EL PASO — U.S. Army veteran Nick D’Amico was already at the Veterans Affairs clinic in El Paso in November 2012 when he was told his appointment with a psychiatrist was canceled.

It was the fifth time that had happened to him, and his mother, Bonnie D’Amico, said her son went “ballistic” when told he would have to wait another two months. “The guards there had him restrained and all,” she said.

Nick D’Amico, who served in Korea and Saudi Arabia, didn’t end up seeing a psychiatrist until May 2013. But before he could make it to his follow-up appointment — a November video-conference — D’Amico committed suicide, leaving his wallet, phone, watch and Desert Storm hat at home and driving off a cliff west of El Paso on Sept. 26.

Home to some of the biggest military bases in the country, Texas has seen its share of veterans return from war with not just physical battle scars. But for those seeking mental health services, getting into the doctor’s office has been especially difficult. Federal data released this week shows four of the nation’s top 10 VA waiting lists for new mental health patients are at Texas facilities.

An audit by the Department of Veterans Affairs released Monday followed a scandal that engulfed VA facilities across the country in allegations of scheduling sleights of hand meant to hide massive backlogs as veterans struggled to get appointments.

The monthslong waits appear to be a combination of systemic scheduling issues and not enough available appointments. The audit showed that among surveyed personnel at VA medical facilities, “the highest scored single barrier or challenge was lack of provider slots.”

U.S. Rep. Beto O’Rourke, D-El Paso, noted that the VA in El Paso has five unfilled but funded positions for mental health professionals. El Paso is home to Fort Bliss, which has about 40,000 soldiers.

“If we need to pay more to recruit and retain, I’ll be the first to advocate for more money, but the VA has not requested it,” said O’Rourke, a member of the House veterans’ affairs committee. He said John Mendoza, the VA’s director in El Paso, promised him last week that those positions would be filled by July.

Sheila Austin, spokeswoman at the VA in El Paso, said recruiting psychiatrists is difficult, both at the VA and in the private sector.

“We offer incentives, but it still is a challenge,” she said.

At the six South Texas facilities that make up the VA Texas Valley Coastal Bend Health Care System, new patients waited an average of 55 days for initial mental health appointments and 85 days for primary care appointments — second only to the VA facility in Honolulu, and its 145-day average wait. The Texas Valley system had a worst-in-the-nation, 145-day average wait for new patients seeking specialist care. Second was the El Paso facility with 90-day waits.

In a statement, Texas Valley Coastal Bend acknowledged “systemic issues in our scheduling practices.”

Spokesman Hugo Martinez said it’s more than doubled its mental health staff to 115 from 50 in August 2011. He said the system is recruiting for 18 more positions.

Besides mental health services, Martinez said three specialties have the longest wait times: audiology, ophthalmology and optometry.

“We don’t have a full-fledged hospital here, but for most of the specialty services that we don’t have the capacity, we feed those out to local providers,” Martinez said.

That outsourcing — one of the VA’s short-term solutions to the backlogs — appears to have its own problems.

U.S. Rep. Filemon Vela, D-Brownsville, said Tuesday that medical providers are having a difficult time getting paid by the VA.

Salvador Castillo, a 35-year-old veteran who is Cameron County’s Veterans Service Office director in Brownsville, said he knows of a doctor who’s been waiting two years for payment.

“What’s happening is this: You go get seen at a doctor’s office, the VA doesn’t pay them, the doctor’s not going to see you when you come back,” the Air Force and Army veteran said.

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