Phoebe Ervin tried everything to drown out the sound. As golf fans descended on her Long Island, New York, community in late September to watch the U.S. and Europe compete for the Ryder Cup, she tried desperately to ignore the whir of helicopter blades.

This time, they were ferrying VIPs to the course, not flying above the desert of Iraq.

“It just really brought up some bad memories,” said the 58-year-old Army reserve veteran, who suffers from mental health issues after multiple deployments during the Gulf and Iraq wars. “I was on edge the whole weekend.”

Normally, she would speak with her VA psychologist about coping mechanisms. But just weeks earlier, Ervin had been told by her therapist of 16 years that she had been getting one-on-one mental health sessions at the Department of Veterans Affairs for too long.

She was getting cut off.

“I feel lost,” she said. “All this stuff is happening to me, [but] I have no outlet to talk to anybody.”

Ervin is one of more than three dozen veterans who reached out to The War Horse to share their deeply personal mental health struggles after the news organization reported in late August how VA medical centers across the country have been limiting the number of one-on-one therapy sessions veterans can receive as part of their care.

Spencer McKinstry, a Marine veteran in New York, said he still struggles with nightmares and wakes up in “a puddle of sweat,” but he was told at the end of last year that he had reached the limit of mental health sessions at his regional VA medical center after seeing a psychologist there for nearly three years.

McKinstry’s psychologist spelled it out in a clinical note, reviewed by The War Horse: “Despite clinical need and veteran’s treatment preferences, undersigned [the 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.”

“I did my job,” said McKinstry, who did two combat deployments to Afghanistan. “You said you’d take care of me for the rest of my life. The rest of my life is not 20 sessions.”

VA is emphatic that it has no policy to cut off one-on-one mental health sessions and says that its doctors work hand in hand with veterans to craft care plans. 

“VA always works with Veterans over an initial series of health sessions and collaboratively plans any needed follow-on care after that,” VA Press Secretary Peter Kasperowicz said in an email response to The War Horse. “As part of this process, Veterans and their health care team decide together how to address ongoing needs.”

“The goal is recovery, healing and helping Veterans achieve greater independence and resilience.”

But mental health providers in five states told The War Horse they have been under pressure in recent years to cap one-on-one therapy, as the department struggles to find enough providers to care for the 1.7 million veterans who get mental health treatment at VA. The caps have been rolling out for years during both the Biden and Trump administrations. The War Horse obtained policies from VA medical centers through a Freedom of Information Act request: Some recommended discharging most patients after eight sessions, others after 15 or 24. While the reduced number of sessions may be enough for some veterans, providers and veterans say that many need longer-term treatment.

Veterans told The War Horse they experienced increased anxiety, depression, substance use, and PTSD symptoms after losing access to one-on-one therapy.

One Navy veteran said he “ended up spiraling” after the VA Medical Center in Richmond, Virginia, ended his one-on-one therapy after nine consecutive months in October 2024. Joe R., who asked that his last name be withheld to protect his medical privacy, said he stopped taking his medication, took up smoking again, and started drinking after being sober for seven years.

The good news: After a six-month disruption in his treatment, he was eventually able to get one-on-therapy again through a private mental health provider billed to VA through its community care program. He said he’s doing better now, but is still angry about the interruption. 

“It’s a bit hypocritical to say, ‘Come here, I’m here to help you and take care of you,’ and then kick you out the door because you didn’t get better on their timeline,” he said. 

In responding to questions for this article, VA’s Kasperowicz pushed back, saying the agency could not address individual allegations in detail without permission from veterans to discuss their cases. 

To verify complaints, The War Horse spoke with the friends and family of some of the veterans, as well as reviewed screenshots of therapy clinical notes. Phoebe Ervin went a step further and signed a waiver allowing VA to speak to The War Horse about her care.

If you are struggling with your mental health, help is available. Contact the Veterans Crisis Line by dialing 988 then pressing 1, or text 838255.

Confronting Her Darkest Hour

Ervin calls Jan. 19, 2009, “The Black Day.”

That’s when she began hearing voices, telling her to kill herself. Alarmed, a friend took her to the Northport VA Medical Center on Long Island, where she has been getting mental health treatment ever since. She’s done art therapy, music therapy, group therapy, anger management courses, and has taken medication. Through a nonprofit foundation, she rode horses as part of equine therapy. For 16 years, she also did one-on-one psychotherapy with a mental health provider.

