WASHINGTON, DC—VHA and DoD have already recognized that they serve the same patients, just at different times during their lives. But it is only during the last few years that the two departments have thought of themselves as a true continuum of care, at least as far as mental health care is concerned, and have endeavored to ease the transition for patients from one system to the other.
Calling Attention to the Issue
In 2007, many issues gained importance for VA and DoD in terms of patient care. Problems at Walter Reed Army Medical Center were surfacing in the press and coming to the attention of Congress. A senior oversight committee, co-chaired by VA and DoD deputy secretaries, was formed with one of their lines of action being psychological health. This new emphasis on mental health led to over 400 recommendations—some of which were Congressional mandates—focusing on psychological health and traumatic brain issues.
“It brought to a head the idea that there were things each department could be doing better, and that there were things we could be doing better jointly,” said Sonja Batten, PhD, at the Military Health Services Conference in January. Batten is the deputy director of the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury (DCoE) and the associate chief consultant for VA/DoD Collaboration in the VA’s Office of Mental Health Services.
In October 2009, the two departments held a joint mental health summit—a weeklong working meeting to identify explicit work recommendations for the two agencies. Out of that summit, department leaders asked for the creation of an Integrated Mental Health Strategy (IMHS) that could turn broad recommendations into specific, actionable goals.
IMHS developed 28 strategic actions designed to promote: early recognition of mental health conditions; delivery of effective treatments; implementation and expansion of prevention services; and education, outreach, and partnerships with other providers.
“Preventive services especially was a big change in terms of how VA looks at mental health,” Batten, one of the IMHS leaders, said. “This is really working on a public health model, addressing these things in a preventive proactive way, before veterans would come forward with a diagnosable problem they needed treatment for.”
Some of the 28 actions are relatively straightforward, while others are more demanding of VA and DoD. Expanded access to Vet Centers is an example of the former. VA has extended access to readjustment counseling services to active duty servicemembers returning from OEF/OIF. “We started this in January and Congress helped us along, because it needed legislative change to authorize,” Batten said. “That moved our timeframe up much faster.”
VA is also exploring the feasibility of adding additional Mobile Vet Centers to its current fleet. The mobile centers have regular routes in catchment areas where VA facilities are sparse.
Another straightforward goal is coordinating training of VA and DoD staff in regards to suicide risk and prevention. Crisis intervention services are already available to all servicemembers and veterans, as well as their families, through a coordinated DoD/VA suicide hotline. “We want to make sure that we’re learning from each other, though,” Batten said. “In March, we have our third DoD/VA suicide prevention conference. We’re making sure our clinicians are learning and sharing the same best practices from one another.”
One of the more challenging parts of the strategic action plan is the sharing of outcome and quality measures between the departments. “This is going to be a heavy lift to get this implemented,” said Capt Robert DeMartino, MD, director of DoD’s Behavioral Medicine Division. “DoD and VA are coming together to identify those areas that are of specific relevance to our patient population. We think this set of outcome measures and these sets of quality measures would be very important for us to track for both departments. And once we have that, the idea is to get people to use them.”
A shared set of quality measures is necessary to gauge what is happening to VA and DoD’s shared patient population over the long term. Without a standard way of gauging how well or poorly a patient is doing on a particular treatment, it will be impossible to track their medical progress from one agency to the other.
“It’s an important hurdle to get over,” DeMartino said. “The ramifications in the long-term are enormous.”