{"id":11356,"date":"2024-07-11T23:00:28","date_gmt":"2024-07-11T23:00:28","guid":{"rendered":"https:\/\/niemanstoryboard.org\/2024\/07\/11\/investigative-journalism-editing-mental-health-military\/"},"modified":"2025-06-12T23:33:56","modified_gmt":"2025-06-12T23:33:56","slug":"investigative-journalism-editing-mental-health-military","status":"publish","type":"post","link":"https:\/\/niemanstoryboard.org\/2024\/07\/11\/investigative-journalism-editing-mental-health-military\/","title":{"rendered":"Effective editing: Navigating failures of the military’s mental health system"},"content":{"rendered":" \n
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Alexandra Zayas caught the journalism bug as a kid growing up in Miami, Florida, following some of biggest news events of the time. From there, she earned a journalism degree, spent several years reporting at the Tampa Bay Times and made a brief move into editing before national news organizations came calling.<\/p>\n\n <\/div>\n <\/div>\n \n

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Now, as deputy managing editor of ProPublica, Zayas has moved into editing where she builds training programs for other editors and reporters, guides big-picture projects and continues to work as the primary editor of the organization\u2019s top bylines.<\/p>\n\n <\/div>\n <\/div>\n \n

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In our occasional series on Effective Editing, we featured a Q&A with Zayas<\/strong><\/a> where she emphasized her belief in emotional intelligence as a crucial editing skill. In this post, Zayas provides an editor\u2019s view of how a major project came together.<\/p>\n\n <\/div>\n <\/div>\n \n

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ANNOTATION: Storyboard\u2019s questions are in red; Zayas\u2019 answers in blue. <\/em><\/p>\n\n <\/div>\n <\/div>\n \n

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Veterans Without Assistance<\/h2>\n\n

Investigating Mental Health Care in the VA System

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Three Days of Tragedy: How a VA Clinic\u2019s Inability to Help Veterans in Crisis Destroyed Two Families<\/a><\/h4>\n\nTwo veterans sought psychiatric care at a VA clinic in Chico, California. They were bounced between virtual providers and struggled to get support in the threadbare system. A staffer worried, \u201cWe are going to kill someone.\u201d Then tragedy struck.<\/em>\n

\nby\u00a0Kathleen McGrory<\/a>\u00a0and\u00a0Neil Bedi<\/a>, ProPublica, photography by\u00a0Loren Elliott\u00a0for\u00a0ProPublica<\/a>,\u00a0\nJan. 6, 2024\n
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\n\nM<\/span>arty and Candy Larsen were in their pajamas, getting ready to watch a movie in the living room, when they heard their 27-year-old daughter scream.
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\n\u201cI need help!\u201d Julia cried.
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\nThey could see her standing just a few feet away, her long blond hair unkempt, her blue-gray eyes at once alert and vacant. She\u2019d looked like this in other moments when fear overtook her and reality slipped away. But a new sight jolted them upright: their daughter\u2019s fingers, wrapped around a pink handgun.
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\nJulia pounded the weapon against a wall, then squeezed its trigger, sending a bullet down an empty hallway. \u201cHelp me!\u201d she shrieked. <\/a>Why did you choose to open the piece here?<\/span>We were all taken aback by the fact that Julia is captured asking for help dozens of times on that 911 call recording. It felt resonant, since this is a story about veterans not getting the help they need.<\/span><\/span>
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\nThe parents scrambled in different directions. Candy was on with 911 while Marty reached toward his daughter. \u201cJulia, stand down,\u201d he said. \u201cHow can we help you if you don\u2019t stand down?\u201d
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\nBut Julia fired again, repeating her plea like a mantra.
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\n\u201cHelp me!\u201d she cried. \u201cHelp me!\u201d
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\nThe need had been building for almost six years, since she returned home from a stint as a Navy firefighter aboard a warship in the Persian Gulf. She was tormented by the rippling trauma of an on-duty sexual assault and grappling with symptoms that led her to be diagnosed with a psychotic disorder.<\/a>When you thought about pacing, how did you and the writers decide this was the right place to zoom out and give the reader some context in terms of Julia\u2019s personal history?<\/span>I don\u2019t like making the reader get too deep into a story without clueing them into its bigger-picture significance. I\u2019ve analyzed 11 years worth of stories that placed in the Pulitzer Prize\u2019s investigative category; they get to their first finding, on average, by word 166. In traditional investigative reports, that often happens with a hard pivot to the nut graf. You can be more artful than that with a narrative, and there are plenty of successful investigative narratives without nut grafs. But baking in as early as possible why this story matters is important. Also, narratively, the 153-word opening scene is enough to establish the situation and the stakes; any more than that would simply be an unfolding of plot points that will resonate more later on, once the reader has gotten to know the characters and history.<\/span><\/span>
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\nShe was dependent on the Department of Veterans Affairs for care. Just that morning, when her latest crisis began, a nurse at the local VA clinic in Chico, California, had told her mother to bring her in. When they arrived, a telehealth provider was too busy to see Julia. A social worker asked questions to gauge her risk of suicide or violence; even though Julia refused to answer, she was sent out into the world and told to return for the next available appointment, in 11 days.
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\nSuch dysfunction had become the norm at the Chico clinic, one of several hundred such community facilities designed to serve veterans who live far from the nation\u2019s big cities. From the outside, it looked like a haven for heroes: a state-of-the-art building with a gleaming atrium, a large American flag flying out front. But the clinic hadn\u2019t had a full-time, on-site psychiatrist in five years. A single nurse was responsible for connecting hundreds of veterans, some with serious mental illness or active suicidal thoughts, with an ever-changing lineup of telehealth providers in different time zones.<\/a> Echoing my question above, how did you decide this was the spot to introduce some systemic context? And how did you balance keeping the pace moving while getting in what you needed to?<\/span>We always knew that we needed to follow Julia\u2019s big-picture context with systemic context, but in earlier drafts, we were doing it in a thinner, more sterile way. It wasn\u2019t until our brilliant top editor, Tracy Weber<\/a>, came in that this paragraph and the next became what they are. She felt it important that we develop the clinic as its own character. She is the best editor I\u2019ve seen who can marshal and hone investigative findings from throughout a piece into the top of a narrative to elevate the whole thing.<\/span><\/span>
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\nThe military has long drawn recruits from remote towns across America, promising them a lifetime of health care in return for their service. But the VA has seldom staffed those same communities with the mental health professionals needed to help them once they return home. Two decades of war in Iraq and Afghanistan have turned this chronic shortcoming into an emergency. The demand for mental health care has grown at a rate that\u2019s triple the rate of growth for all VA medical services. Anguished employees, doing what they can with threadbare staffing and glitchy technology, are burning themselves out trying to avert disasters that feel inevitable. In Chico, nurses and social workers cried after their shifts, and the new site manager, a veteran and longtime health care administrator, had made a grim prediction: \u201cWe are going to kill someone,\u201d she told colleagues.<\/a>This nut graf is super effective.<\/span><\/span>
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\nIf hindsight is 20\/20, agency officials should have exquisite vision by now.<\/a>A cutting line.<\/span>I suggested this line, and I share that with permission to underscore a point: Whether it\u2019s any good is subjective. Another writer may have thought it was too much, or not in line with their voice. This is where building trust comes in; writers need to feel comfortable enough to push back on adds like this.<\/span><\/span>Their files are littered with cautionary tales of missed screenings and insufficient follow-up; in at least 16 instances since 2019, veterans who received inadequate care wound up killing themselves or other people; an additional five died for reasons related to the poor quality of care. Each time, investigators with the VA\u2019s Office of Inspector General swooped in to determine whether the system failed; each time, they concluded it had.<\/a>Shout-out to Neil Bedi who led an analysis of IG reports that allowed us to convey this broader harm. It was important to convey this wasn\u2019t a freak one-off but a chronic problem.<\/span><\/span>
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\nTo plug the holes, the VA grew its nationwide mental health workforce by more than 4,000 last year and plans to hire an additional 5,000 professionals over the next five years. But the sense of dread lingers. It\u2019s a \u201cperfect storm of real potential for gaps in care,\u201d said Alyssa Hundrup, a director on the Government Accountability Office\u2019s health care team.
