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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2018. Evaluation of the Department of Veterans Affairs Mental Health Services. Washington, DC: The National Academies Press. doi: 10.17226/24915.
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Evaluation of
the Department
of Veterans Affairs
Mental Health
Services

Committee to Evaluate the Department of Veterans Affairs
Mental Health Services

Board on Health Care Services

Health and Medicine Division

A Consensus Study Report of

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THE NATIONAL ACADEMIES PRESS
Washington, DC
www.nap.edu

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2018. Evaluation of the Department of Veterans Affairs Mental Health Services. Washington, DC: The National Academies Press. doi: 10.17226/24915.
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This activity was supported by Contract/Grant No. VA77713A0009 between the National Academy of Sciences and the U.S. Department of Veterans Affairs. Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project.

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Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2018. Evaluation of the Department of Veterans Affairs Mental Health Services. Washington, DC: The National Academies Press. doi: https://doi.org/10.17226/24915.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2018. Evaluation of the Department of Veterans Affairs Mental Health Services. Washington, DC: The National Academies Press. doi: 10.17226/24915.
×

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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2018. Evaluation of the Department of Veterans Affairs Mental Health Services. Washington, DC: The National Academies Press. doi: 10.17226/24915.
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Consensus Study Reports published by the National Academies of Sciences, Engineering, and Medicine document the evidence-based consensus on the study’s statement of task by an authoring committee of experts. Reports typically include findings, conclusions, and recommendations based on information gathered by the committee and on the committee’s deliberations. Each report has been subjected to a rigorous and independent peer-reviewed process, and it represents the position of the National Academies on the statement of task.

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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2018. Evaluation of the Department of Veterans Affairs Mental Health Services. Washington, DC: The National Academies Press. doi: 10.17226/24915.
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COMMITTEE TO EVALUATE THE DEPARTMENT OF VETERANS AFFAIRS MENTAL HEALTH SERVICES

ALICIA L. CARRIQUIRY (Chair), Iowa State University

F. JAY BREIDT, Colorado State University

DENNIS M. DONOVAN, University of Washington

SUSAN V. EISEN, Boston University School of Public Health (retired)

CONSTANTINE GATSONIS, Brown University School of Public Health

ROBERT C. GRESEN, Medical College of Wisconsin

STEVEN HEERINGA, University of Michigan

KENNETH W. KIZER, University of California, Davis

JOHN W. KLOCEK, Baylor University (through August 19, 2016)

RICHARD A. KULKA, Consultant, Statistical, Survey and Social Research, Raleigh, NC

BRUCE G. LINK, University of California Riverside

SUSAN M. PADDOCK, RAND Corporation

DEBORAH K. PADGETT, New York University

BETHANY J. PHOENIX, University of California, San Francisco

ROBERT L. SANTOS, The Urban Institute

JEANNETTE E. SOUTH-PAUL, University of Pittsburgh

THANH V. TRAN, Boston College

PETER M. YELLOWLEES, University of California, Davis

Study Staff

LAURA AIUPPA DENNING, Study Co-Director

ABIGAIL MITCHELL, Study Co-Director

MARC MEISNERE, Associate Program Officer

HEATHER L. CHIARELLO, Research Associate (through October 2016)

JOSEPH GOODMAN, Senior Program Assistant

CHRISTIE BELL, Financial Officer

ROBERT POOL, Editor

FREDERICK (RICK) ERDTMANN, Director, Board on the Health of Select Populations (through July 2016)

SHARYL NASS, Director, Board on Health Care Services (from January 2017)

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2018. Evaluation of the Department of Veterans Affairs Mental Health Services. Washington, DC: The National Academies Press. doi: 10.17226/24915.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2018. Evaluation of the Department of Veterans Affairs Mental Health Services. Washington, DC: The National Academies Press. doi: 10.17226/24915.
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Reviewers

This Consensus Study Report was reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the National Academies of Sciences, Engineering, and Medicine in making each published report as sound as possible and to ensure that it meets the institutional standards for quality, objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process.

