal Veterans programs took place on July 21, 1930 when President Herbert Hoover consolidated the Veterans Bureau with the National Home for Disabled Volunteer Soldiers and Pension Bureau and re-designated it as the Veterans Administration.

After VA was established in 1932, the National Homes were converted to domiciliary care to provide services to economically-disadvantaged Veterans. All of the original National Homes have operated continuously since they opened. Also in the early 1930's, General Douglas MacArthur, Summerall’s successor as Army Chief of Staff, resurrected the idea for the Purple Heart medal. On February 22, 1932 -- the 200th anniversary of George Washington’s birth -- the War Department (predecessor to the Department of Defense) announced the establishment of the Purple Heart award in General Order No. 3. On December 5th, 1942, the Navy, Marine Corps, and Coast Guard were authorized to issue Purple Hearts retroactive to the attack on Pearl Harbor, which killed thousands of Navy personnel and pulled the United States into World War II. Initially Oregon State Soldiers' Home, Roseburg VA Medical Center opened in 1933, and designated a Neuropsychiatric Veterans hospital a few years later. Also in 1933, a U.S. Marine Hospital was opened on Beacon Hill in Seattle Washington replacing the Port Townsend facility.

After the end of World War II, the Veteran population vastly increased in the 1940s – more than 15 million Veterans were demobilized – and 671,817 returned injured. The World War II Servicemen’s Readjustment Act – the "GI Bill of Rights", provided new education benefits, unemployment compensation, and home loans. Since 1944, the GI Bill has helped qualifying Veterans and their family members get money to cover all or some of the costs for school or training. In 1946, the Department of Medicine and Surgery was established within VA. VA was able to recruit and retain top medical personnel by modifying the Civil Service system. The first women doctors were hired in 1946. When Bradley left in 1947, there were 125 VA hospitals.

In May of 1946, President Harry S. Truman authorized the transfer of the U.S. Army Barnes General Hospital in Vancouver Washington to the Veterans Administration. Barnes General Hospital, built in 1941 was located on Vancouver Barracks, the first U.S. Army base located in the Pacific Northwest. Vancouver Barracks is significant for its association with World War II U.S. Army hospital operations and early Veterans Administration hospital history. Vancouver Barracks operated as a veterans' hospital until new construction of the Vancouver VA Medical Center was completed in the 1980's. The new Vancouver Washington VA Hospital opened as an annex to the Portland Oregon VA Hospital. VA Memorandum No. 2 of 1946, established affiliations with medical schools to help train physicians and other medical personnel needed to work in VA hospitals.

In January 1942, a major War Department construction project built over 1,000 buildings in the Agate Desert, near Medford, Oregon. Dedicated on September 15, 1942, U.S. Army Camp White became a World War II military training installation. Camp White was named for Major General George A. White, the longest serving adjutant general of the Oregon National Guard, having served nearly 27 years. Major General White was one of the founding members of the American Legion. In 1949, White City VA Medical Center Domiciliary Residential Rehabilitation Treatment Programs (DRRTP) opened in White City, Oregon. DRRTP, established through legislation passed in the late 1860's, is VA's oldest health care program. The Oregon National Guard formally dedicated the new Major General George A. White Headquarters building during a ceremony, Sept. 26, 2018, in Salem, Oregon. The new Headquarters building is designed to ensure operational flexibility, reduce operations and maintenance costs, and allow for future expansion. The facility meets seismic Essential Facility requirements for immediate use in emergency response following a seismic event. 

Just months after taking over as Administrator of VA, General Omar Bradley, along with VA’s first medical director, Major General Paul Hawley. In 1946, General Bradley announced that VA will build 183 new hospitals-105 General, 49 neuropsychiatric, and 29 TB, providing an additional 151,500 beds--in 39 states. It is the largest proposed federal veteran hospital construction program in history. That same year both Veterans Administration Voluntary Services (VAVS) and Veterans' Canteen Service (VCS) were established. On July 26, 1948, President Truman signed Executive Order 9981: Desegregation of the Armed Forces. In 1954, segregation based on race ended in VA Hospitals.