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\nJust as violence was erupting in Julia\u2019s home on Jan. 3, 2022, another veteran sat alone in his dark bedroom, not far away, ruminating. Deep circles hung below his eyes. An unruly beard covered his chin.<\/a>How did you think about threading Julia\u2019s story with the second veteran? Why was it important to introduce both of them in the first section, and did you consider different ways to make this segue?<\/span>The reason we decided to embark on this story at all was the unbelievable fact that these two incidents were linked so closely in time and place. It would\u2019ve felt like a stretch in a fictional movie, and yet, here we were. We wanted to give these two veterans\u2019 stories equal weight, which proved challenging at the start because we had far more information on Julia\u2019s case than Andrew\u2019s. The story got far stronger the more the reporters were able to learn more to achieve that balance.<\/span><\/span>
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\nAndrew Iles, 33, had come to believe the government was monitoring him and that his mother was in on the conspiracy. He, too, had tried to get help at the Chico clinic but for years was passed from provider to provider. Recently, all he could get was a psychiatric pharmacist who prescribed him pills. He felt abandoned, concluded the VA had never wanted to help him and slipped into a state of paranoia so intense that he threw away his belongings and holed himself up inside his mother\u2019s house.<\/a> How did the writers gain these insights into Andrew\u2019s thinking?<\/span>They did a tremendous amount of work to obtain access to both veterans and their surviving families, who participated in multiple interviews. The vets also signed off on allowing the reporters to see their psychiatric records. I want to shout-out Kathleen McGrory<\/a>, whose superpower is her emotional intelligence. She did a beautiful job of building and maintaining trust with these subjects.<\/span><\/span>
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\nHis sister, once his protector and closest ally, had stopped bringing her family to see him. His mother had tried to remove all of the firearms from the house but missed a few. Andrew had stowed them away.
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\nCHICO, CALIFORNIA, SITS<\/strong> in the northern Sacramento Valley, in the shadow of the Sierra Nevada mountain range. It\u2019s a college town home to museums and breweries, funky cottages and trendy restaurants. Climb into the foothill elevation, though, and you enter another world. Aside from some big-box stores and picturesque downtowns, it\u2019s mostly wilderness dotted with private homes. Cellphone service is spotty. Roads snake through dense forests.
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\nAndrew Iles grew up in a particularly isolated community called Concow. When he was a kid, only a few hundred people lived there. They drove the same mountain roads, shopped at the same convenience store. There were enough children for a small school, but each grade level had just a handful of students. Most were eligible for free lunch.
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\nAndrew\u2019s family lived a mile off the main road in a one-room, A-frame home that sometimes had no electricity or running water. His parents, Glen Iles and Sue Hill, used methamphetamines. They disappeared, often for days at a time, and let other drug users hang around the house. Some of them forced Andrew and his big sister, Ashley Hill, to engage in horrific sex acts. The kids stayed quiet about the abuse. \u201cWe were so afraid to say anything,\u201d Ashley recalled.
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\nThe siblings sought refuge on the mountainside. It was their own wild playground, full of creeks to splash in and salamanders to chase. But violence was never far. Once, when Andrew and Ashley were in grade school, they found their mother handcuffed to a refrigerator, bleeding from three gunshot wounds. A few years later, they watched Glen hold Sue at gunpoint and threaten to shoot her. Ashley called 911. Glen fled into the forest on his ATV but was caught and sent to prison. The ordeal made the local newspaper.<\/a>Why did you feel it was important to share details this early in the story about the childhood trauma that Andrew had experienced?<\/span>It was important to show these veterans as whole people, and this was a significant part of Andrew\u2019s early life. Also, the reporters learned the military population has a higher proportion of members who had adverse childhood events than the civilian population.<\/span><\/span>The arrest was a turning point. Sue stopped using drugs. She found a new partner and moved the family a few times, ultimately settling in a small city in the foothills called Oroville. After finding steady work at a rent-to-own furniture store and a new place to live, she started rebuilding her family.
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\nAndrew grew into a gangly teenager with a sly sense of humor who wore braces, dyed his hair bright colors and swept his long bangs across his face. He and his friends were emo kids; they listened to Fall Out Boy and spoke out against the war in Iraq. Andrew dated the same girl for years. He showered her with attention and wrote her silly notes. He put considerably less effort into his schoolwork. As graduation neared, he started to believe he needed structure and discipline, and he thought the Air Force might provide it. Plus, he had a mind for math and technology, and the idea of working on multimillion-dollar airplanes appealed to him. \u201cIf I don\u2019t do something like this,\u201d he told his mother, \u201cI\u2019ll be in Oroville for the rest of my life.\u201d
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\nAs a new airman, Andrew was stationed in Arizona as an aircraft electrical and environmental systems apprentice. His supervisors rated his performance as \u201ctruly among the best.\u201d His first evaluations touted his \u201cunrivaled initiative\u201d and described him as a \u201csuperior performer\u201d and \u201cstellar airman.\u201d One evaluation ended with a simple declaration: \u201cPromote now!\u201d<\/a>Why did you choose to include these performance reviews?<\/span>These are some of my favorite details in the story because they show the tremendous promise Andrew had; it makes what happens later in the story that much more devastating.<\/span>And how did the reporter gain access to them?<\/span>Andrew had saved copies and his family shared them with the reporters with his permission.<\/span><\/span>
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\nAndrew raised his hand for an assignment on Kunsan Air Base in the Republic of Korea where he could work on F-16 fighter jets. He traveled the country by train, visiting university cities so he could meet people his age. He found it thrilling to be somewhere so different from Concow with such freedom to explore.
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\nHis next tour took him to Ramstein Air Base outside Frankfurt, Germany, to work on hulking C-130s. He was 22 then, excited to visit Berlin, Amsterdam and Paris. But he was increasingly looking over his shoulder, wondering what his peers were saying about him.