We thank the following individuals for their review of this report:

Margarita Alegría, Harvard Medical School and Massachusetts General Hospital, Disparities Research Unit

Robert A. Barish, University of Illinois at Chicago

Jonaki Bose, Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services

John Boyle, ICF International

Babette Brumback, University of Florida

Eric Goplerud, NORC at the University of Chicago

Joel B. Greenhouse, Carnegie Mellon University

Ronald C. Kessler, Harvard Medical School

Richard C. Larson, Massachusetts Institute of Technology

Richard A McCormick, MetroHealth/Case Western Reserve University

Bernadette Mazurek Melnyk, The Ohio State University

Harold A. Pincus, Columbia University

Terri Tanielian, RAND Corporation

Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations of this report nor did they see the final

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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2018. Evaluation of the Department of Veterans Affairs Mental Health Services. Washington, DC: The National Academies Press. doi: 10.17226/24915.
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draft before its release. The review of this report was overseen by Dan G. Blazer, Duke University School of Medicine, and Bradford H. Gray, The Urban Institute. They were responsible for making certain that an independent examination of this report was carried out in accordance with the standards of the National Academies and that all review comments were carefully considered. Responsibility for the final content rests entirely with the authoring committee and the National Academies.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2018. Evaluation of the Department of Veterans Affairs Mental Health Services. Washington, DC: The National Academies Press. doi: 10.17226/24915.
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Preface

Approximately 4 million U.S. service members took part in the wars in Afghanistan and Iraq. Shortly after troops started returning from their deployments, some active-duty service members and veterans began experiencing mental health problems. Given the stressors associated with war, it is not surprising that some service members developed such mental health conditions as posttraumatic stress disorder, depression, and substance use disorder. Subsequent epidemiologic studies conducted on military and veteran populations that served in the operations in Afghanistan and Iraq provided scientific evidence that those who fought were in fact being diagnosed with mental illnesses and experiencing mental health–related outcomes—in particular, suicide—at a higher rate than the general population.

Media reports also brought to the nation’s attention problems that veterans were having obtaining timely health care appointments and high-quality care through the Department of Veterans Affairs (VA) health system (that is, the Veterans Health Administration, VHA). Addressing the health needs of the large influx of veterans presented a substantial challenge to the VHA. In the National Defense Authorization Act of 2013, Congress included a mandate for the National Academies of Sciences, Engineering, and Medicine (the National Academies) to conduct a study to assess the VHA’s mental health care services and provide recommendations to assist the VHA with improving its services. The report that follows details the work of the National Academies’ study committee that was appointed to carry out this task.

Gathering the evidence on which the committee developed its findings, conclusions, and recommendations was an enormous task. We on the committee used a multipronged approach to build the evidence base necessary to complete our work by conducting a survey of veterans who served in the operations in Afghanistan and Iraq; visiting 21 areas of the country to talk with veterans and their families, VHA employees, and others who work with the veteran population; conducting multiple literature searches; holding public meetings; and obtaining performance data collected by the VA on its mental health services.

Those of us on the committee could not have accomplished its task without the assistance of the many people who provided valuable information about the VA and the agency’s mental health services. First and foremost, I would like to thank all of the veterans and their families who took time to tell us

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2018. Evaluation of the Department of Veterans Affairs Mental Health Services. Washington, DC: The National Academies Press. doi: 10.17226/24915.
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their stories and about their experiences getting health care at VHA facilities. Their input was critical to the committee’s understanding of their health-related needs.

I would like to extend my sincere thanks to several individuals at the VA who assisted us by responding to our many requests for information. Stacy Gavin from the Office of Mental Health and Suicide Prevention effectively coordinated our requests with others at the VA to send us the information we needed in a timely manner. Rani Hoff from the Northeast Program Evaluation Center compiled a complex set of data for the committee from several groups within the VA so that we could conduct the survey of veterans. Dawne Vogt from the VA’s National Center for PTSD assisted the committee with developing a brief instrument to measure combat exposure to include in the committee’s survey of veterans.

