Improving Access to
High-Quality Mental
Health Care for Veterans
______
Marc Meisnere, Adrienne Formentos,
and Megan Snair, Rapporteurs
Forum on Mental Health and Substance
Use Disorders
Board on Health Care Services
Health and Medicine Division
Proceedings of a Workshop
NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001
This activity was supported by contract no. 36C10X22C0062 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.
International Standard Book Number-13: 978-0-309-70833-3
International Standard Book Number-10: 0-309-70833-8
Digital Object Identifier: https://doi.org/10.17226/27206
This publication is available from the National Academies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313; http://www.nap.edu.
Copyright 2023 by the National Academy of Sciences. National Academies of Sciences, Engineering, and Medicine and National Academies Press and the graphical logos for each are all trademarks of the National Academy of Sciences. All rights reserved.
Printed in the United States of America.
Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2023. Improving access to high-quality mental health care for veterans: Proceedings of a workshop. Washington, DC: The National Academies Press. https://doi.org/10.17226/27206.
The National Academy of Sciences was established in 1863 by an Act of Congress, signed by President Lincoln, as a private, nongovernmental institution to advise the nation on issues related to science and technology. Members are elected by their peers for outstanding contributions to research. Dr. Marcia McNutt is president.
The National Academy of Engineering was established in 1964 under the charter of the National Academy of Sciences to bring the practices of engineering to advising the nation. Members are elected by their peers for extraordinary contributions to engineering. Dr. John L. Anderson is president.
The National Academy of Medicine (formerly the Institute of Medicine) was established in 1970 under the charter of the National Academy of Sciences to advise the nation on medical and health issues. Members are elected by their peers for distinguished contributions to medicine and health. Dr. Victor J. Dzau is president.
The three Academies work together as the National Academies of Sciences, Engineering, and Medicine to provide independent, objective analysis and advice to the nation and conduct other activities to solve complex problems and inform public policy decisions. The National Academies also encourage education and research, recognize outstanding contributions to knowledge, and increase public understanding in matters of science, engineering, and medicine.
Learn more about the National Academies of Sciences, Engineering, and Medicine at www.nationalacademies.org.
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 the committee’s deliberations. Each report has been subjected to a rigorous and independent peer-review process and it represents the position of the National Academies on the statement of task.
Proceedings published by the National Academies of Sciences, Engineering, and Medicine chronicle the presentations and discussions at a workshop, symposium, or other event convened by the National Academies. The statements and opinions contained in proceedings are those of the participants and are not endorsed by other participants, the planning committee, or the National Academies.
Rapid Expert Consultations published by the National Academies of Sciences, Engineering, and Medicine are authored by subject-matter experts on narrowly focused topics that can be supported by a body of evidence. The discussions contained in rapid expert consultations are considered those of the authors and do not contain policy recommendations. Rapid expert consultations are reviewed by the institution before release.
For information about other products and activities of the National Academies, please visit www.nationalacademies.org/about/whatwedo.
PLANNING COMMITTEE ON IMPROVING ACCESS TO HIGH-QUALITY MENTAL HEALTH CARE FOR VETERANS
KENNETH W. KIZER (Chair), Distinguished Professor Emeritus, University of California, Davis, School of Medicine; Adjunct Professor, Stanford University School of Medicine
M. JUSTIN COFFEY, Chief Medical Officer, Workit Health; Professor, Geisinger Medical Center
SHANNON HARRIS, Associate Professor, Virginia Commonwealth University
EVELYN L. LEWIS, President and Chair, Veteran Health and Wellness Foundation; Chief Medical Officer, Warrior Centric Health; Adjunct Associate Professor, Rutgers Robert Wood Johnson Medical School
MICHELE SAMORANI, Associate Professor, Santa Clara University
JAY SHORE, Professor, University of Colorado Anschutz Medical Campus; VA Office of Rural Health
RICHARD J. SILVIA, Professor, Massachusetts College of Pharmacy and Health Sciences
Staff
JENNIFER LALITHA FLAUBERT, Program Officer
MARC MEISNERE, Senior Program Officer
ADRIENNE FORMENTOS, Research Associate
EMMA ROONEY, Senior Program Assistant
SHARYL NASS, Senior Board Director
ALEXANDRA ANDRADA, Director, Forum on Mental Health and Substance Use Disorders
FORUM ON MENTAL HEALTH AND SUBSTANCE USE DISORDERS
MARGARITA ALEGRIA (Co-chair), Harvard Medical School
ROSALIE LICCARDO PACULA (Co-chair), University of Southern California
KIRSTEN BERONIO, Center for Medicaid and CHIP Services
CARLOS BLANCO, National Institute on Drug Abuse, National Institutes of Health
CARLA M. CANUSO, Janssen Research & Development, LLC
CHRIS M. CROWE, U.S. Department of Veterans Affairs
W. PERRY DICKINSON, University of Colorado
ANTHONY T. ESTREET, National Association of Social Workers
RICHARD FRANK, Brookings Institution
HOWARD H. GOLDMAN, University of Maryland School of Medicine
ROBERT K. HEINSSEN, National Institute of Mental Health
KRISTIN KROEGER, American Psychiatric Association
JAN LOSBY, Centers for Disease Control and Prevention
R. KATHRYN McHUGH, Harvard Medical School
BENJAMIN MILLER, Stanford School of Medicine
ANNIE PETERS, National Association of Addiction Treatment Providers
KATHY PHAM, American College of Clinical Pharmacy
JOE PYLE, Scattergood Foundation
DEIDRA ROACH, National Institute on Alcohol Abuse and Alcoholism
MARY ROARY, Substance Abuse and Mental Health Services Administration
BARBARA ROLAND, Indian Health Service
TISAMARIE B. SHERRY, U.S. Department of Health and Human Services
RUTH SHIM, University of California, Davis
MATTHEW TIERNEY, University of California, San Francisco, Office of Population Health
Reviewers
This Proceedings of a Workshop 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 proceedings as sound as possible and to ensure that it meets the institutional standards for quality, objectivity, evidence, and responsiveness to the charge. The review comments and draft manuscript remain confidential to protect the integrity of the process.