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\nAround that time, Andrew sent emails to his mother and sister that described neighbors spying on him. Sue and Ashley found the letters troubling. In some ways, Andrew sounded like his father, who had never been diagnosed with mental illness but was prone to paranoia and conspiracy theories.
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\nAndrew had reached the age when, experts say, a typical life can start to veer off course. It is generally believed that some people have a greater biological risk of developing psychotic disorders than others. Genetics can play a role. Environmental factors like stress can trigger the onset of illness or make it worse than it would have been. Symptoms tend to begin when people are in their late teens or early 20s, as their brains mature. <\/a>Explaining the mechanisms of the onset of psychiatric disorders can be super complex, but you frame it in quite a brief and digestible way here for readers. Was this challenging? <\/span>It wasn\u2019t easy. We started with too little context but realized that spelling this out helped address questions about how to think about his family history and childhood trauma in relation to his illness.<\/span><\/span>
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\nAndrew sought out behavioral health services on the base, he said. But he was certain his bosses saw him differently after that. He felt some treated him like he was less capable, while others seemed to think he was faking. He considered ending his life.
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\nIn late 2010, long before Andrew was supposed to leave Germany, he wrote his commanding officer saying he no longer believed he could do his job and asking to leave the military, he recalled. The Air Force approved his request for separation, giving him an honorable discharge, records show, but required him to transfer his remaining active duty service to the reserves, he said.
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\nWhen asked about the circumstances of Andrew\u2019s separation, an Air Force spokesperson, Michael T. Dickerson, said he could not comment on anything related to an individual\u2019s physical or mental health or the nature of his or her discharge.
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\nAndrew flew back to the United States. He was active in reserves in northern California for a period. But his growing fears about government surveillance kept his mind in constant motion. At night, he thought he could hear strangers talking about him through doors and windows. By 24, he\u2019d moved back in with his mom and stepdad in Oroville, the one place he\u2019d dreaded ending up.<\/a>Did this description of Andrew\u2019s paranoid thoughts come from Andrew himself? Or was it reconstructed from the accounts of people around him?<\/span>It was a combination of those things. Andrew and Kat talked a number of times by phone and she drilled down on this detail, which struck her as a progression of his symptoms; he\u2019d gone from worrying about what others were saying about him to hearing voices. Other people corroborated it.<\/span><\/span>
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\nJULIA LARSEN GREW UP<\/strong> a 40-minute drive from Andrew in a quaint foothills town called Paradise. Her father worked for the post office. Her mother ran a home day care. The youngest of three daughters, Julia was bound by few rules. She spent most of her time outdoors, searching for animals or digging in the red earth. A treasured family photo shows her holding a catfish she reeled in herself.
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\nPeople who knew Julia as a teenager describe her as bubbly and a free spirit.<\/a> Did you intentionally want to parallel the chronology of Julia\u2019s tale with Andrew\u2019s, in terms of jumping backward to childhood early on?<\/span>Yes. It was just remarkable to us how these two very different people, with very different life stories, ended up in the same place.<\/span><\/span>Her senior superlative in high school was \u201cbiggest daredevil.\u201d Her family was always camping or hiking together. On weekends, when her friends came over for backyard sleepovers, her mother often joined them around the campfire. In Julia\u2019s mind, Paradise lived up to its name. But like many young people, Julia was eager to escape the place she was from. So one day, she and some girlfriends struck up a conversation with the local Navy recruiter.
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\nJulia told her parents while the family ate dinner together at the kitchen table. Marty, a Navy veteran with an anchor tattooed to his forearm, was elated. \u201cI couldn\u2019t stop bragging about her,\u201d he would later recall. Candy worried about Julia\u2019s safety overseas but trusted her to make the right decision. The two were more like sisters sometimes than mother and daughter.<\/a>I found this last detail to be really striking and reread it a few times. What did you want this sisterly relationship to signal to the reader? <\/span>There is a lot about this story that saddens me, but the most crushing aspect, to me, is that both of these moms were fighting hard for their sick kids and both of the veterans adored their moms. Establishing those relationships as early as possible was important, as was building out the moms as characters.<\/span><\/span>
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\nJulia arrived at boot camp outside Chicago in June 2012. She was 18. She traded a colorful sweater and jeans for a Navy-issued T-shirt and shorts and lined up to have her hair cut. The recruits marched and swam and studied and shot. It was easier than she expected. Her parents and middle sister came to watch her graduate. They cheered from the bleachers and then celebrated over deep-dish pizza and White Castle hamburgers.
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\nWhen it came time to specialize, Julia became a flight deck firefighter. She went for additional training in the Florida Panhandle, where she learned to work a high-pressure hose and handle rescue equipment. That fall, she was assigned to the USS Theodore Roosevelt, an aircraft carrier undergoing major upgrades near the Naval base in Norfolk, Virginia. Her home was a cramped bunk with a flimsy mattress deep in the ship\u2019s belly. She placed the few personal possessions she had in a tiny locker and reported for duty.
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\nShe doesn\u2019t remember much about the first day or even the first week. But she remembers the comments a supervisor started making about her body, and the way he pressed himself against her when she was chopping lettuce for the salad bar. Later, while she was on dishwashing duty in the ship\u2019s scullery, he approached again, she said. He grabbed her arms and folded them across her chest. Unbuttoned her top. Turned her around. He was bulky, much taller than her 5-foot-7-inch frame, and had a thick, dark mustache. Julia had never felt so helpless. She fought to free herself from his grasp, burning her right wrist on a hot dishwasher in the struggle, but was completely overpowered. Before he could get much further, another young sailor walked in. The supervisor got spooked and scurried out.
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\nJulia told a friend. Then she told the team that handled sexual assault allegations, she said. She wasn\u2019t afraid of repercussions. She had been so excited to enlist. Was this what the rest of her military experience would be like? The Navy gave her the option to transfer to a different ship. For Julia, it was an easy call. She no longer wanted to be on the Roosevelt.
