National Academies report: VA provides high-quality mental health services, but it has an access problem

The Department of Veterans Affairs offers mental health treatment that's on par with or exceeds the quality of other providers, but veterans of recent Middle East wars may struggle to access that care, according to a new report. 

The National Academies of Sciences, Engineering and Medicine was commissioned by Congress in 2013 to study access and quality of VA behavioral healthcare for veterans of the wars in Iraq and Afghanistan. Committee members visited VA behavioral health sites and surveyed veterans about their experiences and needs for the report

The results: About half of veterans who need mental health services do not visit a VA or non-VA site for treatment, leaving post-traumatic stress, depression, addiction and other behavioral health concerns untreated. More than half of the surveyed veterans who screened positive for a mental health condition said they think they don't need care. 

The report suggests several reasons for this trend. For one, many of the interviewed veterans did not know how to not know how to apply for mental health benefits through the VA or whether they qualified for the benefits. In addition, the study found that physically accessing services is a problem for this population, as they may lack transportation. The stigma around behavior health treatment also prevents some from seeking treatment. 

However, veterans who can and do access VA mental health services reported high satisfaction and praised the privacy afforded and the staff who treated them, according to the report. 

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"As the nation's largest provider of [behavioral] healthcare services, the VA system has a unique and unparalleled opportunity to address the mental-health care needs of veterans in a truly integrated and strategic manner," Alicia Carriquiry, a statistics professor at Iowa State University and chair of the study committee, said in an announcement

"The VA needs to make high-quality mental-health care consistently and predictably available at every facility for all veterans," Carriquiry added.

The VA has undertaken a number of quality improvement initiatives over the past several years after a nationwide scandal in 2014 revealed that veterans faced long wait times for care at VA facilities. It launched the Veterans Choice program to allow its patients to seek care elsewhere to ease access issues and has invested heavily in telemedicine services.

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The National Academies offered in the report a number of best practices and possible improvements that could reduce the access issues. Allotting more clinical space for mental health services can ease wait times and improve reliability, while also reducing burnout among mental health clinicians.

The VA also must ensure that it's connecting with minority veterans and women. Women who served in Iraq or Afghanistan, for example, show a greater need for behavioral health services than women who served in other conflicts, according to the report, and are more likely than their male peers from the same wars to believe they cannot access behavioral health services through the VA.

Building partnerships with community groups and standardizing care guidelines for patients with mental health conditions can also improve the quality of services, according to the report.