Enhancing Access to

VA Mental Health
Harold Kudler,
M.D.
Chief Consultant
Department of
Veterans Affairs

Terrence Keane,
Ph.D.
Director
Behavioral Science
Division
VA National Center for
Posttraumatic Stress

Demand for VA Mental Health Services

VA provided mental health treatment to more than 1.6 million

Veterans in FY 2015.
Between FY 2005 and 2015, the number of Veterans who received
mental health care from VA grew by 80 percent (Graph 2) from ~.9M
to ~1.6M.
In 2005, 19% of VA users received mental health services, in 2015,
the figure was 28%.
Us ers of VA Health Care S ervices

Us ers of VA Mental Health S ervices

100%

80%

60%

Perce nt
Grow th
Since
2005

1.6M

40%

20%

0%
4.7M

2005

2006

2007

2008

2009

2010

2011

2012

2013

2014

2015

5.8M

.9M

VETERANS HEALTH ADMINISTRATION

Intro

VETERANS HEALTH ADMINISTRATION

Focus of the Mental Health Initiative:

Ensuring EVERY Veteran reaching out
for care is provided prompt, personal
attention by a provider
Urgent Care Provided Urgently

VETERANS HEALTH ADMINISTRATION

Early Identification, Screening, and

Intervention in Primary Care
Integration of Mental Health Services into Primary
Care
In 2015, over 690,000 Veterans (13.5%) had a depression
diagnosis documented during their primary care visits
Nearly a third of these patients (28.7%) received care
from an integrated mental health provider in the primary
care clinic, while 490,000 (71.3%) had depression
documented exclusively by primary care providers
Other mental health conditions such as PTSD, substance
use disorder and anxiety are also common among VA
primary care patients
VETERANS HEALTH ADMINISTRATION

Full Range of Mental Health Care Services

Veterans Health Administration (VHA) has:
~ 150 medical centers
~ 820 community-based outpatient clinics
~ 300 vet Centers (not formally aligned with
facility mental health)
VA staff on college and university campuses
(VITAL)

~ 1,100 Peer Specialists provide:

Unique opportunities for engaging Veterans in
care
Services to Veterans enrolled in mental health
VETERANS HEALTH ADMINISTRATION
and primary care

Suicide Prevention
Veteran Suicide Statistics, 2014
In 2014, an average of 20 Veterans died from suicide
each day.
6 of the 20 were users of VA services.
In 2014, Veterans accounted for 18% of all deaths from
suicide among U.S. adults, while Veterans constituted
8.5% of the US population.
In 2010, Veterans accounted for 22% of all deaths from
suicide and 9.7% of the population.
There is continued evidence of high burden of suicide
among middle-aged and older adult Veterans. In 2014,
approximately 65% of all Veterans who died from suicide
were aged 50 years or older.
After
adjusting
for differences in age and gender, risk for
VETERANS
HEALTH
ADMINISTRATION
suicide was 21% higher among Veterans when

Reaching Out to Veterans and Families

Veterans Crisis Line (VCL)
2.3 million calls answered since July
2007; dispatch of emergency services
61,000 times; nearly 376,000 referrals
forwarded to local VA Suicide Prevention
Coordinators
Predictive analytics: REACH VET
Increased MH services for Women Veterans
Coaching Into Care for families and
Veterans (www.va.gov/coachingintocare)
VETERANS HEALTH ADMINISTRATION
Vet Center Program

Suicide Prevention Resources

http://spreadtheword.veteranscrisisline.net/video/

VETERANS HEALTH ADMINISTRATION

Telemental Health

In September 2015, VHA surpassed 1.8 M encounters in

In September 2015, VHA surpassed 1.8M encounters in providing telemental health
services, expanding its role as a world leader in telehealth and telemental health
services, including services provided directly into the Veterans home
VETERANS HEALTH ADMINISTRATION

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Employment Services

Veterans Employment Toolkit

www.va.gov/vetsinworkplace

Supports Veterans seeking work

Helps employers support their Veteran or
Reserve/National Guard employees
Includes a section for Employee Assistance
Program (EAP)
One hour course offering continuing
education for EAP providers
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Community Care and Partnerships

Veterans Access, Choice and
Accountability Act
Military Culture: Core(i.e., Choice)
Public, Private, and
Competencies for all
Academic
Healthcare Professional
Including Civilian
Partnerships
Practitioners

Military culture training

curriculum, https://VHA.Train.org
then search for military culture
Since 2014, over 1,500
healthcare professionals have
completed at least one module
Working with community partners
to nationally disseminate
curriculum
VETERANS HEALTH ADMINISTRATION

VAs Veterans Integration

to Academic Leadership
(VITAL)
VA Campus Toolkit
VAs Community Provider
Toolkit
Annual Community Mental
Health Summit
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Reaching Out to Community Providers

About the Consultants

Experienced senior psychologists, psychiatrists, MFTs, social workers,
pharmacists, and other health professionals who treat Veterans with PTSD who
are available to consult on everything from your toughest cases to general PTSD
questions.