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\nBut while the Navy offered Julia a fresh start, it didn\u2019t offer her mental health services, she said, as Department of Defense policies demanded. \u201cI would have taken them up on it,\u201d she told ProPublica. Asked to respond, a U.S. Navy spokesperson said, \u201cWhile we cannot comment on the care Ms. Larsen may or may not have received, the Navy takes mental health for our Sailors seriously.\u201d
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\nIt was, experts said, a crucial missed step. Research shows a clear association between military sexual trauma and mental health conditions including post-traumatic stress disorder, depression and suicidal ideation. Studies have shown treatment can help reduce PTSD and depression symptoms, which sometimes emerge years after the traumatic event.<\/a>I appreciate the clear and authoritative way in which the writers add expertise and perspective here.<\/span> The idea that her sexual trauma could have been somehow tied to her later mental health problems was a revelation to me when the reporters shared that.<\/span><\/span>
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\nJulia was assigned to the USS Kearsarge, a massive assault ship that was already in the Middle East to support troops in the global war on terrorism. During her second deployment to the region, in the spring of 2016, a Harrier jet burst into flames departing from the Kearsarge\u2019s flight deck<\/a>. Julia was startled by the deafening pop. She sprinted toward the burning aircraft with the other firefighters to battle the blaze. \u201cHer initial response, quick action and knowledge during an AV-8B Harrier fire on the flight deck was pivotal in the prevention of a major catastrophe and loss of lives,\u201d her supervisors wrote in her performance evaluation. <\/a>Again, why include the performance evaluation? What purpose did you want this input to serve for the reader?<\/span>In addition to establishing her promise \u2014 it casts her as a literal hero \u2014 it also gives an authoritative sense of the harrowing conditions she experienced during her service.<\/span><\/span>
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\nAlmost four years to the day after she began boot camp, Julia returned to California. She moved into a house in the southern Central Valley with her boyfriend from the Navy and enrolled at the local college. She set a goal of earning a degree in social work and becoming someone who could help veterans. But Julia couldn\u2019t shake the feeling that something was wrong. She had trouble concentrating on schoolwork. Some nights, she couldn\u2019t sleep. She sought out counseling through the VA.
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\nBy June 2017, Julia had started feeling scared of the world around her. One night, she was certain she could hear people walking on her roof and called the police. The officers who showed up made her feel even more anxious. She worried they would take advantage of her. She pushed one and wound up at the police station. She was later taken to a psychiatric unit.
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\nAs soon as Marty heard what happened, he drove six hours to pick up his daughter. He packed her belongings into suitcases and hitched her car to the back of his truck. On the ride back, Julia was convinced they were being followed. She begged her father not to draw attention by driving too fast or changing lanes. Marty was stunned to see his easygoing daughter acting so out of character. \u201cIt was like a switch had flipped,\u201d he recalled. <\/a>What a powerful quote.<\/span><\/span>
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\nFOR VETERANS<\/strong> in the foothills\u00a0like Andrew and Julia, the Chico clinic was all they had.<\/a>How did your team decide where to start and end these chapters?<\/span>We generally knew we wanted two parallel sections on their early lives that ended with their first struggles with mental illness, then two sections of them being failed by the clinic. The instinct was always that the sections would kick on an ominous beat, showing the problem getting ever worse. But the specific moments shifted as we grappled with these two very important clinic sections \u2014 more on that in a bit.<\/span><\/span>
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\nIts mental health team had been trying for years to convince regional leaders to add more positions. Even when the staff included two psychiatrists and a psychologist, plus a nurse, counselor, social workers and designated mental health administrators, the team struggled to keep up with growing demand, former employees told ProPublica. The clinic had more than 500 mental health patients, many of whom had complex illnesses.
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\nThe department\u2019s longtime manager, a psychiatrist named Russell Cottrell, recalled once noticing that other rural mental health departments in the region had more personnel per patient than Chico did, he said. When he asked about the discrepancy, his bosses stopped sharing the data. He fumed, he said.
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\n\u201cI don\u2019t think they paid attention to the growth we had,\u201d Cottrell told ProPublica. \u201cI would point it out and I\u2019d get in trouble.\u201d<\/a>I appreciate how these paragraphs made it clear that the providers are operating in a broken system themselves, rather than framing them as responsible for the ways that their clients\/patients were failed.<\/span>That\u2019s what we always strive to do with systemic investigations.<\/span><\/span>
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\nBy the summer of 2016, the staff had gotten smaller, and Cottrell was the only psychiatrist in the building. Cottrell was no stranger to hard work; an Army veteran, he had devoted his career to treating the most challenging mental health cases. But he was tired of begging for personnel and running out of energy. That fall, he made plans to retire.
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\nThe lead mental health nurse, Michelle Angela, sent an email to a regional mental health leader in the wake of Cottrell\u2019s retirement announcement. \u201cWe would like to invite you to come visit us at Chico Behavioral\/Mental Health for an update on what the plan will be,\u201d she wrote. \u201cIn addition to our concerns as staff members, our local veterans have been asking if there will be (a medical doctor) on site for their mental health needs.\u201d
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\nNo such doctor was hired. Instead, the clinic filled the gap with a combination of visiting doctors and doctors in other locations who connected with patients through computer screens.
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\nIn many ways, the Chico clinic was on the forefront of telepsychiatry, then an emerging way to deliver treatment that had the potential to broaden access to veterans in remote locations. But some mental health professionals had reservations. While virtual sessions might work for some patients, they worried others needed the trust and connection that could only be established in person.
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\nFor Andrew, who started coming in for treatment after his father died in 2013, the changes were disorienting. Andrew had been seeing Cottrell and starting to untangle his thoughts. When Cottrell retired in February 2017, Andrew was assigned to a temporary doctor, then a specialized pharmacist who wrote prescriptions, he said. Andrew resented the arrangement. \u201cI wanted to talk to someone routinely,\u201d he said, \u201cnot just get a load of meds.\u201d
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\nJulia first arrived at the clinic on June 23, 2017. She wouldn\u2019t maintain eye contact with anyone; while in the waiting room, she rearranged the chairs. That day, clinic staff offered her little in the way of answers. \u201cShe was informed that Chico VA Behavioral Health is an outpatient clinic and we do not have a psychiatrist on site,\u201d a social worker wrote in her medical records.<\/a>What was the process lof getting access to these medical records?<\/span>Julia’s attorneys had obtained her comprehensive medical records from the VA. They and Julia agreed to share them with the reporters so that we could accurately describe her symptoms and diagnoses as well as the care she received. Andrew’s relatives had only been able to obtain a subset of his medical records from the VA. They shared them with the reporters, with his permission, for similar reasons. The reporters tried to obtain the records on behalf of both veterans, but were unsuccessful. They learned that tracking down these records can be very challenging, even for veterans themselves.<\/span><\/span>
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\nThe following month, Julia started coming into the clinic for telehealth appointments with an off-site provider. Her records show she was diagnosed with PTSD from combat and military sexual trauma and bipolar disorder, the latter of which she disputes.
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\nFor a while, the patchwork system in the clinic\u2019s mental health department seemed to be working, current and former employees told ProPublica. But cracks started to show. In 2018, the psychologist left. And the clinic sometimes found itself without a telehealth provider available to refill medications or see patients in crisis, emails obtained by ProPublica show. <\/a>Are emails considered to be documents that reporters are entitled to via FOIA requests?<\/span>The reporters didn\u2019t obtain these through a FOIA request. As to emails in general, it depends on the content as well as the FOIA officer\u2019s interpretation of the rules.<\/span><\/span>
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\nThat November, a wildfire started burning up in the foothills. It was called the Camp Fire because it originated off Camp Creek Road. The blaze grew into a raging inferno that affected virtually everyone in the region. More than 10,000 homes were destroyed, including the one belonging to Marty and Candy Larsen where Julia grew up. At least 85 people died.
