Ex­ec­u­tive or­der aims to im­prove vet­er­ans’ men­tal health­care

Modern Healthcare - - FRONT PAGE - Jaimy Lee

By man­dat­ing that the Vet­er­ans Af­fairs Depart­ment con­tract with community-based providers, the Obama ad­min­is­tra­tion aims to im­prove men­tal health­care for the mil­lions of ser­vice mem­bers who served in Iraq or Afghanistan.

In an Aug. 31 ex­ec­u­tive or­der, Pres­i­dent Barack Obama out­lined a num­ber of ac­tions that the ad­min­is­tra­tion ex­pects will bet­ter pro­vide men­tal health­care to vet­er­ans, ser­vice mem­bers and their fam­i­lies. “The need for men­tal health ser­vices will only in­crease in the com­ing years as the na­tion deals with the ef­fects of more than a decade of con­flict,” Obama said in the ex­ec­u­tive or­der.

Along with en­hanced part­ner­ships be­tween the VA and community providers, the ex­ec­u­tive or­der ad­dresses sui­cide preven­tion and sub­stance-abuse treat­ment, men­tal health­care staffing, re­search and de­vel­op­ment, and the cre­ation of an in­ter­a­gency task force that will de­velop new strate­gies to treat vet­er­ans. It re­quires the VA and HHS within 180 days to es­tab­lish at least 15 pi­lot projects in which the VA will con­tract with community-based providers to en­sure timely care for vet­er­ans.

“VA will work closely with our fed­eral part­ners to im­ple­ment the ex­ec­u­tive or­der im­me­di­ately, and continue to ex­pand ac­cess to the high­qual­ity men­tal health­care ser­vices our vet­er­ans have earned and de­serve,” said VA Sec­re­tary Eric Shin­seki in a state­ment.

The VA has tra­di­tion­ally been re­luc­tant to pur­sue con­tracts with community-based providers, said Charles In­goglia, vice pres­i­dent of pub­lic pol­icy for the Na­tional Coun­cil for Community Be­hav­ioral Health­care. Only one state—Mon­tana—has con­tracted with the VA for clin­i­cal ser­vices on a statewide level for sev­eral years, he added, with most VA con­tract­ing lim­ited to non­clin­i­cal ser­vices such as hous­ing.

“It’s im­pos­si­ble for the VA to have suf­fi­cient ca­pac­ity to meet the needs” of vet­er­ans, In­goglia said.

Ron Hon­berg, na­tional di­rec­tor of pol­icy and le­gal af­fairs at the Na­tional Al­liance on Men­tal Ill­ness, said the man­date to es­tab­lish part­ner­ships be­tween community-based providers and the VA is im­por­tant for sev­eral rea­sons. It will pro­vide vet­er­ans and ser­vice mem­bers liv­ing in ru­ral ar­eas with in­creased ac­cess, and it will also of­fer ac­cess to vet­er­ans who choose not to seek men­tal health­care ser­vices at a VA fa­cil­ity. “The VA doesn’t have the ca­pac­ity to reach ev­ery­body who needs it at this point,” Hon­berg said.

More than 2 mil­lion ser­vice mem­bers have been de­ployed to Iraq or Afghanistan since Sept. 11, 2001. A Gov­ern­ment Ac­count­abil­ity Of­fice re­port pub­lished in Oc­to­ber 2011 found that the num­ber of vet­er­ans of those wars who have re­ceived men­tal health­care ser­vices from the VA rose more than 300% to about 139,000 in 2010 from about 35,000 in 2006.

In April of this year, the VA’s in­spec­tor gen­eral’s of­fice re­ported that first-time pa­tients at the VA did not re­ceive timely men­tal-health eval­u­a­tions, and cur­rent pa­tients of­ten had to wait two weeks past their de­sired date for an ap­point­ment.

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