From 1950 to the present, the Boise VA Medical Center has occupied the main part of the grounds of the former Fort Boise. Established in June of 1863, Fort Boise was redesignated as Boise Barracks in 1879. Military units continued to serve and protect the citizens of Boise and southwestern Idaho until the Fort was formally abandoned in 1912. Soldiers returned briefly in 1916 to prepare for the Mexican border campaign. Fort Boise was approved as a Public Health Hospital in 1919. On February 7, 1938 the 110 acres was transferred from the War Department to VA by Executive Order. The Idaho State Veterans Home operates on land excessed from VA. Aside from early settlers' 1863 log cabins preserved as relics, the oldest buildings in Boise are those constructed for the Fort. The sandstone buildings erected in 1864 are still in use by the Boise VA Medical Center today.

During World War II, the city of Spokane and the county donated over 200 acres of land for a hospital. In less than a year, a 1,500-bed hospital was built to care for the wounded returning from war. New construction of a Veterans hospital (Mann-Grandstaff VA Medical Center) in Spokane Washington began in 1950. The Seattle VA Medical Center was built on the grounds of Jefferson Park. During World War II, Jefferson Park was used by the U.S. Army. After the U.S. Army returned the park and golf course, Seattle City Council donated the 44 acre nine-hole golf course for a Veterans Hospital. Construction began in the late 1940's and Seattle VA Medical Center, was dedicated on May 15, 1951. The Seattle VA Medical Center on Beacon Hill provides views of downtown Seattle and the Puget Sound to the North and Northwest; Mt. Rainier and the Cascade mountain range to the South and Southeast. VA began offering special access to medical care, including physical exams, to Vietnam Veterans with Agent Orange health concerns in 1978. The next year Congress passed the Veterans Health Care Amendments Act of 1979. Upon passage, VA set up a network of Vet Centers across the country, separate from other VA facilities providing various counseling services and treating post-traumatic stress disorder (PTSD).

On October 25, 1988, President Ronald Reagan elevated VA to a cabinet-level executive department, renamed the Department of Veterans Affairs. President Ronald Reagan said, "This bill gives those who have borne America’s battles, who have defended the borders of freedom, who have protected our nation’s security in war and in peace—it gives them what they have deserved for so long, a seat at the table in our national affairs. ... I like to think that this bill gives Cabinet rank not just to an agency within the government, but to every single veteran. And so in signing this bill, I’m saying to all our veterans what I say to new Cabinet members, 'Welcome aboard.'"

The switch took effect March 15, 1989, and administrative changes occurred at all levels. President George H. W. Bush hailed the creation of the new Department, saying, "There is only one place for the Veterans of America, in the Cabinet Room, at the table with the President of the United States of America." In January 1991, Operation Desert Storm began in response to Iraq's invasion of Kuwait. Prior to Operation Desert Storm, the U.S. led a nearly six-month build-up of weapon systems in Southwest Asia that began immediately following the invasion of Kuwait on August 2, 1991. Also in 1991, VA Department of Medicine and Surgery re-designated as the Veterans Health Services and Research Administration and called the Veterans Health Administration (VHA).

Partners since 1948, Portland VA Medical Center and Oregon Health and Science University (OHSU) are situated on a 450-foot-tall basalt-rock hill. PVAMC was completed and dedicated in 1987. PVAMC and OHSU became physically connected in 1992 with the completed construction a 660-foot pedestrian skybridge. Connected both physically and through academic partnerships, shared research endeavors, healthcare training, and shared staff including scientists, clinician-educators, and clinician-researchers. The enclosed skybridge, spanning a 150-foot-deep ravine, is the longest in the United States. U.S. Army Corps of Engineer leadership toured PVAMC in September of 2018 to begin work on seismic retrofit design and planning.

