VA Mental Health Services:
We’re Not Your Father’s VA Anymore!
Steve Holliday, Ph.D, ABPP-CN
Chief Mental Health Officer
Substance Abuse Coordinator
Veterans Administration, VISN 17
VISN 17
• Covers 4 VA Health Care Systems along IH-35
from Brownsville to Dallas
– North Texas HCS (Dallas & Ft. Worth)
– Central Texas HCS (Waco/Temple/Austin)
– South Texas HCS (San Antonio & Kerrville)
– Valley/Costal Bend HCS (Harlingen, Laredo, & CC)
• VISN 16 – Houston & East Texas
• VISN 17 – El Paso & West Texas
VISN 17
Justice-Involved Veterans
• Conference Yesterday
• VA Prison Re-Entry Program
– State/Federal Prisons
– Enrolling Eligible Veterans
– Appointments for Care After Release
– Case Management until connected
• Veterans Justice Outreach Program
– County/Local Jails Re-Entry Outreach
– Liaison with local Veterans Courts
– Educate local Law Enforcement/Others
Eligibility Issues
• Not Eligible for VA Care while Incarcerated
– Except for brief outreach visits
• OEF/OIF Vets have full eligibility for 5 years
• Must have Honorable or General D/C
– Bad D/Cs can be upgraded
• Served >180 days or Service-connected
• Co-Pays at Higher Incomes Unless SC
MH Levels of Care
• Outpatient Mental Health Clinics
• Acute Inpatient MH Services
• Residential Rehabilitation Programs
– Domiciliary (Doms)
– Homeless , PTSD, SUD RRTPs
• Community-based MH Specialty Care
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PTSD/MST
MHICM Teams
Homeless Programs
Vocational Programs
Telehealth & Home Health
Bonham Dom Room
New Initiatives
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Mental Health Uniform Services Mandate
Mental Health in Primary Care
Psychosocial Recovery & Rehabilitation
Telemental Health Services
Evidence-Based MH Therapies
Suicide Prevention
Ending Homelessness
Electronic Medical Record
Performance Measures to Improve Quality
Outpatient MH Clinics
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Routine Outpatient MH Care
MH Case Management
Psychotropic Medications
Evidence-based Psychotherapies for
– Depression
– Mild PTSD/Anxiety Disorders
– Psychosis
– Marital/Couples’ Counseling
Substance Abuse Treatment
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Building Motivation/Education in PCC & MHCs
Outpatient SUD Program
Intensive Outpatient SUD Program
SARRTP (28 Day Residential)
SUD Tracks in Doms (90-Day Residential)
Buproprion/Methadone Programs
Inpatient/Outpatient DETOX
Homeless Programs
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Ending Homelessness in 5 years!
Health Care for Homeless Veterans
Contact Emergency Shelters
Homeless Domiciliaries
Grant and Per Diem Transitional Housing
HUD/VASH Vouchers (10,000 more coming)
Emergency Cash Assistance to prevent
Homelessness
Vocational Rehabilitation
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VBA Educational Benefits (30%+ SC)
Incentive Therapy (IT)
Compensated Work Therapy (CWT)
Supported Community Employment
Job Search Assistance
Assistance with VA/SSDI Claims (VSOs)
Volunteer Positions
MH Uniform Services Plan
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Based on President’s MH Commission
Supports Recovery Model
Emphasis on MH/PCC and Suicide Prevention
Mandates Core MH Services at Each Site
Standardized MH Care Throughout USA
Significantly Enhanced MH Staff/Capacity
Mandates Evidence-Based MH Services
Tracks MH Outcomes and Staffing
MH in Primary Care
• Co-located Mental Health in Primary Care
– Reduces Stigma for Seeking MH Care
– Rapid Access for MH Screening/Services
– Treatment for Mild MH issues
• Adjustment Issues/Life Stress
• Uncomplicated Depression & Anxiety D/Os
• Harm Reduction/ME for SUDs
– Referral to MHC/Specialized Tx Programs
• Up to 80% of Cases Managed in PCC
• Healthy Behaviors/Disease Mgmt
Rehabilitation/Recovery Model
• Recovery is possible for everyone (even SMI)
• It’s the Vet’s Recovery Plan; Not the Doc’s
– Uses Understandable Language
– Based on Vet’s Strengths, Goals
– Peer Counselors/Technicians as Role Models
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Include Consumers in MH Planning/Mgmt
Meaningful Work is the Best Therapy
Building Support Systems in the Community
Educating to Reduce Stigma/Facility Recovery
Coordinators
Tele Health Services
• Telemental Health Services
– EBTs from the Hospitals to Remote Clinics
– Cross coverage for Smaller MHCs
– “Health Buddies” to Monitor SMI at Home
– Home-based Videophones for Highly Rural
– Reduces Barriers of Distance & Stigma
• Future Directions
– Anonymous Chat Rooms (Suicide Hot Line)
