The Department of Veterans Affairs opened an Inspector General probe in February in response to a War Horse investigation alleging that veterans were being cut off from one-on-one therapy at VA medical centers.
In an August 2025 investigation and December follow-up, War Horse reporter Leah Rosenbaum documented the experiences of dozens of veterans struggling to access or continue one-on-one mental health care through VA. The December story focused on two veterans who said they were told their individual therapy would be ended because of local session caps.
One of them, Marine veteran Spencer McKinstry, said he struggled with nightmares after two combat deployments to Afghanistan. He shared a clinical note with The War Horse stating that his psychologist “has repeatedly been informed by her supervisor … that she must adhere to local clinical policies and procedures that restrict most veterans to a maximum of 24 therapy sessions or there will be disciplinary action taken.”
The VA Office of Inspector General cited the December War Horse investigation in justifying its review, which began on February 9. Although veterans interviewed by The War Horse described similar experiences at VA facilities around the country, the OIG focused solely on where the central figure of The War Horse story, Army veteran Phoebe Ervin, sought care: Northport VA Medical Center in New York.
Investigators questioned facility staff over allegations that VA leaders had instructed therapists to limit individual psychotherapy to 24 sessions and that two patients had their treatment terminated as a result, according to its report published Aug. 26.
The OIG said it “did not substantiate” that facility leaders had explicitly told staff to limit patients to 24 sessions.
But investigators found that Northport leaders used caseload metrics involving patients who received more than 24 therapy sessions in staff performance evaluations. The report warned that doing so “may influence providers to factor caseload expectations into clinical decisions.”
The facility’s standard operating procedure also described “a typical episode of care up to 24 sessions,” while allowing providers to extend treatment based on clinical need. While many therapists told investigators they felt supported when extending care, others described a different environment.
Several told OIG they feared failing to meet facility benchmarks and believed they were required to end patients’ therapy within a short period. According to the report, some said they made “difficult decisions about terminating patients who they believed could still benefit from psychotherapy and felt pressured to do so against clinical judgment.”
The OIG recommended that Northport VA’s medical center director consider reviewing the inclusion of caseload metrics in performance evaluations and to evaluate whether patients terminated from therapy may have been harmed.