During the Persian Gulf War, members of the Armed Forces were exposed to numerous potentially toxic substances, including fumes and smoke from military operations. In 1992, Congress authorized medical care for Gulf War Veterans for conditions possibly related to exposure to toxic substances or environmental hazards. Threats of enemy use of chemical and biological warfare heightened the psychological stress associated with the military operation. VA Medical Centers were grouped into 22 Veterans Integrated Service Networks (VISNs) in the last decade of the 20th century. The largest geographic region of VA, VISN 20 encompasses 23% of the US land mass across three time zones over 817,417 square miles. VISN 20 serves 135 counties in Alaska, Idaho, Oregon, Washington, and extending into Lincoln County Montana and Del Norte County California. Anchorage Alaska VA Healthcare System was opened in 1992 and the VA-Indian Health Service partnership was established. Nearly half of the 574 Federally Recognized Native American Tribes in the United States are located in VISN 20. Wartime compensation for Persian Gulf War Veterans was passed into law in 1994 for service-connected disability or death. Also in the early 1990s, VHA designated enhancement funds establishing VA Centers of Excellence in Substance Addiction Treatment and Education (CESATE), including the Seattle CESATE located within the VA Puget Sound Healthcare System, Seattle Division.

The history of the NW MIRECC begins with VISN 20 clinicians and researchers working late into a cool March night, drafting the NW MIRECC charter and dreaming of a collaborative approach to research, education, and clinical care that might better serve Veterans. In the fall of 1997, VISN 20 leaders from VA Puget Sound Health Care System (VAPSHCS) and the Portland VA Health Care System (VAPORHCS) were commissioned by Congress and the U.S. Department of Veterans Affairs (VA) to establish one of the first three Mental Illness Research, Education, and Clinical Centers (MIRECCs) in the United States. VA MIRECC's provide for the improvement of the provision of health-care services and related counseling services to eligible veterans suffering from mental illness (especially mental illness related to service-related conditions) through—

• the conduct of research (including research on improving mental health service facilities of the Department and on improving the delivery of mental health services by the Department);
• the education and training of health care personnel of the Department; and
• the development of improved models and systems for the furnishing of mental health services by the Department.

The mission of NW MIRECC is to improve the health, well-being, quality of life, and function of Veterans by developing, evaluating and promoting the implementation of effective treatments for PTSD and its complex comorbidities. The most prominent of these comorbidities is repetitive blast mild Traumatic Brain Injury (mTBI); others are Substance Use Disorder (SUD), Alcohol Use Disorder (AUD), chronic musculoskeletal pain, post-concussive headaches, cognitive impairment, and increased risk for neurodegenerative disorders (chronic traumatic encephalopathy [CTE] and Alzheimer's disease [AD]).

VA's NW MIRECC serves the Pacific Northwest to improve the mental health and well-being of Veterans through research and dissemination of information to providers both within the VA and the general public. As part of the NW MIRECC mission to enhance access to mental health expertise, NW MIRECC collaborates and consults with other MIRECCs and Centers of Excellence, as well as with other VA, DoD, Federal, State departments of Veterans Affairs, community agencies, and experts. VA is the world's leading research and educational center of excellence on PTSD and traumatic stress. Vet Center counselors and outreach staff, many of whom are Veterans themselves, are experienced and prepared to discuss the tragedies of war, loss, grief and transition after trauma. VetCenters are community-based counseling centers that provide confidential counseling, outreach, and referral services, including professional readjustment counseling to eligible Veterans, active-duty Army, Navy, Marine Corps, Coast Guard, Air Force, and Space Force service members, including National Guard and Reserve components, and their families. 1-877-WAR-VETS is an around the clock confidential call center where Veterans, service members and their families can talk about their military experience or any other issue they are facing in transitioning after military service or trauma and get connected to their nearest Vet Center.