This talk therapy was particularly helpful, Ervin said—but it took a long time for her to build trust with her provider. “If I don’t feel comfortable with you, I’m not going to talk,” she said. “That’s how veterans are.”

Sixteen years is a long time to be in therapy—too long, according to many at VA. For one, there just aren’t enough therapists to provide every veteran who wants unlimited therapy. And there are signs this provider shortage is getting worse.

Are you a VA mental health provider or patient who would like to share your story? Reach out to our reporter via email at leah.rosenbaum@thewarhorse.org or leah.rosenbaum@proton.me, or on Signal at leahrosenbaum.01

According to an August report from the VA’s inspector general, psychology was the most frequently reported area for severe clinical staffing shortages at VA medical facilities.

Research shows that short courses of certain types of therapy, like cognitive behavioral therapy, are highly effective for treating issues like anxiety, depression, and PTSD.

“I would absolutely agree that PTSD is recoverable for the vast majority of individuals,” said M. David Rudd, a professor of psychology at the University of Memphis, who studies military suicide prevention. But, he said, “it requires quick treatment.”

When care is delayed, PTSD can become chronic and complicated by other conditions like substance use disorder. But unlike diabetes or high blood pressure, which VA will treat as a lifelong condition, mental health is viewed as something that only needs short-term treatment. “We, for whatever reason, tend to think of mental health differently,” said Rudd, an Army veteran who was a psychologist during the Gulf War for the 2nd Armored Division.

There is still a lot of stigma attached to mental health, he said.

When mental health treatment does end, Rudd said, it should be tapered down slowly. “It’s arguably unethical to just abruptly discontinue care for some individuals that are chronically ill.”

Veterans, particularly those who have served in combat, often have to deal with complicated and unresolved loss. Rudd said. “When a therapist cuts you off, it’s a reemergence of that loss, in a very symbolic, very significant way.”

But more than that, Rudd said, is a feeling of betrayal that veterans can feel from the VA medical system itself. “They feel like the very institution that they have committed to serve and sacrifice for and experience significant loss for has betrayed them,” he said. These types of policy changes “confirm that kind of betrayal.

An Abrupt End to Treatment

For Ervin, the length of treatment mattered, she said. She is still prepared to huddle in the bathtub with a comforter when a thunderstorm hits, and panics during the Fourth of July. But with long-term treatment and the weekly support of a therapist, she said she went from being homeless to working at a shelter for homeless men.

“I don’t give a damn how long it’s been,” she said. “Now you want to take it away, because you’re looking at the years, not at the accomplishments.”

Her younger sister, Alice Ransom, said she has seen “a tremendous change” in Ervin in the years that she has been in therapy. Ransom, who describes her sister as her “rock,” watched her go from suicidal and having trouble holding down a job, to becoming a vibrant, productive person. But now, Ransom said, “I don’t know if she’s gonna slide back to her old feelings and ways.”

What was especially difficult for Ervin was the abruptness with which her sessions ended. Ervin said she wasn’t transitioned from weekly appointments to monthly, or even given much of a warning.

“They didn’t wean me off,” she said, “They just said, that day, ‘That’s it. Gone.’”

VA’s Kasperorwiscz disputes that, saying when Ervin’s “most recent round of care with a psychologist concluded in September,” the department “immediately reached out to the veteran to assess next steps and schedule additional treatment.” He said Ervin “has declined to engage in this follow-up discussion so far.”

Ervin said VA only reached out after she called the VA crisis line, and she no longer trusts the Northport VA to have her best interests in mind when it comes to mental health treatment. She is trying group therapy and is still being followed by a VA psychiatrist.

But since her therapy ended, Ervin said she has experienced an increase in anxiety, irritability, and other symptoms. At work, she said, “I can’t afford to be having outbursts,” so she stuffs her feelings down as much as possible.

At the shelter, coworker Louis Marcelin said, Ervin is the one going “above and beyond,” advocating on behalf of homeless veterans and linking them to services.

Now, her coworkers worry about her. Marcelin said Ervin became so anxious at work one day about no longer having access to therapy that she had to go to the hospital. “I never saw her like that,” he said.

Instead of feeling like herself, these days Ervin said she just feels tired. “I can see myself going backwards.”

This War Horse news story was edited by Mike Frankel, fact-checked by Jess Rohan, and copy-edited by Mitchell Hansen-Dewar. Hrisanthi Pickett wrote the headlines.