By Sandra Basu
WASHINGTON – A revision in the VA drug formulary and an expansion of suicide prevention training were among 19 new executive actions announced recently by President Barack Obama to improve mental healthcare for troops and veterans.
“So long as any servicemember or veteran is suffering or feels like they have nowhere to turn or doesn’t get the support that they need, that means we haven’t done enough,” Obama told an audience at the annual American Legion conference where he announced the initiatives.
Because of differences in the drug formularies between the two agencies, VA providers must seek waivers for DoD-prescribed mental health medications not on the VA drug formulary. Under the executive action, mental health patients transitioning to VA will now be able to continue using their mental health medications prescribed by authorized DoD providers, regardless of whether the medication is currently on the VA formulary, unless the healthcare providers identify specific reasons to make changes, according to the White House.
Veterans and their families have complained that that the differing formularies hinder mental healthcare for veterans. At a hearing this summer, the parents of the late Sgt. Daniel Somers, who committed suicide in 2013, told lawmakers that “the fact that the formularies of the DoD and VA are separate and different makes no sense, since many DoD patients who are stabilized on a particular medication regimen must re-justify their needs when they transfer to the VA.”
VA spokesperson Ndidi Mojay told U.S. Medicine that, as of last month, VA was still in the process of revising its current policy to implement this portion of Obama’s executive actions but, meanwhile, will “streamline its processes in order to not require all of the information currently needed to process non-formulary medication requests.”
Mental Health Training
VA already provides suicide prevention training during orientation for all medical employees and even trained benefits staff in FY 2013. As part of the executive action, however, VHA clinicians now will be required to renew online suicide risk management training every three years.
In addition, all other staff members who interact with veterans will participate in VA’s “Operation SAVE” suicide prevention training every two years. VA will partner with the Treasury Department, meanwhile, to provide mental health awareness training to volunteer tax preparers at VA facilities.
DoD also will expand existing mental health training for all troops and improve chaplain training to recognize and refer troubled servicemembers for care when appropriate, according to the White House.
Other initiatives announced by the White House as part of the executive action include:
- A $34.4 million VA study on strategies to help prevent future suicidal related activities among veterans who have survived a recent attempt.
- Automatic enrollment in the inTransition program for troops leaving military service who are receiving mental healthcare. The program helps servicemembers transition to new care teams in the community. Currently, troops must be referred to the programby their DoD providers or seek out the program on their own.
Advocacy groups said they welcomed the executive actions but called for more to be done to support mental healthcare for troops and veterans.
“In spite of all of the efforts in place and in the works, suicide continues to claim the life of an active duty servicemember nearly every day and 22 veterans per day,” the Military Officers Association of America (MOAA) said in a written statement.
CEO Paul Rieckhoff of the Iraq and Afghanistan Veterans of America added that the president’s actions are “small steps on the very long road to fully supporting our community and re-establishing trust in the VA.”
“These steps must be supplemented by congressional action, community support outside of Washington and a clear national strategy for veteran’s care — in particular, a real strategy to combat veteran suicide,” Rieckhoff said in a press release.
The president’s announcement came days before the VA and DoD kicked off their observation of Suicide Prevention Month in September with a joint project called “The Power of 1.”
“The campaign emphasizes the effect that just one person, one conversation or one act can have on the life of a veteran or servicemember by offering hope and opening the door to support,” explained Carolyn M. Clancy, MD, VA’s interim under secretary for health.
During the past three years, VA’s suicide rates have increased by nearly 44% among males under age 30 who use VHA services and by more than 70% among 18 and 24 years old males who use VHA services, according to a recent report.
The 2013 suicide rate for active duty military personnel was 18.7 suicides per 100,000 servicemembers, down from 22.7 per 100,000 in 2012. For the Reserves, the rate climbed from 19.3 to 23.4 per 100,000 troops in 2013, while the rate for the National Guard was even higher at 28.9 per 100,000 troops in 2013.
At a recent hearing, Maureen McCarthy, VHA deputy chief patient care services officer, told lawmakers that VA anticipates its requirements for providing mental healthcare “will continue to grow for a decade or more after current operational missions have come to an end.”
“VA believes this increase is partly attributable to proactive screening to identify veterans who may have symptoms of depression, PTSD, substance use disorder or those who have experienced military sexual trauma,” she explained.