We thank the following individuals for their review of this proceedings:
CARRIE M. FARMER, RAND Corporation
EVELYN L. LEWIS, Veteran Health and Wellness Foundation Warrior Centric Health, Robert Wood Johnson Medical School
MARK MATTHEWS, University College, Dublin, Ireland
Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the content of the proceedings nor did they see the final draft before its release. The review of this proceedings was overseen by HUGH H. TILSON, University of North Carolina. He was responsible for making certain that an independent examination of this proceedings was carried out in accordance with standards of the National Academies and that all review comments were carefully considered. Responsibility for the final content rests entirely with the rapporteurs and the National Academies.
This page intentionally left blank.
Acknowledgments
The National Academies of Sciences, Engineering, and Medicine (the National Academies) are grateful for the support of the U.S. Department of Veterans Affairs (VA), which sponsored this workshop, and that of the many annual sponsors of the National Academy of Sciences. The National Academies wishes to thank all the members of the planning committee, who collaborated to ensure a workshop complete with informative presentations and rich discussions. Finally, the forum wants to thank the speakers and moderators, who generously shared their expertise and time with workshop participants.
Support from the many sponsors of the Forum on Mental Health and Substance Use Disorders is critical to its work. The sponsors include the Centers for Medicare & Medicaid Services; the National Institutes of Health (National Institute on Alcohol Abuse and Alcoholism, National Institute on Drug Abuse, and National Institute of Mental Health); American College of Clinical Pharmacy; American Psychiatric Nurses Association; American Psychiatric Association; American Psychological Association; Centers for Disease Control and Prevention; Council on Social Work Education; Janssen Research & Development, LLC; National Academy of Medicine; Office of the Assistant Secretary for Planning and Evaluation; Think Bigger Do Good Policy Series (a partnership of the Scattergood Foundation, Peg’s Foundation, Patrick P. Lee Foundation, and Peter & Elizabeth Tower Foundation); VA; and Well Being Trust.
This page intentionally left blank.
Inhalt
Organization of the Proceedings
Overview of Mental Health Care Services in the Veterans Health Care System
2EXPERIENCES OF VETERANS ACCESSING MENTAL HEALTH SERVICES
Iraq and Afghanistan Veterans of America (IAVA)
3LEVERAGING VA’S STATUS AS A NATIONAL HEALTH CARE SYSTEM
Improving Mental Health Care Quality in the United States: Intermountain Health Care
4IMPROVING AND SUSTAINING ACCESS TO MENTAL HEALTH SERVICES
Innovative Strategies to Improve and Sustain Access
5OPPORTUNITIES FOR IMPROVING MENTAL HEALTH CARE THROUGH PARTNERSHIPS
Leveraging Industry Partnerships
6TAKING INNOVATIVE STRATEGIES TO SCALE: ACHIEVING INSTITUTIONAL ADOPTION
Improving Access with Community Health Workers
Using Pharmacists as Entry Points
Boxes and Figures
BOXES
4-1 Lessons from Echo Park Lake, Los Angeles
5-1 Levels of Care Within WellPower
6-1 Characteristics of Optimal Technology Benefit Coverage Determination Processes
FIGURES
1-1 Veterans Health Administration Mental Health Continuum of Care Model
2-1 Barriers to care for female veterans
3-1 Nuka System of Care: rates of emergency room visits per month for unintentional injuries
3-2 Complexity of mental health integration science
4-1 Health professional shortage areas, by county, 2022
4-2 Increasing access via digital navigators: Roles and benefits
4-3 Virtual reality (VR) relaxation for chronic low back pain
Acronyms and Abbreviations
AI | artificial intelligence |
CBT | cognitive behavioral therapy |
CHW | community health worker |
EHR | electronic health record |
EMS | emergency medical services |
GAD | Generalized Anxiety Disorder |
HIE | health information exchange |
IAPT | Increasing Access to Psychological Therapies |
IAVA | Iraq and Afghanistan Veterans of America |
IHS | Indian Health Service |
ML | machine learning |
NLP | natural language processing |
PHQ | Patient Health Questionnaire |
PTSD | posttraumatic stress disorder |
VA | U.S. Department of Veterans Affairs |
VHA | Veterans Health Administration |
VMET | Veterans Mental Evaluation Team |
VR | virtual reality |