From its early days, NW MIRECC has conducted research to understand PTSD, TBI, schizophrenia, and other mental health challenges facing Veterans, including Alzheimer’s disease. That emphasis led to genetic discoveries in schizophrenia and to the identification of cerebrospinal fluid biomarkers for disruptive agitation in Alzheimer's disease. These findings were then passed on to clinicians and other VA personnel via MIRECC Presents, an accredited Continuing Education series on mental health topics provided by NW MIRECC. In this way, MIRECC Presents empowers mental health providers nationwide to integrate cutting-edge treatments and timely research into their daily clinical practices, thereby raising the quality of care for Veterans who experience mental health challenges. 

The NW MIRECC research center located at VAPSHCS is affiliated with the University of Washington. The NW MIRECC research center located at VAPORHCS is affiliated with the OHSU. VAPSHCS serves Veterans from a five-state area in the Pacific Northwest with two main divisions: American Lake VA Medical Center and Seattle VA Medical Center. Veterans in Washington are served by VA Medical Centers in Spokane, Vancouver, and Walla Walla. VAPORHCS serves Veterans in Oregon and Southwest Washington with two main divisions: Portland VA Medical Center and Vancouver VA Medical Center. Veterans in Oregon are served by VA Medical Centers in Roseburg, White City, and Vancouver, Washington. A Joint Venture was developed as a sharing agreement between the Anchorage VA clinic and the Joint-Base Elmendorf-Richardson (JBER) base in 1999. Also in 1999, VA launched the first treatment trials for Gulf War Veterans' Illnesses, focusing on antibiotics and exercise.

On September 11, 2001, terrorists flew commercial airliners into the World Trade Center buildings, the Pentagon, and downed Flight 93 in a field near Shanksville, Pennsylvania. There were 2,996 American lives lost, almost 600 more than Pearl Harbor on December 7, 1941. Those we lost September 11, 2001, will forever hold a cherished place in our hearts and in the history of our nation. By a joint resolution approved December 18, 2001, (Public Law 107-89), Congress authorized the President to designate September 11 of each year as "Patriot Day" to perpetuate the memory of those who perished in the attack on America, and to pursue peace and justice in the world and security at home.

Since 2003, VA has collaborated with the Department of Defense (DoD) and military treatment facilities (MTFs) to transition the health care of injured or ill service members and Veterans to VA medical facilities. VA launched My HealtheVet nationwide in 2003. My HealtheVet is VA’s online Personal Health Record for Veterans, active duty service members, their dependents and caregivers. The resources and tools offer Veterans greater control and understanding over health care and wellness. Post-9/11 Transition and Case Management (TCM) ensures that transitioning service members and Veterans receive the care and support they need as they transition from military to civilian life. Every VA medical center has a specialized Post-9/11 Military2VA (M2VA) team ready to welcome you as you transition from service member to Veteran.

NW MIRECC approaches research in two ways: clinical and translational. NW MIRECC studies are conducted through clinical research and through translational research wherein teams of clinicians and scientists work side-by-side to characterize and model key features of clinical problems and then translate the findings from scientific theory or animal models into practical applications for Veterans. NW MIRECC applies modern genetic, neurologic and clinical trial methodology to the discovery and development of new and more effective treatments for major and often treatment resistant mental disorders. NW MIRECC partners with Veteran and non-Veteran volunteers as clinical research subjects to develop and evaluate effective treatments for PTSD and its associated conditions, including mTBI, SUD, chronic musculoskeletal pain, post-concussive headaches, and dementia.

One example of this renewed emphasis on PTSD and its associated conditions has been our work with the blood pressure medication prazosin. Staff at the NW MIRECC pioneered the use of this medication to treat trauma-related nightmares, one of the most common symptoms of PTSD. Due in part to NW MIRECC's web-based and face-to-face educational outreach efforts, prazosin is now prescribed to over 100,000 Veterans and active-duty Servicemembers, and we continue to investigate its usefulness for other Veteran-related illnesses, including, for example, the postconcussive headaches that Veterans report as one of the most disabling symptoms of mTBI. NW MIRECC now provides protected research time, developmental study support, and new resources to a diverse, multidisciplinary cadre of biostatisticians, endocrinologists, geneticists, molecular biologists, neurologists, neuropsychologists, psychiatrists, radiologists, educators, clinicians, young investigators, and support staff, all of whom work together to deliver world-class, cutting-edge science, education, and clinical care to Veterans and health professionals.

