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
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 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
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
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
Distance Consultation
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 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