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Department of Veterans AffairsVeterans Health Administration

Office of Mental Health Services Ira Katz, MD, PhD, Senior Consultant

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Department of Veterans Affairs

• Veterans Health Administration

• Veterans Benefits Administration

• National Cemetary Administration

• Veterans Health Administration– 21 Veterans Integrated

Services Networks– 153 Medical Centers– 765 Community-Based

Outpatient Clinics– ~250 Vet Centers

VA / Veteran Population Facts

• 23.8 million veterans– 1.8 million women (and growing)– Almost 60% of American men > 65 are veterans

• Not all Veterans are eligible for VA health care– Main factors: OEF/OIF services, Service Connected

disability, other disability, or low income

• 7.8 million enrolled for health care in Department of Veterans Affairs (VA)– ~ 5.2 million seen / yr (22% of all veterans)– ~ 1.6 million with MH Diagnoses (31% of those seen)

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Defining Mental Health (MH)

• Includes:– Mental Disorders– Problem Drinking– Other Substance Use

Disorders– Homelessness

• Settings:– Ambulatory

• Primary Care • MH Specialty• MH Subspecialty• Other Specialty

– Residential Rehabilitation– Inpatient

• Budget for FY 2010– Over $5 Billion

• Staffing– Over 20,000

• Being extended to include:– Health Psychology/

Behavioral Medicine• Pain• Sleep• Problems with adherence

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OEF/OIF Veterans Cumulative from FY02 to Q3 FY09

• Total – 1,049,540

• Seen in VA Medical Centers or Clinics– 480,324 (46% of total)

• With a Mental Health Diagnosis (MH Dx) – 227,205 (47% of those seen in VA)

• PTSD– 120,480 (53% of those with a MH Dx)– Additional 13,623 Veterans with PTSD were seen in Vet

Centers only

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Comparing Mental Health Issues in OEF/OIF and All Veterans

Men

Received care: 4.7%

MH Diagnosis: 6.2%

PTSD: 14.8%

Women

Received care: 11.8%

MH Diagnosis: 11.6%

PTSD: 21.3%

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OEF/OIFPTSD (53%)Depression (36%)Anxiety (29%)

All VeteransDepression (52%)PTSD (23%)Anxiety (19%)

Proportion of Utilizers from OEF/OIF

Most Common Mental Health DiagnosesAmong those with any diagnosis

Welcoming Home a New Generation of Veterans

• Reintegration is an issue for every Veteran, and for their families

• Some will have more profound needs for mental health care

• VA provides support for reintegration– Outreach and reintegration support provided by Vet

Centers and VA medical centers and clinics

Welcoming Home a New Generation of Veterans

• Reintegration is an issue for every Veteran, and for their families

• Some will have more profound needs for mental health care

• VA provides support for reintegration– Outreach and reintegration support provided by Vet

Centers and VA medical centers and clinics

Major Complications of Mental Health Conditions

• Behaviors seen as dangerous or criminal

• Incarceration

• Unemployment

• Homelessness

• Suicide

VA Mental Health Programs

• Suicide Prevention– VA mental health enhancements began in 2005, and specific VA suicide prevention

programs began in 2007.– Question: Are there suggestions that these programs may be effective in preventing

suicide?– Answer: Look at the ratio of suicide rates in Veterans (men and women) aged 18-29 who

use VA health care services relative to Veterans in the same age group who do not.

» Data on all Veterans from the Centers for Disease Control and Prevention National Violent Death Reporting System. Data on users of VA health care services from the VA Serious Mental Illness Treatment Research and Evaluation Center.

VA/DoD Summit Model

DoDClinical

VAClinical

Communities

Society as a Whole

VA / DoD Summit: Public Health Model

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Two Mental Health Strategies

Vet CentersMedical Facilities

Evidence-BasedCare for Conditions

Readjustment Counseling For Problems

Post Traumatic Stress Disorder

(PTSD)

Cross-referrals→ Readjustment issues and Peer Support← Stepped care

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Mental Health Services:

Integrated and Specialty Care

Specialty MH and SUD Service

Integrated MH- Primary Care

ServicesGeneral MH and Specialty Services.

Specialty services include:

PTSD specialty care

Substance Use Disorder programs

Homeless programs

Recovery-oriented services for seriously mentally ill

Focus on improved access for care for common mental illnesses including:

Depression

Anxiety disorders

Problem drinking

Evidence-Based Psychotherapy

Clinical Neuroscience

Public Health Model:VA’s Vision

• Paths to mental health services:– Vet Centers

– Primary Care

– Police

– Courts

– Families and friends

– Housing issues

– Community providers

– Community organizations and agencies

– Employers

– Clergy

– Call centers

– Web-based resources

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