Research studies at NW MIRECC are currently enrolling Military Veterans, First Responders, Health Care workers, and Civilians in Seattle, Washington. NW MIRECC's diligent search for answers to mental health problems afflicting our Veterans continue today. NW MIRECC has adapted its mission to more readily address the most critical needs of Veterans in this region: PTSD and its associated conditions; mTBI, SUD, AUD, chronic musculoskeletal pain, post-concussive headaches, and dementia. The following three factors compelled us to make this shift:

1. The return home of Veterans from Operation Enduring Freedom (OEF), Operation Iraqi Freedom (OIF), and Operation New Dawn (OND) has substantially increased the already large number of Veterans who struggle with the distress and functional impairments of PTSD and its associated conditions.
2. The close geographic proximity (40 miles) of Department of Defense (DoD) Joint Base Lewis-McChord/Madigan Army Medical Center to VA Puget Sound has provided an exciting opportunity to develop innovative and productive research, education, and clinical care collaborations with DoD personnel that address PTSD and its associated conditions in their early stages in active-duty Servicemembers.
3. It has become clear to NW MIRECC clinicians that PTSD is usually complicated by at least one--and often multiple--associated conditions. The typical OEF, OIF, and OND combat Veteran with PTSD -- as well as Veterans from the Vietnam War and other conflicts--also experiences persistent post concussive symptoms (such as chronic headache) from one or multiple mTBI's; struggles with chronic musculoskeletal pain; is excessively using alcohol to relieve symptoms; and is increasingly concerned that his or her subjective cognitive symptoms will develop into dementia. These other conditions associated with PTSD demand the concentrated focus of multidisciplinary centers like the NW MIRECC.

In 2005 VA announced major funding initiatives for research on neurotrauma, chronic pain, and other health problems prevalent in combat-wounded Veterans returning from Iraq and Afghanistan. NW MIRECC and VAPORHCS played a significant role in co-leading Oregon's Post Deployment effort. VAPORHCS added additional Neuro-Psychologist staff to clinically identify and manage Veterans suffering TBI. Working with the Oregon National Guard (ONG) and Oregon Department of Veterans Affairs (ODVA); NW MIRECC, VAPORHCS, and Portland VAMC compiled a comprehensive resource directory website for services and materials. Post Deployment Summits were held with various federal and state agencies, along with Veterans organizations. The Post Deployment Summits helped all aspects of Veterans return to civilian life. Outreach efforts for returning Servicemembers included the development of Unseen Injuries - Medical Information for Combat Veterans led by Oregon Department of Veterans Affairs. The post deployment efforts received national recognition in both VA and ONG.

In operation since 2007, VA’s National Suicide Prevention Hotline is a free, confidential resource for all servicemembers, including members of the National Guard and Reserve, and Veterans, even if they’re not enrolled in VA benefits or health care. Signed into law in 2020, the National Suicide Hotline Designation Act authorized 988 as the new three-digit phone number for the purpose of the national suicide prevention and mental health crisis hotline. Also in 2007, a Pilot program of the Integrated Disability Evaluation System (IDES) was launched at three military treatment facilities. IDES is a joint DOD and VA disability evaluation process. Based on the success of the pilot, the integrated process expanded to all remaining worldwide locations and is available to all Service members. Service members determined to be unfit for duty receive a single set of disability ratings to determine the appropriate level of DOD and VA disability benefits. Integration with the VA provides medically separated or retired veterans timely access to their VA benefits.

In 2008, each branch of military service stood up Wounded Warrior Commands under the DoD Warrior Care Program (WCP) to proactively support wounded, ill, and injured Service members in their recovery and reintegration or transition to civilian life.