Ask about:
Evidence-based treatment
Medications
Clinical management
care
Resources

Assessment
Referrals
Collaborating with VA on Veterans
Developing a PTSD treatment program

Available Resources - www.ptsd.va.gov/consult

Free continuing education
PTSD, trauma assessment, screening tools
Videos, ADMINISTRATION
educational handouts, and manuals
VETERANS HEALTH

PTSD-related publications
Mobile Apps and more
WWW.PTSD.VA.GOV

Web and Mobile Resources

Web-Based Self-Help Tools http://
www.veterantraining.va.gov
Mobile Apps https://
mobile.va.gov/appstore?page=1
PTSD Coach/PTSD Coach Online
VetChange
PE Coach
- STAIR
(Coming soon)
CBT-i Coach
Concussion Coach
VETERANS
HEALTH ADMINISTRATION
PFA
Mobile

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Quality of VA Mental Health Care

Continuously Improving for our Veterans and
their Families
Measurement Based Care (MBC)
Organizational Improvement
Inclusion of MH on SAIL; Mental Health
Management System (MHMS)
Academic Affiliations and Training
Hiring Efforts, including retention
Safe Prescribing Practices

VA performance is superior to that of private

sector by more than 30% according to The
Altarum/RAND report,
VETERANS HEALTH ADMINISTRATION
VHA MH Program Evaluation (2011)

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Continuously Improving for our Veterans

and their Families

Safe Prescribing Practices

Psychotropic Drug Safety Initiative (PDSI)
Pharmacologic treatment of Veterans with PTSD
Evidence-based pharmacotherapy for substance
use disorders
Decreased inappropriate use of benzodiazepines
Decreased polypharmacy
Opioid Safety Initiative
Opioid Overdose Education and Naloxone
Distribution
VETERANS HEALTH ADMINISTRATION

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Continuously Improving for our Veterans

and their Families

Academic Affiliations and Training

Trains ~ 6,400 trainees in mental health per year
~ 70% of VA psychiatrist and psychologist
received some of their clinical training at a VA
facility
VAs Mental Health Education Expansion Initiative
A new five-year commitment
Will increase clinical education in mental
health professions
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Quality of VA PTSD Care

Continued support of training in evidence-based
PTSD treatments Prolonged Exposure (PE) and
Cognitive Processing Therapy (CPT) - ~ 10,000
clinicians trained in and outside VA
Comparative Effectiveness Research in Veterans
with PTSD: Randomized Clinical Trial of PE and
CPT in 900 Veterans
VA PTSD Brain Bank promises to discover novel
treatments for PTSD
National Center for PTSD Working to improve the
care of Veterans through research and education
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CAP: Joint VA and DoD effort to understand

and treat PTSD and related conditions in
Active Duty Military & Veterans
18 Initial Participating Institutions
VA: National Center for PTSD; VA Boston Healthcare

Open Request for Applications:

www.ConsortiumToAlleviatePTSD.com

System, Boston, MA; Ralph H. Johnson VA Medical

Center, Charleston, SC; South Texas Veterans Health
Care System, San Antonio, TX; Michael E. DeBakey VA
Medical Center, Houston, TX; VA Connecticut Healthcare
System, West Haven, CT

Boston
New Haven/
West Haven
State College

Academic: UT Health Science Center San Antonio, TX;

Boston University, Boston, MA; Duke University Medical
Center, Durham, NC; Emory University, Atlanta, GA;
Pennsylvania State University, State College, PA;
University of Memphis, Memphis, TN; University of North
Texas, Denton, TX; Wake Forest University, Winston
Salem, NC; Yale University, New Haven, CT

Ft Detrick

Winston-Salem Durham
Memphis
Charleston
Denton
Ft Hood

Atlanta
San Antonio

DoD: Carl R. Darnall Army Medical Center, Ft Hood; San

Antonio Military Medical Center, JBSA-Ft Sam Houston;
Wilford Hall Ambulatory Surgical Center, JBSA-Lackland
VETERANS HEALTH ADMINISTRATION

Houston

Coordinating Center
Research Site
Research Core
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VA National PTSD Brain Bank

Aim: Promote understanding of the impact of stress,
trauma and PTSD on brain tissue, neurocircuitry, and
gene expression. The brain bank will:
acquire & prepare brain tissue, establish psychiatric diagnosis,
promote research through intramural and extramural programs

