VA and NW MIRECC History

VA 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. Later, the Continental Congress of 1776 encouraged enlistments during the Revolutionary War, providing pensions to disabled soldiers. 

On August 7, 1782, General George Washington ordered a "Badge of Military Merit" worn as the "Figure of a Heart in Purple Cloth or Silk edged with narrow Lace or Binding." The Purple Heart is also the nation’s oldest military award. 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. The U.S. Naval Asylum in Philadelphia was the first federal facility to provide institutional care for disabled and elderly Veterans.

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. 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. 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

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".

From 1866 to 1930, branches of the National Home for Disabled Volunteer Soldiers opened throughout the country. Following the Civil War, many state Veterans homes were established. Indigent and disabled Veterans of the Civil War, Indian Wars, Spanish-American War, and Mexican Border period, as well as the discharged regular members of the Armed Forces, received care at these homes. Beginning in late 1800's, National and State Homes opened in Idaho, Oregon, and Washington.

A majority of existing VA hospitals and medical centers began as National Home, Public Health Service, U.S. Marine Hospitals, or Veterans Bureau Hospitals. 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. 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. Roseburg Oregon VA Hospital opened in 1917 and within five years was redesignated to operate as a Neuropsychiatric Veterans hospital. 

The first Veterans Hospital in Portland Oregon opened in November 1921. A year later the United States Public Health Service (USPHS), founded as U.S. Marine Hospital Service (USMHS), transferred the Portland hospital to the United States Veterans Bureau. In January 1926, Sam Jackson, publisher of The Oregon Journal, deeded 25 acres on Marquam Hill in Portland to the United States Veterans Bureau for a Veteran hospital. Site preperation of the 450-foot-tall basalt-rock hill began in 1927. Construction of Building #1 of the new Veterans Hospital began in early 1928 - the beginning of what is now Portland VA Medical Center (PVAMC). Also in 1928, admission to the National Homes was extended to women, National Guard, and militia Veterans.

The American Lake Washington campus began 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 - neuro-psychiatric treatment. On March 15, 1924, the first 50 patients were admitted to the hospital, by transfer, from Western State Hospital at Fort Steilacoom. In Washington, there were U.S. Marine Hospitals located in Seattle, Port Townsend/Port Angeles, and Knappton Cove. 

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.” 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. 

In President Herbert Hoover's State of the Union message, December 3, 1929, President Hoover informed Congress, "The administration of all laws concerning the veterans and their dependents has been upon the basis of dealing generously, humanely, and justly…  I am convinced that we will gain in efficiency, economy, and more uniform administration and better definition of national policies if the Pension Bureau, the National Home for Volunteer Soldiers, and the Veterans' Bureau are brought together under a single agency." Despite the challenging times facing the country, President Hoover acted. On July 21, 1930, President Hoover signed Executive Order 5398, consolidating three agencies administering Veterans benefits programs into a single entity called the Veterans Administration, thereby creating the modern VA.

In January 1931, 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. The Veteran population vastly increased in the 1940s following World War II – 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.

On January 3, 1946, President Harry Truman established the forerunner of today’s Veterans Health Administration when he signed Public Law 79-293, creating the Department of Medicine and Surgery within the Veterans Administration. The law enabled VA to recruit and retain top medical personnel by modifying the civil service system. In May of 1946 President Hary S. Truman authorized the transfer of the U.S. Army Barnes General Hospital in Vancouver Washington to the Veterans Administration. A year later, the new Vancouver VA Hospital would open as an annex to the Portland VA Hospital.

From 1950 to the present, the Boise VA Medical Center has occupied the main part of the grounds of the former Fort Boise. The sandstone buildings erected in 1864 are still in use by the Boise VA Medical Center today. After the end of World War II, the VA constructed the Seattle VA Medical Center on a 44-acre site. The Seattle VA Medical Center was dedicated on May 15, 1951, on Beacon Hill, with 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. The American Lake Veterans Golf Course, owned by the VA, was added shortly after World War II in the mid 1950’s. New construction of the Portland VA Medical Center on Marquam Hill was completed and dedicated in 1987 and opened to patients in February 1988.

On October 25, 1988, President Ronald Reagan elevated VA to a cabinet-level executive department. 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." The Veterans Administration was then renamed the Department of Veterans Affairs, and continued to be known as VA.

As part of the cabinet-level elevation, VA’s Department of Medicine and Surgery was re-designated as the Veterans Health Services and Research Administration. In 1990, President George H.W. Bush announced that the United States considered Iraq's aggression and invasion of its neighbor Kuwait unacceptable. President Bush backed up his words with a military response named Operation Desert Shield, and organized a coalition of 35 nations to defend Saudi Arabia and ultimately liberate Kuwait. President Bush announced the start of the Desert Storm air campaign on January 16, 1991. Also in 1991, the Veterans Health Services and Research Administration was re-designated Veterans Health Administration (VHA). The Anchorage Alaska VA Medical Center was opened in 1992. Construction of a bridge spanning the 150-foot-deep ravine at the Portland VA Medical Center was completed in 1992. The 660 foot skybridge physically joined the Portland VA Medical Center to the Oregon Health and Science University (OHSU) Medical School.

The history of the NW MIRECC begins with the many Veterans and Servicemembers who served their country and then found their lives unsettled by flashbacks, nightmares, thinking difficulties, and other mental health concerns. It begins with Veterans Integrated Services Network (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 these Veterans. And it begins with a nationwide response by VA leaders and Congress, who funded leaders from the Puget Sound VA Health Care System (VAPSHCS) and the Portland VA Health Care System (VAPORHCS) in the fall of 1997 to establish one of the first three Mental Illness Research, Education, and Clinical Centers (MIRECCs) in the United States.