– Peer Support Networks
– Secure Email with MH Providers
Health Buddy
Distance Consultation
Suicide Prevention
• National Suicide Hotline 1-800-273-TALK (8255)
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Staffed by Trained MH Providers 24/7
Over 3000 Rescues in Past Year
Arrange for Immediate Help
Live Hand Off to Local VA Facilities for F/U
• Facility Suicide Prevention Coordinators
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Suicide Risk Assessments
Maintains List of High Risk Patients/Chart Flags
Develops/Implements Suicide Safety Plans
Investigates Attempts/Completed Suicides
Educates Staff and Community
Evidence-Based Therapy
• Evidence-Based Psychotherapy
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PE/CPT/ACT for PTSD
CBT for Depression
SUD – ME, 12-SFT, New Medications
Couples/Marital Therapy
SST and MHICM for SMI
• National Training Program in EBTs
– One-week intensive workshop (national experts)
– 6-12 Months of weekly case supervision
– Train the Trainer Model for future staff
• Monitor Use for fidelity to EBTs (CPRS)
Electronic Medical Record
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Follows Veterans Across Sites/Locations of Care
Digital X-Rays, Consults, Meds, Lab, etc.
Flags High-Risk Conditions
Clinical Reminders for Better Care
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MH Screening and Requires F/U
Smoking Cessation
Obesity
Diabetes
Hypertension
• Tracks Quality of Care through Performance Ms
• Integration with DoD Medical Records Planned
Ending Homelessness!
• Secretaries 5-Year Plan – $3.2 Billion
• From 160K to ZERO Homeless Vets!
• Enhanced Existing Homeless Services
– 10,000 New HUD-VASH Vouchers this Year
– Enhanced VA SUD and MH Capacity
– Enhanced RRTP/Doms & Contract Beds
– Enhanced Jail/Prison Diversion & Outreach
• New Initiatives/Services
– Homeless Hot Line
– Emergency Funding to Prevent Homelessness
OEF/OIF Resources
• www.texvet.com
– On Line Searchable Database
– Texas MH, Job, Education, Emergency Services
– Eligibility Tool Under Development
• 211 Texas
– Just Dial 211
– 24/7 Information Line
– Services for Vets/Active Duty
• Vet Centers
– Storefront locations, walk-in service
– Veteran and Family Counseling
– GWAT Outreach Staff
The Best Care Anywhere
By Phillip Longman
Ten years ago, veterans hospitals were
dangerous, dirty, and scandal-ridden.
Today, they're producing the highest
quality care in the country. Their
turnaround points the way toward
solving America's health-care crisis.
Washington Monthly, 2006
The Best Medical Care in the U.S.
The VA uses the data gathered in its computers to
pinpoint problem areas, such as medication errors.
The network also allows it to track how closely the
medical staff is following evidence-based treatment
and monitor deficiencies. Such tracking pays off.
When Rand did an extensive study comparing
quality of care at the VA with private-sector
hospitals, it found that performance measurement
played an important role in helping the VA score
higher in every category except acute care, where it
came in about even.
Business Week, 2006
VA medical system earns high
customer satisfaction ratings
Good news about government is rare enough. What's
outright shocking is when that good news is about how
nice government employees are. But that is the bottom
line of the recently released American Customer
Satisfaction Index report on the Department of Veterans
Affairs' medical system.
Not only do veterans rate their VA care much higher
overall than the general population rates its hospital
experiences, vets also consistently give VA doctors and
nurses high scores for "responsiveness" (83 out of a
possible 100), courtesy (90), and "respect and dignity
afforded patients" (91).
National Journal February 10, 2006
VA: From Worst to First!
• Moving from Hospitals to the Community
• CPRS & Performance Measures
– Improved Access to Care
– Improved Quality of Care & Outcomes
– Improved Cost Effectiveness
– Improved Patient Satisfaction
• Holding VA Staff Accountable
– Managers’ Performance Plans
– Providers Performance Plans/Incentive Pay
Next Steps…
• Contact your VISN MH Lead
– VISN 16: [email protected]
– VISN 17: [email protected]
– VISN 18: [email protected]
• Meet your local VJO and Re-Entry Specialist
• Work with you local MHMR Jail Diversion
Committee!
• Work to Establish Veterans’ Courts
• Ask you clients if they are vets and give us a
chance to help!
Any Questions?
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VA Mental Health Services - Texas Corrections Association