Over the course of the study, the committee held several public meetings to obtain information from subject-matter experts. We committee members are grateful to have heard from the following people and I thank them for taking time to meet with us:

David Carroll, Office of Mental Health and Suicide Prevention, VA

Carolyn Clancy, Veterans Health Administration, VA

Mike Davies, Access and Clinic Administration Program, VA

Peter Duffy, Colonel, U.S. Army (Ret.), The National Guard Association of the United States

John Fairbank, VISN 6 Mental Illness Research, Education and Clinical Center, VA

Warren Goldstein, The American Legion

Rani Hoff, Northeast Program Evaluation Center, VA

Joy Ilem, Disabled American Veterans

Kenneth Jones, Office of Academic Affiliations, VA

Daniel Kivlahan, Seattle VA Medical Center

Laura Krejci, Office of Patient Centered Care and Cultural Transformation, VA

Harold Kudler, Durham VA Medical Center

David Latini, Office of Academic Affiliations, VA

Thomas Lynch, Veterans Health Administration, VA

Jacqueline Maffucci, Iraq and Afghanistan Veterans of America

Jennifer Patterson, Office of Patient Centered Care and Cultural Transformation, VA

Andrew Pomerantz, Integrated Services, Mental Health Services, VA

Stacy Pommer, Office of Academic Affiliations, VA

Paula Schnurr, National Center for PTSD, VA

Mary Schohn, Office of Mental Health and Suicide Prevention, VA

Howard Somers and Jean Somers, Coronado, CA

Jodie Trafton, Program Evaluation and Resource Center, VA

Janet Vertrees, Office of Patient Centered Care and Cultural Transformation, VA

Kendra Weaver, Mental Health Clinical Operations, VA

The committee worked closely with Westat, an independent research corporation, on the conduct of the survey of veterans and the site visits. We appreciate the hard work put forth by Westat team members to produce the array of technical products necessary to support the committee’s work. I thank the Westat project director, Shelley Perry, along with her team members.

I was honored to chair the committee and lead a group of very knowledgeable and hardworking individuals. Their dedication to this study, which took place over 4 years, is commendable. I would like to thank Thomas Horvath for his committee service during the initial period of the study. I also would like to thank the staff from the National Academies who guided the committee through the study process.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2018. Evaluation of the Department of Veterans Affairs Mental Health Services. Washington, DC: The National Academies Press. doi: 10.17226/24915.
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Laura Aiuppa and Abigail Mitchell directed the study and kept us on task. Heather Chiarello and Marc Meisnere assisted the committee with research and with writing the report. Joseph Goodman provided administrative support and handled the logistics for our committee meetings; he made sure that all 16 meetings ran smoothly. Constance Citro, Director of the National Academies’ Committee on National Statistics, and Krisztina Marton provided valuable input on the committee’s survey.

Finally, I thank the VA for providing support for this study. We hope that the committee’s recommendations will help the VHA to improve mental health care for veterans.

Alicia L. Carriquiry, Chair

Committee to Evaluate the Department of Veterans Affairs Mental Health Services

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2018. Evaluation of the Department of Veterans Affairs Mental Health Services. Washington, DC: The National Academies Press. doi: 10.17226/24915.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2018. Evaluation of the Department of Veterans Affairs Mental Health Services. Washington, DC: The National Academies Press. doi: 10.17226/24915.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2018. Evaluation of the Department of Veterans Affairs Mental Health Services. Washington, DC: The National Academies Press. doi: 10.17226/24915.
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6-2 Number of OEF/OIF/OND veterans enrolled in each VA priority group versus number of OEF/OIF/OND veterans enrolled and using VA health care services in FY 2016

6-3 Veteran population by Veterans Integrated Service Network, FY 2015

9-1 Actual versus VA calculated wait time for mental health appointments

11-1 Average number of veteran mental health visits for fiscal years 2013–2017

12-1 Continuum of VA mental health services

15-1 VHA Mental Health Management System Framework

TABLES

3-1 MIRECCs in the VHA

3-2 VA Centers of Excellence

3-3 National Center for Posttraumatic Stress Disorder Focus Areas by Division

4-1 Comparison of DSM-IV-TR Criteria to DSM-5 Criteria for PTSD

4-2 Comparison of DSM-IV-TR Criteria to DSM-5 Criteria for Substance Use Disorders (SUDs)

