Patients Still Struggle to Access Mental Health Care at VA

November 04, 2016 - More than a third of veterans struggle to access mental health care within the VA system despite a high prevalence of post-traumatic stress disorder, according to a recent survey from the Wounded Warrior Project.

Although nearly three-quarters of wounded veterans report suffering from PTSD, 34.8 percent had trouble accessing care for those mental health conditions, indicating significant gaps in healthcare access for veterans serving in the post-9/11 military.

In addition to struggling with post-traumatic stress disorder, 75 percent of veterans suffer from sleep problems and 70 percent experience depression.

Overall, 53.3 percent of respondents managed to access treatment for these mental health conditions. For 69 percent of respondents, the VA is their primary source for mental healthcare, but mental health services within the health system are not always easily available or suited for patient needs.

Thirty-six percent of veteran respondents said they had difficulty scheduling an appointment that met both their and their provider’s timelines.

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Thirty-five percent of respondents said they were not comfortable with VA treatment offerings and therefore did not access them, while 33 percent did not access treatment because they felt it would bring up painful memories.

According to the survey, more veterans are facing a lack of mental health treatment resources than reported in the 2015 poll. In 2016, 26 percent of respondents noted a lack of treatment options in their region, while 16 percent reported the same the year prior.

Veterans also report having trouble accessing treatment for their physical ailments.

Forty-three percent of respondents stated that they had difficulty accessing healthcare for physical ailments in the past 12 months, or that they delayed or went without treatment. Forty percent of these veterans said scheduling appointments was their primary barrier to treatment.

Veteran healthcare access has been an issue at the Department of Veterans Affairs (VA) for some time.

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In an April report from the Government Accountability Office, researchers found that wait times at the VA are still long.

In a sampling of 180 newly-enrolled VA patients, 60 were unable to make a primary care appointment. Those who were able to make an appointment saw a wait time between 27 and 71 days.

“VA healthcare is a high-risk area,” GAO said in its report. “In several cases, newly enrolled veterans were never contacted to schedule appointments, due to medical center staff failing to comply with VHA policies for scheduling such appointments or medical center staff being unaware of veterans’ requests.”

According to GAO, ensuring veteran access to primary care is vital for ensuring strong patient-provider relationships. Because veterans often manage multiple chronic conditions, having a strong relationship with a provider is integral for maintaining wellness.

“Providing our nation’s veterans with timely access to primary care is a critical responsibility of VHA,” GAO concluded. “As primary care services are often the entry point to the VA health care system for newly enrolled veterans, the ability to access primary care and establish a relationship with a VHA provider can be instrumental in the ongoing management of a veteran’s overall health care needs.”

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In response to these issues, VA says it is working toward making appointment scheduling and patient care access more widespread. The agency has launched the MyVA program, which emphasizes both quality treatment and patient satisfaction.

“MyVA is our framework for modernizing our culture, processes, and capabilities – combining functions, simplifying operations, providing Veterans a world-class, customer-focused, Veteran-centered enterprise,” McDonald explained to VA’s Commission on Care.

“I know transforming change is not easy but it is our commitment to the Veterans we serve in order to bring them the customer experience and the care and benefits they have earned.”

MyVA includes five strategic points: improving the veteran experience, improving the VA employee experience, improving internal support services, establishing a culture of continuous improvement, and expanding strategic partnerships.

VA has also proposed changing its healthcare provider standards to allow advanced practice registered nurses to practice at the top of their licenses. If approved, this would allow all four categories of APRNS – certified nurse practitioners, certified registered nurse anesthetists, clinical nurse specialists, and certified nurse-midwives – to practice medicine at their highest licensed qualifications.

By allowing more providers to see primary care patients, VA may expand patient care access.

“This rulemaking would increase veterans' access to VA health care by expanding the pool of qualified health care professionals who are authorized to provide primary health care and other related health care services to the full extent of their education, training, and certification, without the clinical supervision of physicians,” VA wrote in its proposal.

Providing adequate access to patient care is a part of the healthcare industry’s overarching goals for value-based care. Ensuring that care extends to veterans, who often manage multiple chronic conditions, will be critical for the industry to achieve fully patient-centered care.

Dig Deeper:

• How Patient Engagement Supports Chronic Disease Management
• ​Care Coordination May Improve Behavioral Health Access