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\nThe day after the fire, when the air was still heavy with smoke and ash, Cottrell showed up at the clinic to help. He knew the fire would increase the demand for mental health services, he said. Seven months later, he came back on a part-time basis to help out until the clinic could hire a new full-time psychiatrist on site.
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\nMonths passed without a hire. Meanwhile, the Chico clinic moved into a gleaming new facility just a few miles away. The VA\u2019s website trumpeted its status as a green building with energy-reducing and cost-saving features. But none of that improved the mental health department, former employees said. In fact, the new building eliminated a designated waiting area for veterans in crisis as well as private offices for mental health practitioners, meaning patients were seen in bare-bones exam rooms that evoked a school nurse\u2019s office.
\n
\nAmid the turmoil, Andrew struggled. When he noticed Cottrell back in the clinic, he wondered if Cottrell hadn\u2019t really retired but had discarded him as a patient. Experts who were not involved in Andrew\u2019s care told ProPublica that the constant provider changes would likely have reinforced Andrew\u2019s paranoia and made him feel less connected to his care. One said the churn would have felt like a parent continually rejecting their child.
\n
\nJulia\u2019s life had become a rollercoaster. Some days, she felt great. She enrolled at Chico State and floated around its red-brick campus. \u201cShe could be very lucid and be her old self,\u201d Marty recalled. \u201cWe kept thinking, she\u2019s over it.\u201d But stressors would trigger her. She would flash back to her darkest moments, start feeling paranoid. It wasn\u2019t unusual for her to go days without sleeping.
\n
\nShe wanted counseling, she told ProPublica. But at the clinic, there was never enough time to get into it all. The focus seemed to be more on medication than talk therapy, she said. \u201cThey wanted to help me and (then) shoo me along,\u201d she said.
\n
\n***
\n
\nTHE STRAIN ON THE CLINIC<\/strong> would only get worse.<\/a>In terms of structure, how did you and the writers decide when to focus on the two narratives and when to focus on how the clinic was faring?<\/span>We initially had two sections that individually forefronted Julia and Andrew and their struggle to get treatment, but Tracy\u2019s excellent feedback on enhancing the clinic as its own character led us to instead forefront the clinic for these two sections and let chronology be our guide. That really helped capture the clinic\u2019s descent; naturally, the two vets\u2019 narratives mingled in new and interesting ways amid that. The approach amplified the gravitational pull toward how this would all culminate.<\/span><\/span>
\n
\nThe same month that COVID-19 swept across the country, the mental health team learned its designated administrative assistant would be shared by several departments. That made managing appointments even more difficult. Not long after that, one of the two telepsychiatrists started seeing fewer Chico patients.
\n
\nCottrell had had enough, he said. He decided he would retire for good at the end of the year. \u201cI saw it as a lost cause,\u201d he told ProPublica.<\/a>Did he express experiencing any internal conflict over this decision? <\/span>By this point in the chronology, Dr. Cottrell was so exhausted and frustrated, he felt like he had no other choice.<\/span><\/span>
\n
\nThat summer, a psychiatrist on the East Coast was hired to do virtual visits on a part-time basis. But increasingly, technical problems were disrupting appointments.
\n
\nIn emails to regional mental health leaders, Chico\u2019s front-line workers insisted that hiring an on-site psychiatrist should be the priority and noted the VA\u2019s own guidelines, which said veterans who were suicidal, violent or in need of immediate medical attention should not be referred for telehealth services. \u201cWe currently have numerous serious suicidal ideation patients,\u201d a nurse named Diana McMaster wrote. \u201cWith losing Dr. Cottrell, do we not need a psychiatrist in the building? A lot of times it is left up to Michelle and me to manage what happens with these patients on our side of the video. \u2026 That puts us in a precarious position.\u201d
\n
\nDr. David Gellerman, the chief medical director for mental health services in the VA\u2019s Northern California region, replied, writing, \u201cNo, we are not placing anyone in a precarious position. We can’t hire someone who does not exist… if we get a good psychiatrist or [psychiatric nurse practitioner] candidate who can be on location, we can try, but so far we have not had any acceptances.\u201d<\/a> This does give some helpful insight into the fact that the VA was trying, but clearly having difficulty, hiring for the role (rather than totally neglecting the effort).<\/span><\/span>
\n
\nGellerman pointed out that precautions were being relaxed in the pandemic. \u201cCare by telehealth is better than no care at all,\u201d he added.
\n
\nReached by email by ProPublica, Gellerman did not comment on the correspondence. He referred a reporter to the VA\u2019s public affairs office that covers the broader region of Northern and Central California, Nevada, Hawaii and the Philippines, which did not respond. A national spokesperson said agency guidance does not establish absolute conditions under which virtual care should not be given.
\n
\nBy then, Andrew had been diagnosed with schizoaffective disorder, a mental illness marked by a combination of schizophrenia and mood disorder symptoms. People with the disorder can experience psychotic symptoms, losing their connection to reality.
\n
\nAndrew hadn\u2019t been employed since returning to Oroville. He had come to believe people were trying to kill him, even his family. He spent most of his time alone in his bedroom. He slept upright in his computer chair and ate only food that came in a can so nobody could poison him.
\n
\nSue quit her job to care for her son. She made sure he had canned food to eat and drove him back and forth from his VA appointments. In conversations with her sister, Sue worried Andrew\u2019s doctors were always changing and he wasn\u2019t getting the help he needed. Ashley felt helpless watching her little brother slip away. He was withdrawn and angry, a far cry from the outgoing kid she remembered. She thought back on how she had tried to protect him when they were children. \u201cIt felt like I\u2019d failed,\u201d she said.
\n
\nThe pandemic had rekindled Julia\u2019s paranoia, too, so much so that she began to believe strangers wanted her dead. That May, her oldest sister, Jordan Pepper, a clinical mental health counselor in Ohio, traveled to Chico and helped her to seek in-patient treatment at the VA hospital near Sacramento, California. Doctors there diagnosed her with general psychotic disorder.
\n
\nRecords show Julia went to the Chico clinic in the weeks and months that followed. Candy and Marty took turns accompanying her. Candy made it a point to get to know the people who cared for her daughter, in some cases getting their personal cellphone numbers. She tried to stay optimistic.
\n
\nIn the fall of 2021, the telepsychiatrist who had been seeing Julia stopped seeing Chico patients. That November, Julia had a virtual appointment with a psychiatric nurse practitioner she had never seen before who prescribed a drug called atomoxetine to help her concentrate, her medical records show. But two days later, Julia called back and asked for something that would work faster. The nurse practitioner prescribed an antidepressant called bupropion and instructed Julia to take the two medications together, her records show.
\n
\nMore than a year later, in its report on Julia\u2019s case, the VA\u2019s inspector general would note that the combined use of atomoxetine and bupropion can trigger psychotic or manic symptoms. The nurse practitioner told investigators that despite what his notes said, he had not intended for Julia to take both.<\/a>What a horrific oversight on the NP\u2019s part.<\/span><\/span>It isn\u2019t clear which, if any, Julia took. She doesn\u2019t remember.