4-3 Prevalence of Mental Health Conditions and Suicide Rates in Veteran and Non-Veteran Populations

4-4 Example of the Scope of Mental Health Practice for Five Main Types of Health Care Providers

4-5 Mental Health Screening in the VA

5-1 Second-Phase Stratification and Sample Sizes

5-2 Timeline of Actual Data Collection Activities

5-3 Final Survey Status at End of Data Collection

5-4 Final Survey Completes, by User and Need Status

5-5 Five Raking Cells

5-6 Site Visit Data Collection Modality and Location by Respondent Type

5-7 Sites and Dates of Site Visits (in Order by VISN Number)

6-1 Survey Estimates of the Demographic Characteristics of the OEF/OIF/OND Veteran Population (population size about 4.1 million)

6-2 Survey Estimates of the Military Characteristics of the OEF/OIF/OND Veteran Population (population size about 4.1 million)

6-3 Percent of U.S. Armed Forces Veterans by Service Era

6-4 Six States with Largest Populations of OEF/OIF/OND Veterans

6-5 Percentage of OEF/OIF/OND Veterans Who Have a Mental Health Need by Screener and/or Received a Mental Health Diagnosis

6-6 Percentage of OEF/OIF/OND Veterans by Mental Health Need, Service Use, and Demographic Characteristics

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2018. Evaluation of the Department of Veterans Affairs Mental Health Services. Washington, DC: The National Academies Press. doi: 10.17226/24915.
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6-7 Description of Service Use Among OEF/OIF/OND Veterans Who Have a Mental Health Need and Use Mental Health Services

6-8 Percentage of OEF/OIF/OND Veterans by Mental Health Need, Perceived Need, and User Group

6-9 Perceived Need for Mental Health Care Among OEF/OIF/OND Veterans Who Screened Positive on a Mental Health Screener or Who Reported a Mental Health Diagnosis

6-10 Core Independent Variables Used in the Multivariate Analyses

6-11 Among All OEF/OIF/OND Veterans, Adjusted Odds Ratios of Having a Mental Health Care Need (statistically significant variables only)

6-12 Among All OEF/OIF/OND Veterans, Unadjusted Odds Ratios of Having a Perceived Mental Need by Mental Health Screener Scores (statistically significant variables only)

6-13 Among All OEF/OIF/OND Veterans, Adjusted Odds Ratios of Having a Perceived Mental Health Care Need (statistically significant variables only)

6-14 Among OEF/OIF/OND Veterans Who Have a Mental Health Need and Use VA Services, the Percentage Who Strongly or Somewhat Agree with Reasons for Using VA Services

6-15 Among OEF/OIF/OND Veterans Who Have a Mental Health Need and Do Not Use VA Services (Users of Non-VA Services and Nonusers of Any Mental Health Services), the Percentage Who Agreed with Various Reasons for Not Using Services

6-16 Among OEF/OIF/OND Veterans Who Have a Mental Health Need, Geographic Accessibility to the Nearest VA Facility That Offers Mental Health Services

6-17 Among OEF/OIF/OND Veterans Who Have a Mental Health Need and Use VA Mental Health Services (an estimated 476,654 veterans), Attitudes on Access to Care and Availability of Mental Health Care

6-18 Among OEF/OIF/OND Veterans Who Have a Mental Health Need and Used VA Mental Health Services Satisfaction with Availability of Mental Health Providers and Services at the VA

6-19 Among OEF/OIF/OND Veterans Who Have a Mental Health Need and Used VA Mental Health Services by Opinion Rating with Aspects of VA Mental Health Care

6-20 Additional Independent Variables Included in the Regression Models

6-21 Among OEF/OIF/OND Veterans Who Have a Mental Health Need, Adjusted Odds Ratios of Responding That the Process of Obtaining Mental Health Care Through the VA Is Very/Somewhat Burdensome (statistically significant variables only)

