Evaluation of the Department of Veterans Affairs Mental Health Services (2018) / Chapter Skim
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veterans who supported the wars in Iraq and Afghanistan and who may have mental health conditions, Congress passed Section 726 of the National Defense Authorization Act for fiscal year 2013; Section 726 required that the Department of Veterans Affairs (VA) enter into an agreement with the National Academies of Sciences, Engineering, and Medicine for a study that would assess veterans' ability to access mental health services at the VA and the quality of mental health services within the VA and would provide recommendations to improve problems with access and quality of services.
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The committee's approach to gathering information was threefold: reviewing the relevant published literature, conducting site visits, and developing and fielding a survey of OEF/OIF/OND veterans.2 The committee sought input on the use of VA mental health services directly from veterans, veterans' families and caregivers, providers, and others at each of the 21 VISNs across the United States.3 The committee developed a survey that was administered to veterans to gather information on access to and the quality of VA mental health services and to determine why some veterans choose not to use VA mental health services. The major mental health conditions addressed in this report are posttraumatic stress disorder (PTSD)
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• Transportation to and the convenience of VA medical facilities may pose challenges for many OEF/OIF/OND veterans who live far from VA facilities or who have chronic health conditions that make traveling long distances difficult. • Additional barriers to seeking mental health care include employment concerns (spending time off from work, harm to their careers, denial of security clearance, and receiving less confidence and respect from co-workers and supervisors)
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However, the VA does not collect adequate information about the approaches that it uses to ensure care coordination and quality monitoring for services the VA offers through contracts with community providers. CONCLUSIONS AND RECOMMENDATIONS As the nation's largest provider of mental health care services, the VA health care system has tremendous mental health care expertise, many and diverse care delivery assets, and substantial training and research capabilities.
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The Veterans Health Administration (VHA) , the sub-cabinet level agency within the VA that provides health care, needs to undertake a concerted, system-wide effort to organize and align its care delivery assets and processes of care toward this end, while concomitantly working with the Veterans Benefits Administration (VBA)
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The lack of awareness about how to connect to the VA for mental health care demonstrates the need for awareness campaigns and effective dissemination of the mental health care opportunities, eligibility criteria, and services to help veterans understand how and where to access mental health care. The VA's recent initiative to offer emergency mental health care to veterans with other-than-honorable discharge status is an important step to improving access for veterans who may be in need of immediate help.
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They also are at times uncomfortable in VA clinic waiting rooms because they get unwanted sexual attention, which can be particularly unsettling for women veterans who have experienced military sexual trauma. Research on homeless veterans shows that they are more likely to defer or delay mental health care than housed veterans even though they have a greater need for services.
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Reclassifying all types of mental health care workers, including substance use counselors, under Title 38 might help in addressing some of the mental health care workforce problems. The committee heard repeatedly during its site visits that the VA's human resources management process is cumbersome and onerous.
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and mHealth (mobile health apps) , to increase access to mental health care and to treat and help manage a variety of mental health conditions, including PTSD, depression, and SUD.
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For example, current efforts by the VA include the collection and use of more mental health care measures, the use of facility-level and system-level performance data to engage VA management in mental health programming and improvement, and programs (such as the Quality Enhancement Research Initiative and the Diffusion of Excellence program) to identify and disseminate best practices.
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Given the large numbers of veterans who do not seek mental health care and the significant percentages of veterans who are not receiving mental health treatments that meet recommended dosages, frequency, or follow-up, particular attention should be placed on measuring and monitoring the delivery of evidence-based care, patient engagement in care, and continuity of care. These areas of performance measurement should address veterans who receive care within the VA health system and veterans who receive care through VA community care programs, such as the Veterans Choice Program.
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