Evaluation of the Department of Veterans Affairs Mental Health Services (2018) / Chapter Skim
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8 Mental Health Workforce and Facilities Infrastructure
8 Mental Health Workforce and Facilities Infrastructure
Pages 175-198
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From page 175... ...
The Government Accountability Office (GAO) reported that while the VA has met recent hiring initiatives designed to increase the number of inpatient and outpatient mental health providers, the VA continues to face challenges in hiring mental health staff to meet the demand for services (GAO, 2015)
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. Provider vacancies in the VA, particularly for mental health providers, are in part a reflection of a mental health provider shortage nationwide (Annapolis Coalition on the Behavioral Health Workforce, 2007)
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A study from 2009 revealed that 77 percent of counties had a severe shortage of prescribing and non-prescribing mental health providers, and 96 percent had at least some unmet need for mental health (Thomas et al., 2009)
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VHA mental health clinicians who provide evidence-based posttraumatic stress disorder (PTSD) care, 50.0 percent reported feeling exhausted and 47.1 percent reported feeling cynical on the job.
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While the additional support staff could prepare patients before a physician sees them, without additional exam room space there may be nowhere for that to happen, and productivity would not increase (Grant Thornton LLP, 2015)
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Separately, beginning in 2012, the VA began a 5-year mental health education expansion (MHEE) program to strengthen the pipeline of well-trained mental health professionals with the goal of recruiting and hiring an additional 1,600 VA-trained mental health providers (VA, 2015)
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From page 181... ...
That program employs veterans, who are in recovery for a mental health condition themselves, to serve as peer supports to other veterans receiving mental health care. Peer specialists in the VA can offer tools, resources, and navigational assistance to veterans in VA care.
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. Quality of Mental Health Providers in the Veterans Health Administration Workforce recruitment, retention, and compensation described above affect the VA's capacity to provide access to specialized clinical knowledge and expertise that meets patients' expectations.
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. The VA's training programs in evidence-based psychotherapies are generally targeted at licensed independent providers: psychologists, psychiatrists, social workers, and mental health nurses as well as licensed professional mental health counselors and marriage and family therapists.
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Results from VA's Veterans Satisfaction Survey (VSS) , the VA's annual survey of veterans served by the VA, also suggest veteran satisfaction with VA mental health providers.
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• My mental health provider looks down on me and the way I live my life. • I never have a hard time communicating with my mental health provider because of accents or language barriers.
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186 TABLE 8-4 Among OEF/OIF/OND Veterans Who Have Mental Health Need, VA and Non-VA Users' Experiences of Mental Health Care All OEF/OIF/OND Veterans VA Users Non-VA Users Experience of Care Unwgt n Wgt N Wgt % SE % Unwgt n Wgt N Wgt % SE% Unwgt n Wgt N Wgt % SE% Total 1,105 749,453 – – 849 476,654 – – 256 272,799 – – My mental health provider understands my background and values Strongly/somewhat agree 785 535,295 71.4% 1.6% 592 327,702 68.8% 1.8% 193 207,594 76.1% 3.1% I feel welcome at my mental health provider's office Strongly/somewhat agree 887 599,396 80.0% 1.4% 676 375,206 78.7% 1.7% 211 224,190 82.2% 2.6% My mental health provider looks down on me and the way I live my life Strongly/somewhat disagree 880 587,951 78.5% 1.7% 670 365,392 76.7% 1.9% 210 222,559 81.6% 3.1% I had a hard time communicating with my mental health provider because of accent or language barrier Never 876 602,821 80.4% 1.7% 649 359,523 75.4% 1.9% 227 243,299 89.2% 2.5% NOTE: SE = standard error of percentage; Unwgt = unweighted; Wgt = weighted. SOURCE: Committee to Evaluate VA Mental Health Services, Veteran Survey, 2017.
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The one mental health provider who really cared .
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TABLE 8-7 Among OEF/OIF/OND Veterans Who Have Mental Health Needs, Reported Ability to See the Same Mental Health Provider, by User Group Among OEF/OIF/OND Veterans Who Have Mental Health Need by Level of Agreement Strongly or Somewhat Agree Strongly or Somewhat Disagree Not Sure/Refused Unwgt n Wgt N Wgt % SE % Unwgt n Wgt N Wgt % SE % Unwgt n Wgt N Wgt % SE % At the VA, you can see the same mental health provider on most visits All OEF/OIF/OND veterans 816 509,161 30.0% 1.1% 247 181,931 10.7% 0.8% 889 972,445 57.2% 1.1% who have mental health need VA users 629 350,699 73.6% 1.7% 123 70,470 14.8% 1.3% 76 44,175 9.3% 1.1% Non-VA users 33 22,730 8.3% 1.9% 36 28,409 10.4% 1.9% 178 214,754 78.7% 2.3% Non-users 153 133,697 14.3% 1.1% 88 83,052 8.9% 0.9% 625 703,377 75.1% 1.3% NOTE: SE = standard error of percentage; Unwgt = unweighted; Wgt = weighted. SOURCE: Committee to Evaluate VA Mental Health Services, Veteran Survey, 2017.
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. Furthermore, GAO identified clinical space constraints at some VA facilities as an impediment to being able to get new mental health providers in place (GAO, 2015)
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From page 190... ...
Parking Veterans and VA clinicians both reported during the committee's site visits that the VA facilities themselves have barriers that prevent veterans from seeking treatment or having a positive experience while doing so. For example, inadequate parking was a complaint at nearly all of the VAMCs that were visited on the site visits conducted for this study, and nearly half of all veterans surveyed did not think parking was readily available (see Table 8-7)
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SE = standard error of percentage; Unwgt = unweighted; Wgt = weighted. SOURCE: Committee to Evaluate VA Mental Health Services, Veteran Survey, 2017.
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If a VA provider is not within a 40-mile drive of a veterans' home, the Veterans Choice Program permits the veteran to seek care from an approved non-VA provider. According to the VA's Office of Rural Health, 2.9 million out of 5.5 million rural veterans are enrolled in the VA health care system.
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From page 193... ...
The authors evaluated data from the VA National Patient Care Database outpatient treatment files for all veterans who received a new-onset diagnosis for depression, anxiety, or PTSD at a VA outpatient facility between FY 2007 and FY 2010. The authors found that rural veterans were less likely to receive psychotherapy than their urban counterparts.
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• The VA is the largest training program for health professionals in the United States. • The VA experiences significant shortages of mental health providers due to widespread national shortages of mental health professionals, lengthy and inefficient hiring processes, and high turnover in some areas.
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From page 195... ...
2014. Burnout in Veterans Health Administration mental health providers in posttraumatic stress clinics.
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From page 196... ...
2016c. National Mental Health Providers Survey: 2015.
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From page 197... ...
Department of Veterans Affairs. VA Office of Mental Health Operations.
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