6-22 Among OEF/OIF/OND Veterans Who Have a Mental Health Need, Adjusted Odds Ratios of Responding That It Is Never Easy to Get Appointments with a VA Mental Health Provider (statistically significant variables only)

6-23 Among OEF/OIF/OND Veterans Who Have a Mental Health Need, Adjusted Odds Ratios of Responding That They Are Never Able to Get VA Mental Health Care on Evenings, Weekends, or Holidays (statistically significant variables only)

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2018. Evaluation of the Department of Veterans Affairs Mental Health Services. Washington, DC: The National Academies Press. doi: 10.17226/24915.
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6-24 Among OEF/OIF/OND Veterans Who Have a Mental Health Need, Adjusted Odds Ratios of Responding That They Are Somewhat/Very Dissatisfied with Period of Time from VA Appointment Request to Appointment Date (statistically significant variables only)

6-25 Among OEF/OIF/OND Veterans Who Have a Mental Health Need, Statistically Significant Predictors of Higher Satisfaction with Availability of Primary Care, General Mental Health, and Specialized Mental Health Services at the VA

6-26 Among OEF/OIF/OND Veterans Who Have a Mental Health Need, Statistically Significant Predictors of Higher Satisfaction with Availability of Mental Health Providers at the VA

6-27 Among OEF/OIF/OND Veterans Who Have a Mental Health Need, Statistically Significant Predictors of Higher Satisfaction with Availability of Mental Health Services at the VA (medication management, psychotherapy, group therapy, emergency services, case management)

6-28 Among OEF/OIF/OND Veterans Who Have a Mental Health Need, the Percentage Reporting Obstacles to Using Mental Health Services

6-29 Among OEF/OIF/OND Veterans Who Have a Mental Health Need, the Percentage Who Agree or Disagree with Statements About Getting Mental Health Care

6-30 Percentage of OEF/OIF/OND Veterans by Mental Health Need and User Group Who Are Somewhat Likely, Likely, and Very Likely to Use VA Mental Health Services in the Future

6-31 Among OEF/OIF/OND Veterans Who Are Not at All Likely to Use VA Mental Health Services in the Future Even If in Need, the Percentage Who Agree with Select Reasons by Use Groups

6-32 Among OEF/OIF/OND Veterans Who Have a Mental Health Need and Not at All Likely to Use VA Mental Health Services in the Future Even If in Need, the Percentage Who Agree with Select Reasons

6-33 The Percentage of OEF/OIF/OND Veterans by the Importance of Select Changes the VA Could Make

6-34 The Percentage of OEF/OIF/OND Veterans by the Importance of Select Changes the VA Could Make, by User Group

6-35 The Percentage of OEF/OIF/OND Veterans by Their Likelihood of Mode of Future VA Mental Health Service Use

6-36 The Percentage of OEF/OIF/OND Veterans Within Each Age Category by Their Likelihood of Mode of Future VA Mental Health Service Use

6-37 Among OEF/OIF/OND Veterans Who Have a Mental Health Need, Adjusted Odds Ratios of Mental Health Service Use (statistically significant variables only)

6-38 Among OEF/OIF/OND Veterans Who Use Mental Health Care, the Adjusted Odds Ratios of Using the VA for Their Mental Health Care

7-1 MyVA 2016 Priorities

7-2 Types of Quality Assessment Questions

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2018. Evaluation of the Department of Veterans Affairs Mental Health Services. Washington, DC: The National Academies Press. doi: 10.17226/24915.
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8-1 VHA Mental Health Position Vacancy Rates

8-2 VA Mental Health Training Slots by Profession, Expansion Since 2013/2014 and Current Total (as of May 31, 2017)

8-3 Psychotherapies in VA Dissemination and Implementation Model

8-4 Among OEF/OIF/OND Veterans Who Have Mental Health Needs, VA and Non-VA Users’ Experiences of Mental Health Care

8-5 Among OEF/OIF/OND Veterans Who Have Mental Health Needs, Perceived Local Availability of Mental Health Services