• Army Recovery Care Program
• Navy Wounded Warrior
• Marines Wounded Warrior Regiment
• Air Force Wounded Warrior Program
• USSOCOM Care Coalition

VA, DoD, Military Services, and collaborating organizations mark Warrior Care Month in November of each year. Warrior Care Month highlights the strength and resilience – physically, mentally, and spiritually – of our wounded, ill, and injured service members and their families and caregiver. Also in 2008, Defense Health Agency's Recovery Coordination Program launched the National Resource Directory (NRD) as a resource website that connects wounded warriors, Service Members, Veterans, their families, and caregivers to programs and services that support them.

Occasionally Veterans face challenges that perplex their mental health providers at the VA. To assist providers with these more difficult cases, experts at the NW MIRECC developed the Mental Illness Consultation Program (MICON). In this program, VA clinicians may contact the NW MIRECC consultants with academic questions concerning a mental health topic or with clinical questions concerning unusual, complex, or difficult patient issues. NW MIRECC clinicians are essential for the diagnosis and management of mental health conditions. They serve in mental health clinics as well as specialty clinics that provide a key space for the development and evaluation of new treatments for PTSD, mTBI, SUD, chronic musculoskeletal pain, post-concussive headaches, and dementia. NW MIRECC specialty clinics also offer clinicians in-depth training in the diagnosis and management of mental health conditions.

First launched in 2009, Mobile Vet Centers (MVCs) are large vehicles used to provide outreach to eligible individuals in communities that are distant from existing services. VISN 20 MVCs are currently deployed in Idaho, Oregon, and Washington. MVCs can access records through encrypted connection. With this capability, MVCs are often called upon to support VA in its important mission of providing emergency services in response to national emergencies and disasters. Throughout the country there are 83 MVCs with space for confidential counseling. In 2023, VA announced deployment of 25 Mobile Medical Units (MMUs) comprised of Ford F-550 Super Duty Trucks and Mercedes-Benz Sprinter Vans. VISN 20 is scheduled to deploy two MMUs in Washington. MMUs will provide health care and support to homeless and at-risk Veterans to meet with medical providers, including mental health clinicians, social workers, and staff. VISN 20 Mobile services include primary care, laboratory services, social work, nutrition, clinical pharmacist consultations, mental health, telehealth specialty services, prosthetics and orthotics.

In 2010, VA's Domiciliary Care programs and RRTPs were merged into a single system of residential care to become Mental Health Residential Rehabilitation Treatment Program (MH RRTP). The primary goal of the MH RRTP is to provide treatment and rehabilitation services to Veterans who have mental health and substance use disorders that are often complex and co-occur with medical concerns and psychosocial needs, such as employment and housing. MH RRTPs include the Compensated Work Therapy-Transitional Residence (CWT-TR) which is designed for Veterans participating in Compensated Work Therapy and who are in the process of transitioning to successful independent community living. VHA also provides RRTP for Veterans to overcome SUD problems from AUD to life-threatening addiction. VHA's Community Living Center (VA Nursing Homes) are for Veterans who do not need hospital or nursing home care but cannot live alone because of medical or psychiatric conditions. This distinct level of mental health residential care serves Veterans with mental illnesses or addictive disorders who required additional structure and support to address multiple and severe psychosocial deficits, including homelessness and unemployment. Veterans may stay for a short time or, in rare instances, for the rest of their life. It is a place where Veterans can receive nursing home level of care, which includes help with activities of daily living and skilled nursing and medical care. VISN 20 CLC's (VA Nursing Homes) are located in Idaho, Washington, and Oregon. There are 21 State Veterans Home in all six states served by VISN 20.

VHA operates one of the largest health care systems in the world and provides training for a majority of America’s medical, nursing and allied health professionals. Every year, thousands of research studies are conducted at VA medical centers, outpatient clinics, and nursing homes. These research studies have significantly contributed to advancements in our understanding of medical problems and that have led to health improvements for Veterans and civilians alike. The VA Advanced Psychology Postdoctoral Fellowship in Mental Illness Research and Treatment (MIRT) is a two-year postdoctoral training program at VAPORHCS. The primary goal of the NW MIRECC Advanced Psychology Postdoctoral Fellowship program is to train and equip physicians, psychologists, and other allied health professionals with the knowledge and expertise to lead clinical research efforts that make lasting contributions in the lives of Veterans experiencing mental health challenges.