\n
\nAround that time, Julia began taking note of unusual things she believed were happening to her: strangers following her at the dog park, electronic files going missing. She installed a camera in her car and started carrying a pink handgun she bought after separating from the Navy.
\n
\nThe Chico clinic\u2019s mental health department, meanwhile, fell further into disarray, current and former employees told ProPublica. Several other telehealth providers left, including the Connecticut-based telepsychiatrist who was seeing Andrew. Those who stayed buckled under the weight. \u201cWe were abandoned,\u201d said Belva Fay, a senior social worker who was also the clinic\u2019s acting manager for eight months. \u201cWe were trying to run a clinic with nobody to prescribe medications, nobody to see emergency cases, nobody to talk to these clients who are angry. \u2026
\n
\n\u201cWe kept saying, there is going to be a problem,\u201d Fay said. \u201cThis is going to blow up.\u201d<\/a>These kinds of omens are really haunting.<\/span>Agree. These on-the-record worker interviews were among the most important, and hard-to-get, pieces of reporting. <\/span><\/span>
\n
\nBy the time Michelle Gradnigo started as the clinic\u2019s site manager in October 2021, disaster felt all but certain. Gradnigo, a retired lieutenant colonel in the Army and longtime military health care administrator, was so troubled by the lack of on-site mental health care providers that she asked if the clinic\u2019s primary-care physicians could handle some of the load, she said. The answer was no, she recalled.
\n
\n\u201cI reached out to anyone at the time who would listen and said we are going to kill someone,\u201d she told ProPublica.
\n
\nVA officials told ProPublica the Chico clinic was trying to recruit mental health professionals by offering special salary rate increases, education debt reduction and relocation incentives.
\n
\nNorthern California VA leaders were also trying to grow the virtual mental health program. A proposal obtained by ProPublica through a Freedom of Information Act request shows that mental health vacancies were dogging clinics across the region and that \u201cpainstaking and time-consuming recruitment efforts\u201d were bearing little fruit. The only positions drawing quality applicants, according to the presentation, were virtual.
\n
\n***
\n
\nWHEN THE SUN ROSE<\/strong> over the Sierra Nevada mountains on the third morning of 2022, Julia\u2019s eyes were already open.
\n
\nShe had been awake for days, a fact she blamed on what felt like a constant barrage of electric shocks. She had tried to stop them by covering her walls in aluminum foil, but it wasn\u2019t helping. She wanted pills to calm her down. At 8 a.m., she left a message at the clinic that she was \u201cin crisis and very anxious,\u201d government records show. An hour later, she started texting her mother, who called the clinic in tears. The mental health nurse was home that day with COVID, so a nurse from another department took the call.
\n
\nThe nurse sent an instant message to Julia\u2019s nurse practitioner, who was seeing patients from another location, asking if Julia should come into the Chico clinic or go to the VA hospital in Sacramento. The nurse practitioner wanted Julia to go to Sacramento, government records show. But the nurse misunderstood and told Julia\u2019s mother to bring her to Chico.
\n
\nMarty and Candy brought Julia to the clinic around 2:30 p.m. Her body was tense, her eyes red and heavy with tears. But the nurse practitioner never evaluated her. He had nine appointments that day and no time to see Julia, a violation of VA policy requiring same-day availability for patients in crisis.
\n
\nA triage social worker tried to ask Julia questions to help determine her risk of suicide or violence, but Julia wouldn\u2019t engage, records show. Instead, she quibbled with her diagnoses and voiced frustration over the recent change in her mental health provider. The social worker should have posed the questions to Julia\u2019s mom, who was inside the clinic while Julia\u2019s dad waited in his truck. Instead, she marked Julia\u2019s disposition as \u201croutine\u201d and concluded she wasn\u2019t a threat to herself or others. There is no indication the social worker asked about Julia\u2019s access to guns or other lethal means.<\/a>Why was it so important to point out what the expected protocol was and what went wrong here?<\/span>One of the most useful storytelling tools in investigative narrative is to establish how the system is supposed to work before letting the reader fully grasp the consequences of it not really working that way. Take a look at how we kicked the top in Hannah Dreier\u2019s A Betrayal<\/a> to see this strategy at its best. There\u2019s no nut graf in that story, no list of findings \u2014 only a foreboding sense that there\u2019s a way the system should work and it\u2019s not going to work out that way this time.<\/span><\/span>
\n
\nLater, in an interview with the inspector general\u2019s office, the social worker said she was unfamiliar with the protocols. She ultimately gave Julia the nurse practitioner\u2019s next available appointment, in 11 days.
\n
\nJulia stormed out of the clinic, furious that she had not been given the medication she wanted, her father recalled. Candy was frustrated; she wanted clear direction on how to help. Exhausted, they all headed back to Candy and Marty\u2019s home, a cozy ranch on a remote hillside outside of Red Bluff, California.
\n
\nBack at home, Candy offered Julia some soup and a sandwich and tried to help her calm down. Julia was still agitated, but around 10 p.m., she took a sleeping pill and retired to her parents\u2019 bedroom. When it was quiet, Candy and Marty got ready to watch a movie in the living room, hoping it might help them relax.
\n
\nJust before 11 that night, a call came into 911 dispatch.
\n
\nThe recording captured Julia as she pleaded for help, then fired one gunshot, then another. The line stayed open for an hour, chronicling all that unfolded.<\/a>It\u2019s been many words and chapters since you first opened with this anecdote at the top of the piece. Did you trust the reader would remember and connect the dots that they already knew how this would end?<\/span>That was, indeed, the hope.<\/span> <\/span><\/span>
\n
\nAfter the second bullet fired into nowhere, Candy was determined to lower the temperature. \u201cWe are trying to help,\u201d she assured her daughter. \u201cYou gotta put the gun down first, honey.\u201d Marty followed suit. \u201cWe\u2019re here for you, OK?\u201d he told Julia. \u201cIt\u2019s not too late. Nothing bad has happened.\u201d
\n
\nFor a moment, it seemed like Julia might relent. \u201cOK,\u201d she said quietly. \u201cOK.\u201d
\n
\nInstead, she fired again.
\n
\nActing on intuition, Marty leaped at his daughter in an effort to disarm her. He wrapped his arms around her, he said, and tried to overpower her. Could it have felt to her, in that moment, like she was back in the ship scullery, trying to escape the grip of her attacker? It\u2019s impossible to know. But she felt threatened and thrashed with all the strength she could summon, smashing at his ribs and clawing his eyes.
\n
\nThe gun fired again. This time, a bullet struck her mother in the thigh, tearing through a large blood vessel.
\n
\nJulia didn\u2019t realize. She fought her father for control of the gun for the next 10 minutes, pistol whipping his head until he started slipping out of consciousness. After that, she told him she loved him and went outside. He came to, and by the time she returned, had retrieved his own pistol from a drawer in the kitchen. He warned Julia he would shoot and then did, he said, striking her once in each shoulder and once in the thigh.
