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Veterans Health Administration Mental Health Program Evaluation, Summary

October 19, 2011

This report summarizes a four-year evaluation of mental health services provided by the Veterans Administration (VA) for veterans with schizophrenia, bipolar disorder, posttraumatic stress disorder, major depression, and substance use disorders. The population of veterans with the diagnoses included in the study comprises a large and growing number of veterans with severe and complex general medical and mental disorders and accounts for a disproportionately large proportion of utilization and costs for the VA. Study veterans represented 15.4 percent of all veterans who used VA services in 2007 but accounted for 32.9 percent of the costs due to higher utilization of inpatient and outpatient services. Across the country, VA facilities report substantial capacity for treating seriously mentally ill veterans. Although capacity has increased since the implementation of the Mental Health Strategic Plan in 2005, important gaps remain. The proportion of veterans receiving recommended care varies widely, and there is variation in many of the performance indicators assessed with regard to specific populations, services, and locations. In most instances, VA care performance is as good as or better than that reported by other groups or shown by direct comparisons with other systems of care, but the level often does not meet implicit VA expectations. Most performance indicators did not show substantial improvement from FY 2004 through FY 2007, but recent structural enhancements and increased availability of services may yield improvements in the future, and the number of veterans in the study cohorts who were served during the study period increased annually. Veterans' perceptions of VA services were favorable, although they did not perceive significant improvement in their conditions. Opportunities for further investigation are identified, along with specific problem areas and strategies for improving performance and methods to enhance capacity for quality monitoring and improvement.

A Needs Assessment of New York State Veterans: Final Report to the New York State Health Foundation, Summary

January 26, 2011

Mental health disorders and other types of impairments resulting from deployment experiences are beginning to emerge, but fundamental gaps remain in our knowledge about the needs of veterans returning from Iraq and Afghanistan, the services available to meet those needs, and the experiences of veterans who have tried to use these services. The current study focuses directly on the veterans living in New York state; it includes veterans who currently use U.S. Department of Veterans Affairs (VA) services as well as those who do not; and it looks at needs across a broad range of domains. The authors collected information and advice from a series of qualitative interviews with veterans of Operation Iraqi Freedom (OIF)/Operation Enduring Freedom (OEF) residing in New York, as well as their family members. In addition, they conducted a quantitative assessment of the needs of veterans and their spouses from a sample that is broadly representative of OEF/OIF veterans in New York state. Finally, they conducted a review the services currently available in New York state for veterans. The study found substantially elevated rates of post-traumatic stress disorder (PTSD) and major depression among veterans. It also found that both VA and non-VA services are critically important for addressing veterans' needs, and that the health care systems that serve veterans are extremely complicated. Addressing veterans' mental health needs will require a multipronged approach: reducing barriers to seeking treatment; improving the sustainment of, or adherence to, treatment; and improving the quality of the services being delivered. Finally, veterans have other serious needs besides mental health care and would benefit from a broad range of services.