The primary research center located at VAPSHCS is affiliated with the University of Washington (UW). VAPSHCS serves Veterans from a five-state area in the Pacific Northwest with two main divisions: American Lake and Seattle. Veterans in Washington are also served by VA Medical Centers in Spokane, Vancouver, and Walla Walla. The research center located at VAPORHCS is affiliated with the OHSU. VAPORHCS serves Veterans from Oregon and Southwest Washington with two main divisions: Portland and Vancouver. Veterans in Oregon are also served by VA Medical Centers in Roseburg and White City. VISN 20 spans three time zones and includes medical centers in Alaska, Idaho, Oregon, and Washington.  

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 military PTSD and its complex comorbidities. The most prominent of these comorbidities is repetitive blast mild traumatic brain injury (mTBI); others are alcohol use disorder (AUD), chronic pain (in particular, post-concussive headaches), cognitive impairment, and increased risk for neurodegenerative disorders (chronic traumatic encephalopathy [CTE] and Alzheimer’s disease [AD]). NW MIRECC seeks 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. The knowledge produced by NW MIRECC research efforts is disseminated through VA's Institute for Learning, Education and Development (ILEAD) web-based learning platforms and face-to-face educational offerings, and directly implemented in clinics throughout the Northwest and throughout the country.

From its early days, NW MIRECC has conducted research to understand PTSD, TBI, and other mental health challenges facing Veterans, including Alzheimer’s disease. During its first years, NW MIRECC focused on PTSD, schizophrenia, and 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 collaboration with the VA ILEAD. In this way, MIRECC Presents empowers mental health providers 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.

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. 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. 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. 

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. Because it is provided online, the MIRECC Presents continuing education series is accessible to clinicians throughout the United States. The target audience includes, but is not limited to, Physicians, Nurses, Psychologists, Social Workers and other professionals supporting Veteran care and active-duty combat personnel who will become Veterans. As part of the VISN 20 Northwest MIRECC mission to enhance access to mental health expertise, the 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.

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. The VISN 20 NW MIRECC research studies significantly contribute to advancements in understanding medical problems that lead to health improvements for Veterans and civilians alike. VA is the world's leading research and educational center of excellence on PTSD and traumatic stress. Research studies at NW MIRECC are currently enrolling Military Veterans, First Responders, Health Care workers, and Civilians in Seattle, Washington. 

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's diligent search for answers to mental health problems afflicting our Veterans continue today. However, since that time, NW MIRECC has adapted its mission to more readily address the most critical needs of Veterans in this region: PTSD and its associated conditions; traumatic brain injury (mTBI), substance use disorders, chronic pain, 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 military 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.

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 military PTSD. Due in part to our 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 illnessess, including, for example, the postconcussive headaches that Veterans report as one of the most disabling symptoms of mTBI.

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.

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, the 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. VA has opened outpatient clinics and established telemedicine and other services to accommodate a diverse Veteran population, and continues to cultivate ongoing medical research and innovation to improve the lives of America’s patriots.

On March 15, 2019, VA Puget Sound Health Care System opened a new 220,000-square-foot Mental Health and Research Building on the Seattle campus. 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. Today's VHA - the largest of the three administrations that comprise VA - continues to meet Veterans' changing medical, surgical, and quality-of-life needs. The VA health care system has grown from 54 hospitals in 1930 to 1,600 health care facilities today, including 144 VA Medical Centers and 1,232 outpatient sites of care of varying complexity. VA provides health care for Veterans from providers in your local community outside of VA. The VA MISSION Act went into effect on June 6, 2019 providing Veteran eligibility to receive care from a community provider when VA cannot provide the care needed. 

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 pain, and dementia. NW MIRECC specialty clinics also offer clinicians in-depth training in the diagnosis and management of mental health conditions. 

Vet Centers in the VISN 20 Health Care Network 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. On August 5, 2003, then-VA Secretary Anthony J. Principi authorized Vet Centers to furnish bereavement counseling services to surviving parents, spouses, children and siblings of service members who die of any cause while on active duty, to include federally activated Reserve and National Guard personnel. 1-877-WAR-VETS is an around the clock confidential call center where combat Veterans and their families can call to talk about their military experience or any other issue they are facing in their readjustment to civilian life. 

The Plymouth colony first cared for veterans beginning in 1636. Three hundred and eighty-seven 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

Browse facilities by state

VA VISN 20 consists of four states across three time zones; Alaska, Idaho, Oregon, and Washington. The primary research center located at VA Puget Sound Health Care System (VAPSHCS) is affiliated with University of Washington (UW). VAPSHCS serves Veterans from a five-state area in the Pacific Northwest with two main divisions: American Lake and Seattle. Veterans in Washington are also served by VA Medical Centers in Spokane, Vancouver, and Walla Walla. In Washington, there are VA Community Based Outpatient Clinics (CBOC's) located in Bellevue, Bremerton, Chehalis, Edmunds, Everett, Federal Way, Mount Vernon, Olympia, Port Angeles, Puyallup, Richland, Renton, Silverdale, Seattle, Wenatchee, and Yakima. The research center located at VA Portland Heath Care System (VAPORHCS) is affiliated with Oregon Health and Science University (OHSU). VAPORHCS serves Veterans from Oregon and Southwest Washington with two main divisions: Portland and Vancouver. Veterans in Oregon are also served by VA Medical Centers in Roseburg and White City. In Oregon, there are CBOC's 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. VA provides health care for Veterans from providers in your local community outside of VA. Veterans may be eligible to receive care from a community provider when VA cannot provide the care needed.

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