\n
\nWhen the police had Julia in their custody around midnight, both she and her father were seriously injured. Her mother was dead.<\/a>With an anecdote like this, where the reader was told the outcome at the beginning (in the lede), what are you hoping to impart when you return back to the same scene later?<\/span>The reader saw Julia with the gun, but we saved the specific outcomes \u2014 the injuries and death \u2014 until the reader could experience the characters and their relationships. The consequences resonate more deeply this way.<\/span><\/span>
\n
\nThe morning after the shooting, her bereaved sister Jordan called the Chico clinic, she said. She wanted someone there to explain Julia\u2019s mental illness to the authorities, to advocate for her sister. The staff member who answered knew nothing about the shooting. \u201cOh shit,\u201d Jordan recalled hearing from the other end of the phone.
\n
\nThat afternoon, just before 4, the clinic\u2019s phone rang again.
\n
\nIt was Andrew, who was in a particularly rough place. The departure of his telepsychiatrist had made him feel cast aside yet again. He\u2019d enrolled in an intensive VA program for people with serious mental illness, but abruptly withdrawn, believing the VA didn\u2019t really want to help him.<\/a> It\u2019s so clear by these attempts that he was, at various points, seriously trying to get help.<\/span>Just unbelievable how these events played out.<\/span><\/span>On the call, he asked to speak to a doctor, he recalled. When he didn\u2019t get one, he told a pharmacist that he had not been taking his medication and was feeling paranoid again. The pharmacist encouraged him to restart the prescription and scheduled a follow-up appointment in two days.
\n
\n\u201cVet does not appear to be a harm to himself or others,\u201d the pharmacist wrote in Andrew\u2019s notes.
\n
\nThe next day, Jan. 5, Andrew sought out the family shotgun. While Sue had gotten rid of most of the firearms in the house just a few months earlier, Andrew had kept three in his possession.
\n
\nAround 12:30 p.m., Andrew called 911 and told the dispatcher he had shot his mother. He was standing in the driveway when deputies arrived.
\n
\nSue died on the scene.
\n
\nAshley first learned there had been a shooting at her mother\u2019s house when a friend called. She initially thought Andrew had taken his own life. She and her husband raced to the house, arriving alongside first responders. Deputies wouldn\u2019t let her on the property until well after night had fallen. Ashley struggled to make sense of what had happened. Officials told her Andrew had performed CPR on his mother. \u201cHe tried saving her life,\u201d Ashley said.
\n
\n***
\n
\nOVER THE COURSE<\/strong> of about 36 hours, employees\u2019 worst fears about the Chico clinic had become reality. Many returned to the office in a state of shock.
\n
\nGradnigo, the site manager, requested a chaplain be brought into the clinic. But when she asked her supervisors what the next steps would be, she got no response, she said. Hoping the VA\u2019s central office might intervene, she sent a tip about the shootings to the agency\u2019s inspector general\u2019s office, she said. She withheld her name so she wouldn\u2019t face retaliation.
\n
\nGradnigo was fired in March 2022. The reasons provided to her were \u201cinappropriate\u201d comments and interactions with colleagues, records show. Gradnigo says the allegations about her conduct are exaggerated or false. She believes she lost her job because she reported wrongdoing and she is Black. She is pursuing a discrimination claim against the VA. The agency did not comment on the claim and told ProPublica it does not comment on personnel matters.
\n
\nThe inspector general\u2019s office went on to investigate Julia\u2019s case. Its report, which was published in February 2023, ticked off all the ways the clinic had failed, from medication mismanagement to not having a same-day access availability and improperly assessing her risk of violence. But the report did not mention a second patient involved in a violent act. It did not address systemic staffing issues. In fact, the office said it did not substantiate employee claims that facility leaders had failed to address their concerns about mental health staffing. The report found facility leaders had \u201censured the use of telehealth and community care.\u201d
\n
\nThe inspector general\u2019s office declined to say why it did not include Andrew\u2019s case in its report or publish a separate review. Spokesperson Fred Baker said the office reviews all complaints it receives. With respect to the employee concerns about staffing, he said, the inspector general\u2019s office \u201cfound that leadership was taking steps to fill vacancies.\u201d
\n
\nThe VA declined to make a clinic leader or official at its regional office in Sacramento available for an interview. In a statement<\/a>, a Washington, D.C.-based spokesperson, Joseph Williams, said the agency \u201cfell short\u201d in treating Julia. \u201cThis incident does not represent the quality of care Veterans have come to expect from our facilities, or the standard to which we hold ourselves accountable, and we have taken several measures to ensure that it does not happen again,\u201d he wrote.
\n
\nThe agency later said it could not answer specific questions about the care Julia or Andrew received due to privacy concerns.
\n
\nAfter the shootings, the Chico clinic hired an on-site psychiatrist and an additional social worker, according to the inspector general report. The psychiatric nurse practitioner who prescribed the medications to Julia resigned. For the last several months, the mental health team has been fully staffed, the VA told ProPublica.
\n
\nAndrew was charged with his mother\u2019s murder in January 2022. He remains in the Butte County Jail. As early as this month, a judge could determine whether Andrew was legally sane at the time of the killing.
\n
\nIn an interview with ProPublica, Andrew described being stuck in a loop when he fired the shotgun. He was convinced his mom was poisoning him, something he now says was a delusion. \u201cI love my mom,\u201d he said. \u201cI wish she was here.\u201d
\n
\nHe doesn\u2019t want to scapegoat the military or the VA for what happened, he said. He accepts responsibility. But he stressed that he had tried to get help from the VA repeatedly. \u201cI do believe if there had been some form of intervention on their end, this might not have happened,\u201d he said.
\n
\nAshley stayed in Oroville for a while, but it became impossible to go grocery shopping without someone staring at her or asking about her mother. \u201cIt felt like we were on display,\u201d she said. Over the summer, she moved to Texas with her husband, young son and stepfather. She\u2019s hoping to give her son the childhood she and Andrew never had.
\n
\nAshley is still mourning her mother, whom she described as a devoted grandmother and her closest friend. She has also been doing whatever she can to support Andrew in jail. She calls and texts him regularly and makes sure he has enough money in his account for the commissary. When he texted about playing Dungeons & Dragons recently, she replied like a mother might. \u201cI\u2019m so happy that you\u2019re doing something fun,\u201d she wrote. \u201cI love you, Andrew.\u201d
\n
\nJulia was also charged criminally for her mother\u2019s death. In January 2023, she was found not guilty by reason of insanity. She is now a patient at Patton State Hospital, a sprawling forensic psychiatric complex at the base of the San Bernardino Mountains about 60 miles east of Los Angeles. She reads books in the library, helps organize group activities like bingo and keeps her fingernails painted vibrant colors. She has a journal with positive affirmations on each page; she writes down the things she\u2019s grateful for.<\/a>Why did your team choose to include these details?<\/span>We\u2019d given you so much of Julia before these tragic events, and we felt it important to now give the best insight into what is going on in her head after. The reporters also felt it important to show Julia as you’d find her on any given day. We spent a lot of time describing Julia on the day of the shooting, which was, in many ways, an outlier.<\/span><\/span>
\n
\nFor some time after the shooting, Julia didn\u2019t know she had caused her mother\u2019s death. It was only after listening to the 911 recording months later that she began to understand what had happened. Coming to grips with that has been excruciating, she said. Her mom was her best friend. On a recent afternoon, during an open mic event at the hospital, she read a poem she wrote about their relationship. Audience members were brought to tears, she said.
