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So I have some questions to ask before the VA goes down this slippery slope. As you are all very aware those with the "Invisible Wounds of War" are treated by many in the military and the public as weak, not having a real injury or just crazy. You now want to compound the feelings of anxiety and mistrust by forcing the veteran into treatment that may or may not help and they may or may not be ready for because we as tax payers have the right to demand that?

Also is it right to make mental illnesses the only disability that a veteran will not be rated for at the time they apply and not have any pay given until someone decides they are well or as well as they can get from the treatment provided? So taking that logic; when I had patients who do not comply with the diabetes or HTN treatments I recommended for the good of their health the checks should be withheld and they should not get a full rating ? Only when they have met A1c goals and controled Blood presure the money can be given. To bad if they and their families have nothing else to live on.

Sorry but when a person joins the military they are promised that the government/taxpayer will care for any medical disabilities incurred for being willing to do a job that could end in disability or death. They are to be paid for these disabilities, provided the very best care possible, have easy access to it if they wish to use it and not to be discriminated against because it is a mental injury/illness and not a physical on. They can be an alcoholic without a mental health problem and still get paid for their SC disabilities because he does not have PTSD. How is this fair?

As a current mental health patient with my local VA I can attest to the problem of immediate access when there is a urgent need. It can take months to get routine appointments and have continuity of care with the high turnover in providers.

I also can tell you there are not any programs that my VA advertises, refers to or strongly encourages me to participate in. I had to ask what else we could try to help me get better because I was fed up with being unable to keep jobs, go out in public, being very depressed and feeling hopeless. I was offered a one on one program with a counselor to try some of the new treatment modalities but they were not in any available times that would work for me. I finally gave up trying to do it with the VA and I am now working with the much more flexible Vet Center. I do support providers and the VA both pushing patients who need help at every encounter to get treatment just as we encourage smokers to stop.

I recommend that there is an advocate position created at each VA who calls and writes those who need treatment encouraging them to get the help they need with a list of the programs available that are open at multiple hours, inpatient or out patient. That same person should then invite the vet to come in a discuss the options and how they can make it work best for them. It should be some one who acts a coordinator for the patient to get help. This person is the one who can be seen as the personal advocate for those who are resistant to treatment because of fear of everything and a lack of trust with military/VA. It still all comes down to the patient being ready for treatment because you cannot make someone well. They alone must choose to work on getting better; while we as Americans continue to support the troops as promised.

The Program of Assertive Community Treatment is an evidence-based strategy that has been employed in community mental health centers for decades. ACT utilizes a team-based approach which has been effective in engaging patients in mental health treatment; the core intervention in ACT is case management, in combination with wrap-around mental health services. It's a costly program, but  has the potential to reduce more expensive interventions, such as inpatient hospitalization.

The VA's Mental Health Intensive Case Management (MHICM) program has a similar model to ACT, however, this service is only available to very psychiatrically ill  patients, who have been hospitalized many times.

Veterans who are having trouble engaging in "traditional" psychiatric treatment (based in a medical model) but who are not sick enough to require MHICM, may benefit an intermidiate level of service that a well-implemented ACT program can provide.

However, without addressing the widespread access issue to mental health and substance use services, ACT programs will likely fail at the VA. Being "assertive" means that when the Veteran responds to your efforts to engage him or her in treatment, there needs to be treatment available...immediately. When the Veteran is finally ready to seek substance use or mental health treatment, it is unreasonable to expect them to wait for another several months for an appointment.

Assertive Community Treatment can be a successful alternative to coercive treatment. It is voluntary, ethical and evidence-based. However, the VA will need to promote a recovery-based, integrated culture of mental health treatment for this to be feasible.