A manager at the Roudebush Veteran Affairs Medical Center in Indianapolis appears to mock the mental health problems of returning combat veterans in an email to her employees.

The email obtained by The Indianapolis Star contains photographs of a toy Christmas elf posing as a patient in what appears to be the hospital's transitional clinic for returning veterans. In one photograph, the elf pleads for Xanax. In another, he hangs himself with an electrical cord.

UPDATE | VFW wants Indianapolis VA manager removed for email mocking veterans suicides

The woman who sent the email is Robin Paul, a licensed social worker who manages the hospital's Seamless Transition Integrated Care Clinic. The clinic provides returning veterans with transition assistance, including mental health and readjustment services.

When initially asked about the email, Paul responded, "Oh my goodness." She then referred a reporter to the hospital's public affairs department, which emailed The Star a statement on her behalf.

"I would like to sincerely apologize for the email message and I take full responsibility for this poor judgment," Paul said. "I have put my heart and soul into my work with veterans for many years. I hold all veterans and military personnel in the highest regard and am deeply remorseful for any hurt this may have caused."

Julie Webb, a Roudebush spokeswoman, said administrators were made aware of the email "a couple of months ago."

"The email is totally inappropriate and does not convey our commitment to veterans," she said. "We apologize to our veterans and take suicide and mental health treatment seriously, striving to provide the highest quality."

Webb said the issue was "administratively addressed." She declined to provide specifics, citing employee confidentiality.

Paul remains employed at the hospital and continues to manage the clinic, earning an annual salary of $79,916. She received a $2,000 performance bonus in 2013, records show. More recent bonus information was not immediately available.

The Dec. 18 email was sent to the "IND STICC Team" with the subject, "Naught Elf in the STICC clinic."

"So, photos have appeared that indicate that the STICC clinic may have been invaded," the email says. "Looks like this magical character made his way through a few areas."

One photo depicts the elf peering between the legs of a female doll. "Trying his skills as a primary care provider (doing a pap)," the email says.

Another shows the elf next to a sticky note with the words, "Out of XANAX -- please help!" A caption says, "Self-medicating for mental health issues when a CNS would not give him his requested script."

A third photograph shows the elf hanging from a strand of Christmas lights. "Caught in the act of suicidal behavior (trying to hang himself from an electrical cord)," the email says.

It is unclear from the email whether other VA employees were involved in the joke, but a note visible in one photo appears to include directions about passing the elf to others.

Webb said she didn't know how many employees were involved.

The email surfaces as the nation grapples with an epidemic of veteran suicides. An estimated 22 veterans commit suicide in the United States every day, according to the VA.

The email immediately drew outrage from veterans groups.

"It is a slap in the face to our recent and past veterans suffering from mental health issues every single day," said Ken Hylton, commander of the Indiana Department of the American Legion. "These men and women went to war and do not deserve this type of ridicule. This is a disgusting display of mockery. This is supposedly someone who is caring for our veterans, and we in the Indiana American Legion are disgusted."

He called for an investigation and the "immediate dismissal of this government employee and all of those who received this correspondence and said nothing."

Paul Rieckhoff, founder and CEO of Iraq and Afghanistan Veterans of America, has lobbied for federal legislation intended to help stem veteran suicides.

"We hope it's an isolated incident," he said. "We hope this person has been dealt with aggressively because we're in the middle of a suicide problem."

The suicide crisis has prompted action from Congress and President Barack Obama.

Just last month, the Clay Hunt Suicide Prevention for American Veterans Act was signed into law. The measure will help the VA study new strategies for suicide prevention and give student loan incentives to recruit psychiatrists to work with veterans. Two Indiana lawmakers, U.S. Rep. Jackie Walorski and U.S. Sen. Joe Donnelly, attended the White House signing ceremony.

In December, the Sexton Act was signed into law as part of a national defense bill. It requires annual mental health assessments for all servicemembers, maintains privacy protections and requires the Pentagon to evaluate existing military mental health practices. Authored by Donnelly, it is named after Jacob Sexton, a 21-year-old Indiana National Guardsmen from Farmland who shot himself in the head at a Muncie movie theater while home on a 15-day leave from Afghanistan.

The issue of veteran suicide is a personal one for Gregg Keesling of Indianapolis. His 25-year-old son, Chancellor, shot himself in Baghdad in 2009, two weeks into his second tour.

He called the email "wrong," but stopped short of calling for terminations.

"It's very inappropriate, but I can understand it — making light of something awful because it's so awful," he said. "I think it's a way of coping with things."

Still, he said, "They are trying to be funny. It's not... Somebody should get in trouble. Maybe not fired, but taken out to the woodshed, as they say."

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