8-6 Among OEF/OIF/OND Veterans Who Have Mental Health Needs, Perceived Local Availability of Mental Health Services, by User Group

8-7 Among OEF/OIF/OND Veterans Who Have Mental Health Needs, Reported Ability to See the Same Mental Health Provider, by User Group

8-8 Among OEF/OIF/OND Veterans Who Have Mental Health Needs, VA and Non-VA Users’ Perceptions of the VA Facility

10-1 Experience of Care Among OEF/OIF/OND Veterans Who Use VA Mental Health Services

10-2 Statistically Significant Predictors of Mental Health Outcomes

11-1 National Evidence-Based Psychotherapy Dissemination and Implementation Model in the Department of Veterans Affairs

13-1 Among Men and Women OEF/OIF/OND Veterans Who Have Mental Health Needs and Do Not Use Mental Health Services, the Percentage Who Agreed with Various Reasons for Not Using Services

13-2 Among OEF/OIF/OND Veterans Who Have Mental Health Needs and Do Not Use Mental Health Services, the Percentage Who Agreed with Various Reasons for Not Using VA Services by Race/Ethnicity (selected races)

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Abbreviations and Acronyms

A/PI Asian/Pacific Islander
ACA Patient Protection and Affordable Care Act
ACT acceptance and commitment therapy
AI/AN American Indian/Alaska Native
APPN advanced practice psychiatric nurse
ATP asynchronous telepsychiatry
AUDIT Alcohol Use Disorder Identification Test
BHIP Behavioral Health Interdisciplinary Program
CAPS Clinician-Administered PTSD Scale
CBOC community-based outpatient center
CBT cognitive behavioral therapy
CCHT care coordination home telehealth
CDC Centers for Disease Control and Prevention
CIH complementary and integrative health
CPG clinical practice guideline
CPT cognitive processing therapy
CVT clinical videoconferencing technology
CWT compensated work therapy
CWT-TR compensated work therapy-transitional residence
DAST Drug Abuse Screening Test
DBT dialectical behavior therapy
DCHV domiciliary care for homeless veterans
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2018. Evaluation of the Department of Veterans Affairs Mental Health Services. Washington, DC: The National Academies Press. doi: 10.17226/24915.
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DoD Department of Defense
Dom SA domiciliary substance abuse
DRRI Deployment Risk and Resilience Inventory
DRRTP Domiciliary Residential Rehabilitation and Treatment Program
DSM-5 Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition
EBP evidence-based practice
ECT electroconvulsive therapy
ED emergency department
EHR electronic health record
FDA Food and Drug Administration
FRCP Federal Recovery Coordination Program
FTE full-time equivalent
FY fiscal year
GAD generalized anxiety disorder
GAO Government Accountability Office
GPD Grant and Per Diem
HCHV Health Care for Homeless Veterans
HCRV Health Care for Re-entry Veterans
HUD Department of Housing and Urban Development
HUD-VASH Department of Housing and Urban Development-Department of Veterans Affairs Supportive Housing
ICD-9 International Classification of Diseases, Ninth Revision
IOM Institute of Medicine
IOP intensive outpatient program
IPT interpersonal therapy
IT information technology
LCSW licensed clinical social worker
LGBT lesbian, gay, bisexual, transgender
LPC licensed professional counselor
LRC local recovery coordinator
MA matched attention (health education control intervention)
MAOI monoamine oxidase inhibitor
MDD major depressive disorder
MFT marriage and family therapist
MH RRTP Mental Health Residential Rehabilitation Treatment Program
MHEE mental health education expansion
MHICM mental health intensive case management
MHIS Mental Health Information System
MHMS Mental Health Management System
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2018. Evaluation of the Department of Veterans Affairs Mental Health Services. Washington, DC: The National Academies Press. doi: 10.17226/24915.
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MIRECC Mental Illness Research, Education, and Clinical Center
MSA medical support assistant
MST military sexual trauma
NCPTSD National Center for Posttraumatic Stress Disorder
NDAA National Defense Authorization Act
NIAAA National Institute on Alcohol Abuse and Alcoholism
NQF National Quality Forum
NSDUH National Survey on Drug Use and Health
OAT opioid-agonist treatment
OEF Operation Enduring Freedom
OHE Office of Health Equity
OIF Operation Iraqi Freedom