Roughly 60 percent of all medical residents obtain a portion of their training at VA hospitals; and VA medical research programs benefit society at-large. Postdoctoral fellows have the opportunity to provide individual and group psychotherapy, supervise doctoral-level trainees, and actively participate in weekly team meetings and PTSD consultation as junior colleagues. In collaboration with their mentors, NW MIRECC Advanced Psychology Postdoctoral Fellows develops and implements research projects, publishes, presents findings, writes grants, and utilizes the latest technology for educational activities and clinical service delivery. Psychology Postdoctoral Fellows devote 75% of their time to research and education activities and 25% to clinical training. Over the course of the two-year program, NW MIRECC fellows are trained in clinical and health systems research, advanced clinical care service delivery, and program administration in an interdisciplinary setting. In 2018 VA launched a telehealth program to serve Veterans living in rural areas who have PTSD.

Today's VHA - the largest of the three administrations that comprise VA - continues to meet Veterans' changing medical, surgical, and quality-of-life needs. VHA Medical Centers provide a wide range of services including traditional hospital-based services such as surgery, critical care, mental health, orthopedics, pharmacy, radiology, and physical therapy. In 2019, VAPSHCS opened a new 220,000-square-foot Mental Health and Research Building on the Seattle Washington campus. The Seattle expansion provides outpatient mental health care services, from medication management and psychosocial case management to Dialectical Behavior Therapy and evidence-based individual, family and group psychotherapy for all major mental health diagnoses. In addition, most VA medical centers offer additional medical and surgical specialty services including audiology and speech pathology, dermatology, dental, geriatrics, neurology, oncology, podiatry, prosthetics, urology, and vision care. VHA medical centers throughout the country offer advanced services such as organ transplants and plastic surgery through the VA National Transplant Program.

Veterans may be eligible for care through a provider in their local community depending on their health care needs or circumstances, and if they meet specific eligibility criteria. VA launched its new and improved Veterans Community Care Program on June 6, 2019, implementing portions of the VA Maintaining Internal Systems and Strengthening Integrated Outside Networks Act of 2018 (MISSION Act), which both ended the Veterans Choice Program and established a new Veterans Community Care Program (VCCP). Types of care under the new VCCP include General Community Care, Urgent Care, Emergency Care, Foreign Medical Care, Home Health and Hospice Care, Indian and Tribal Health Services, In Vitro Fertilization, State Veterans Home, and Flu Shots. Under the new VCCP, Veterans work with their VA health care provider or other VA staff to see if they are eligible to receive community care based on new criteria. Community care must be first authorized by VA before a Veteran can receive care from a community provider. The VA Community Care Network (CCN) is VA’s direct link with community providers to ensure Veterans receive timely, high-quality care.

VA continues to innovate and modernize to serve millions of America’s patriots and their families and beneficiaries. Today’s VHA has roots spanning over 150 years and continues to meet Veterans’ changing medical, surgical, and quality of life needs. In recent years VHA has opened more outpatient clinics, established telemedicine, vet centers, and suicide prevention hotlines, and developed other services to accommodate a diverse and ever-changing Veteran population. VHA continually evolves and cultivates on-going cutting-edge medical research and innovation to improve the lives of America’s patriots. New programs provide treatment for traumatic brain injuries, post-traumatic stress disorder, suicide prevention, women Veterans, and more.

The Plymouth colony first cared for veterans beginning in 1636. Three hundred and eighty-eight years later, the United States continues to provide the best possible care for our greatest assets. NW MIRECC reaffirms its commitment that there is no higher priority than caring for the wounded, ill, and injured service members who have sacrificed so much. NW MIRECC continues to be at the tip of the sword in response to Warrior Care and continues to strive to improve the health and well-being of our Veterans. There is no greater calling than to care for those who ensured our freedom; Warrior Care is America's duty!