Budget: First year $1.8 million, Recurring $1.5 million

At Boston, programmatically linked with the VAs
Alzheimer's, ALS, TBI & CTE Brain Banks
Will receive comparison tissue (normal & psychiatric
controls) from all receiving sites
Only VA Brain Bank that is authorized to accept tissue
from non-Veterans
VETERANS HEALTH ADMINISTRATION

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Veteran Experience
VHA conducts an annual satisfaction survey in
outpatient mental health developed with
Veteran input
Veterans rate VHA mental health care
positively
Generally reported ability to obtain mental
health appointments in a timely manner
Quarterly Veterans Outcomes Assessment
telephonic survey

VETERANS HEALTH ADMINISTRATION

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Outreach
Make the Connection:

http
://maketheconnection.net/stories/98

9.7M website visits; 310,000 resource locator

uses; 12.9M video views; 17,800 YouTube
subscribers; 2.8M likes, one of the largest
government Facebook communities in the country

Homelessness: HUD-VASH
33,000 Veterans have entered case management
and over 63,000 Veterans housed

SMI Reengage
Ongoing evaluation analyses indicate that for
Veterans contacted between March 2012 and
VETERANS HEALTH ADMINISTRATION
March 2016, 24% returned to VA care within

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VHA Justice Programs: Mission

To partner with the criminal justice system to identify
Veterans who would benefit from treatment as an
alternative to incarceration. Veterans Justice Programs
(VJP) will ensure access to exceptional care, tailored to
individual needs, for justice-involved Veterans by linking
each Veteran to VA and community services that will
prevent homelessness, improve social and clinical
outcomes, facilitate recovery and end Veterans cyclical
contact with the criminal justice system.
VETERANS HEALTH ADMINISTRATION

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VHA Justice Outreach Services

Veterans Justice Outreach
(VJO)

Health Care for Reentry

Veterans (HCRV)

Gain access to the jail

Identify Veterans and Determine
Eligibility
Conduct outreach, assessment, and case
management for Veterans in local courts
and jails
Provide/coordinate training for law
enforcement personnel
Linkage to VA and Community
Services/Resources

Number of VJO Specialists funded: 261

Number of 3,365 local jail facilities
serviced: 1,284
Number of Veterans receiving VJO
services (Oct. 2009 Aug. 2016):
135,838

VETERANS HEALTH ADMINISTRATION

Gain access to the prison

Educate Veterans groups about VA
and VA services
Identify Veterans and Determine
Eligibility
Reentry Planning
Linkage to VA and Community
Services

Number of HCRV Specialists funded: 44

Number of state and federal prisons
serviced: 998 (81%) of 1,234 US prisons
Number of incarcerated Veterans
receiving reentry services (Aug. 2007Aug. 2016): 75,780
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Estimated Percentage of Veterans in U.S. Prison

and Jail Population

Bureau of Justice Statistics, Veterans in Prison and Jail, 201112: http://www.bjs.gov/content/pub/pdf/vpj1112.pdf

VETERANS HEALTH ADMINISTRATION

VA Partnership with
Veterans Treatment Courts
Veterans Treatment Courts:
Hybrid Drug and Mental Health Treatment Courts, serving Veteran
defendants
Volunteer Veteran Mentors
435 courts operating (up from 50 courts in January 2011)

VA Contributions:

VJO Specialist on treatment team and in courtroom when in session

Linkage to health care services at VA medical centers
Benefits assistance: VBA participation (both in and out of court)
Partner with National Association of Drug Court Professionals to
spread the model and established best practices
Clark, McGuire, Blue-Howells in Drug Court Review (2010) - Early
Development of Veterans Treatment Courts: Local and Legislative
Initiatives
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Outcomes: What Do We Know So Far?

Most Veterans seen in VJO and HCRV have a mental health
(VJO 77%; HCRV 57%) or substance use disorder (VJO 71%;
HCRV 47%) diagnosis, or both (VJO 58%; HCRV 35%).
Within one year of their VJO outreach visit, 97% of Veterans
with mental health diagnoses had had at least one VHA
mental health visit, and 78% had had at least six visits.
(HCRV: 93%; 52%)
Within the same timeframe, 72% of Veterans with substance
use disorder diagnoses had had at least one VHA substance
use disorder visit, and 54% had had at least six. (HCRV:
57%; 39%)
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Questions?

Harold.Kudler@va.gov
Terry.Keane@va.gov
Sean.Clark2@va.gov
Joel.Rosenthal@va.gov

VETERANS HEALTH ADMINISTRATION