OMHSP Office of Mental Health and Suicide Prevention
OND Operation New Dawn
OPCC&CT Office of Patient Centered Care and Cultural Transformation
OSI Opioid Safety Initiative
OTH other than honorable (discharge)
OTP opioid treatment program
PACT Patient Aligned Care Team
PAM Patient Activation Measure
PC-PTSD Primary Care PTSD screen
PC3 Patient-Centered Community Care
PCL(-M) PTSD checklist (Military)
PCMH patient-centered medical home
PC-MHI primary care-mental health integration
PCP primary care physician
PCT present-centered therapy
PDSI Psychotropic Drug Safety Initiative
PE prolonged exposure (therapy)
PERC Program Evaluation and Resource Center
PET prolonged exposure therapy
PHQ Patient Health Questionnaire
PII personally identifiable information
PRRC psychosocial rehabilitation and recovery center
PRRTP Psychosocial Residential Rehabilitation Treatment Program
PST problem-solving therapy
PTSD posttraumatic stress disorder
QI quality improvement
QUERI Quality Enhancement Research Initiative
RANGE Rural Access Network for Growth and Enhancement
RCT randomized clinical trial
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2018. Evaluation of the Department of Veterans Affairs Mental Health Services. Washington, DC: The National Academies Press. doi: 10.17226/24915.
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RRTP residential rehabilitative treatment program
SAIL Strategic Analytics for Improvement and Learning
SARRTP Substance Abuse Residential Rehabilitative Treatment Program
SeRV-MH Services for Returning Veterans-Mental Health
SIT stress inoculation training
SMI serious mental illness
SMITREC Serious Mental Illness Research and Evaluation Center
SNRI serotonin norepinephrine reuptake inhibitor
SoCRR Social and Community Reintegration Research
SPAN Suicide Prevention Applications Network (of the VA)
SSN Social Security number
SSRI selective serotonin reuptake inhibitor
SSVF Supportive Services for Veteran Families
STEPS-UP Stepped Enhancement of PTSD Services Using Primary Care
SUD substance use disorder
TAP Transition Assistance Program
TBI traumatic brain injury
TCA tricyclic antidepressant
TLC time-limited care (coordination intervention)
TOP Telemedicine Outreach for PTSD
UBHC Unified Behavioral Health Center
VA Department of Veterans Affairs
VABHS VA Boston Healthcare System
VACO Department of Veterans Affairs Central Office
VAMC Department of Veterans Affairs medical center
VAR veteran appointment request
VBA Veterans Benefits Administration
VCCE VA Medical Center Call Center Expansion (project)
VCL Veterans Crisis Line
VCP Veterans Choice Program
VHA Veterans Health Administration
VISN Veterans Integrated Service Network
VSE VistA Scheduling Enhancements
WTU warrior transition unit
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2018. Evaluation of the Department of Veterans Affairs Mental Health Services. Washington, DC: The National Academies Press. doi: 10.17226/24915.
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Evaluation of the Department of Veterans Affairs Mental Health Services Get This Book
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Approximately 4 million U.S. service members took part in the wars in Afghanistan and Iraq. Shortly after troops started returning from their deployments, some active-duty service members and veterans began experiencing mental health problems. Given the stressors associated with war, it is not surprising that some service members developed such mental health conditions as posttraumatic stress disorder, depression, and substance use disorder. Subsequent epidemiologic studies conducted on military and veteran populations that served in the operations in Afghanistan and Iraq provided scientific evidence that those who fought were in fact being diagnosed with mental illnesses and experiencing mental health–related outcomes—in particular, suicide—at a higher rate than the general population.

This report provides a comprehensive assessment of the quality, capacity, and access to mental health care services for veterans who served in the Armed Forces in Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn. It includes an analysis of not only the quality and capacity of mental health care services within the Department of Veterans Affairs, but also barriers faced by patients in utilizing those services.

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