Veterans Integrated Service Network 20 (VISN 20) serves 135 counties in Alaska, Idaho, Oregon, Washington, and extending into Del Norte County California and Lincoln County Montana. VISN 20 is the largest geographic region of VA and home to 273 federally recognized American Indian and Alaskan Native tribes, 229 of which are located in Alaska. Encompassing 23% of the US land mass, VISN 20 spans three time zones over 817,417 square miles. VA Puget Sound Health Care System (VAPSHCS) and the Portland VA Health Care System (VAPORHCS) were commissioned by Congress and the U.S. Department of Veterans Affairs (VA) as one of the first three Mental Illness Research, Education, and Clinical Centers (MIRECCs) in the United States. VAPSHCS serves Veterans from a five-state area in the Pacific Northwest with two main divisions: American Lake VA Medical Center and Seattle VA Medical Center. VA Outpatient Clinics and Vet Centers in Washington are located in Bellingham, Bellevue, Bremerton, Chehalis, Edmunds, Everett, Federal Way, Lacey, Mount Vernon, Olympia, Port Angeles, Puyallup, Richland, Renton, Silverdale, Seattle, Spokane, Union Gap, Vancouver, Walla Walla, Wenatchee, and Yakima. Veterans in Washington are also served by VA Medical Centers in Spokane, Vancouver, and Walla Walla. VAPORHCS serves Veterans in Oregon and Southwest Washington with two main divisions: Portland VA Medical Center and Vancouver VA Medical Center. VA Outpatient Clinics and Vet Centers in Oregon are located in Bend, Boardman, Brookings, Enterprise, Eugene, Fairview, Grants Pass, Hines, Hillsboro, Klamath Falls, LaGrande, Lincoln City, Newport, Portland, Salem, The Dalles, Warrenton, and West Linn. Veterans in Oregon are also served by VA Medical Centers in Roseburg, White City, and Vancouver, Washington.

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VA provides health care for Veterans from providers in the local community outside of VA. Veterans may be eligible to receive care from a community provider when VA cannot provide the care needed. VA launched its new and improved Veterans Community Care Program (VCCP) on June 6, 2019, implementing portions of the VA Maintaining Internal Systems and Strengthening Integrated Outside Networks Act of 2018 (MISSION Act), which both ended the Veterans Choice Program and established VCCP. Types of care under the new VCCP include General Community Care, Urgent Care, Emergency Care, Foreign Medical Care, Home Health and Hospice Care, Indian and Tribal Health Services, In Vitro Fertilization, State Veterans Home, and Flu Shots. Veterans work with their VA health care provider or other VA staff to see if they are eligible to receive community care based on new criteria. The VA Community Care Network (CCN) is VA’s direct link with community providers to ensure Veterans receive timely, high-quality care.

Vet Centers in the VISN 20 Health Care Network are community-based counseling centers that provide a wide range of social and psychological services, including professional readjustment counseling to eligible Veterans, active-duty Army, Navy, Marine Corps, Coast Guard, Air Force, and Space Force service members, including National Guard and Reserve components, and their families. 1-877-WAR-VETS is an around the clock confidential call center where Veterans, service members and their families can talk about their military experience or any other issue they are facing in transitioning after military service or trauma and get connected to their nearest Vet Center.

Vet Centers in VISN 20

Vet Centers provide counseling to make a successful transition from military to civilian life or after a traumatic event experienced in the military. Individual, group, marriage and family counseling is offered in addition to referral and connection to other VA or community benefits and services. If you can’t make it to a nearby Vet Center, VA offers satellite Vet Center locations and Mobile Vet Centers that may be closer to you.

Explore VA.gov

VA has a variety of mental health resources, information, treatment options, and more — all accessible to Veterans, Veterans’ supporters, and the general public. Explore the pages below to learn more about a specific mental health topic. Each of these pages includes resources, information on treatment options, and more.

Stories of Support