\n
\nIt is hard to say what prompted the shooting. She recalls hearing an explosion in the distance \u2014 maybe a gas tank \u2014 and feeling like she needed to protect herself from some unknown threat. \u201cIt felt like I was unconscious, not awake,\u201d she told a psychologist who evaluated her in January 2023, records show. \u201cIt felt like I was in a video game.\u201d The psychologist speculated the explosion triggered her PTSD and may have put her in a dissociated state.
\n
\nJulia isn\u2019t sure how long she\u2019ll be at Patton. She would have to be cleared by the hospital and the court to be released for supervised treatment in the community.
\n
\nIt has taken many months for Marty to begin recovering. His ribs were fractured and his back was broken in two places. He needed 15 staples in his head. The emotional recovery, he knows, will be much longer. He\u2019s chosen to stay in the hilltop ranch where the shooting took place. He bought the property to grow old there, and that\u2019s what he still intends to do. He finds comfort in his fruit trees and livestock and the sweeping mountain views.
\n
\nHe said he forgives his daughter. He keeps her military photo in his wallet. But he is furious at the VA. \u201cI want to punch VA in the face,\u201d he said one afternoon late in the summer, while the sun poured into his den. To him, it was obvious what had needed to happen and what went wrong.
\n
\nIt crystallized deep in his mind the night of the shooting, after Julia had finally relented and he picked up Candy\u2019s cellphone to speak with the 911 operator.
\n
\n\u201cShe really, really needs help,\u201d he told the operator while waiting for the police to come and arrest his daughter. \u201cWe tried to get her help at the VA. And, God, the VA didn\u2019t really help that much.\u201d<\/a>This quote gave me the chills. What a powerful line that gets straight to the heart of the issue.<\/span>No kidding. We knew from the moment we heard it that this exchange was going to be the ending.<\/span><\/span>
\n
\nThe dispatcher was empathetic. She\u2019d heard Julia\u2019s cries for help all night; dozens of them were captured in a recording of the call.<\/a>Did your writers interview the dispatcher? <\/span>No. The only thing they had to go on was an audio recording of the 911 call that did not identify the dispatcher, and police wouldn\u2019t provide additional records.<\/span><\/span>
\n
\n\u201cI\u2019m sorry the VA didn\u2019t help her,\u201d the dispatcher said.
\n
\n* * *
\n
\nEDITOR’S NOTE:<\/strong> After reading a February 2023 report by the Department of Veterans Affairs\u2019 Office of Inspector General<\/a> about inadequate mental health care at a VA clinic in Chico, California \u2014 a document that did not name any veterans or health care professionals or provide specific dates \u2014 ProPublica reporters wanted to more fully understand the tragedy that unfolded and what lessons it offered for the larger VA health care system. They spent months investigating the case at the center of the report involving a veteran named Julia Larsen as well as a second case involving a veteran named Andrew Iles who was also treated at the clinic.<\/a>What did you hope to achieve by providing this kind of visibility into the reporting process, and transparency, to your readers? <\/span>Even though we didn\u2019t attribute each and every sentence to a source within the narrative, it was important to show the reader that this was all verified through rigorous reporting. We\u2019ve found time and again at ProPublica that this kind of transparency \u2014 we call it showing the receipts \u2014 resonates with readers. <\/span><\/span>
\n
\nThe reporters interviewed Julia in person at Patton State Hospital near San Bernardino, California, and spent many hours interviewing her by telephone and video call. They traveled to St. Louis to meet with her attorneys. They reviewed hundreds of pages of her military personnel and medical records, as well as police reports from the night of the shooting and transcripts of interviews Julia gave to detectives and psychologists after her arrest. They listened to the 911 call Julia\u2019s mother, Candy Larsen, made before she died. They interviewed Julia\u2019s father, Marty Larsen, at his home in Red Bluff, California. They interviewed her sister Jordan Pepper, childhood friend Brittney Apel and former boyfriend Ignacio Gutierrez by telephone. In addition to Brittney and Ignacio, who served in the Navy with Julia, they interviewed four other people who knew Julia from the military, one of whom Julia told about the sexual assault and corroborated her recollections. They also interviewed Laurie Smith, a close friend of Julia\u2019s mother.
\n
\nThe reporters interviewed Andrew in person at the Butte County Jail in Oroville, California, and by telephone. They reviewed some of his medical records, military performance reviews and discharge records, as well as his court records and family photos from his childhood. They interviewed his sister, Ashley Hill, at her home in Texas and his half-brother William Iles, aunt MaryJo Hendricks, former girlfriend Kayley Reni and childhood friend Alex Kenworthy by telephone. They interviewed a second childhood friend who declined to be named.
\n
\nBoth Julia and Andrew consented to ProPublica publishing information from their medical records about their diagnoses and medical histories.
\n
\nTo better understand the issues at the Chico clinic, the reporters interviewed a half-dozen current and former employees. They reviewed emails sent between 2016 and 2022 that detailed staffing issues, as well as hundreds of pages in former site manager Michelle Gradnigo\u2019s discrimination complaint. They also reviewed an internal proposal from 2021 to grow the virtual mental health program and documents from the Office of Inspector General\u2019s investigation obtained through Freedom of Information Act requests.
\n
\nTo put the case into broader context, the reporters reviewed and analyzed more than 300 routine inspections and investigative reports published by the VA\u2019s inspector general since January 2020, some examining events that occurred in 2019. They brought their findings to experts and interviewed the relatives of three veterans who died by suicide after receiving inadequate mental health care from the VA. They reviewed national reports on mental health staffing and outcomes.
\n
\nOverall, the reporters spoke to more than a dozen mental health professionals, researchers and policy experts. They consulted with some on how to interview people who have experienced trauma and been diagnosed with severe mental illness. They asked others to describe how the treatment Julia and Andrew received from the Chico VA clinic differed from generally established standards of care and offer insight into the issues facing the VA\u2019s health system.\n\n <\/div>\n <\/div>\n","protected":false},"excerpt":{"rendered":"

A project annotation by Alexandra Zayas of ProPublica offers insights to how an editor sees story potential and guides reporters<\/p>\n","protected":false},"author":1,"featured_media":11357,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[10],"tags":[],"topics":[],"authors":[8],"issue":[],"class_list":["post-11356","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-annotation-tuesday","authors-carly-stern"],"acf":[],"yoast_head":"\nEffective editing: Navigating failures of the military's mental health system - Nieman Storyboard<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/niemanstoryboard.org\/2024\/07\/11\/investigative-journalism-editing-mental-health-military\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" 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