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This activity was supported by contract no. 36C10X22C0062 between the National Academy of Sciences and the U.S. Department of Veterans Affairs. Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project.

International Standard Book Number-13: 978-0-309-70833-3
International Standard Book Number-10: 0-309-70833-8
Digital Object Identifier: https://doi.org/10.17226/27206

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Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2023. Improving access to high-quality mental health care for veterans: Proceedings of a workshop. Washington, DC: The National Academies Press. https://doi.org/10.17226/27206.

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PLANNING COMMITTEE ON IMPROVING ACCESS TO HIGH-QUALITY MENTAL HEALTH CARE FOR VETERANS

KENNETH W. KIZER (Chair), Distinguished Professor Emeritus, University of California, Davis, School of Medicine; Adjunct Professor, Stanford University School of Medicine

M. JUSTIN COFFEY, Chief Medical Officer, Workit Health; Professor, Geisinger Medical Center

SHANNON HARRIS, Associate Professor, Virginia Commonwealth University

EVELYN L. LEWIS, President and Chair, Veteran Health and Wellness Foundation; Chief Medical Officer, Warrior Centric Health; Adjunct Associate Professor, Rutgers Robert Wood Johnson Medical School

MICHELE SAMORANI, Associate Professor, Santa Clara University

JAY SHORE, Professor, University of Colorado Anschutz Medical Campus; VA Office of Rural Health

RICHARD J. SILVIA, Professor, Massachusetts College of Pharmacy and Health Sciences

Staff

JENNIFER LALITHA FLAUBERT, Program Officer

MARC MEISNERE, Senior Program Officer

ADRIENNE FORMENTOS, Research Associate

EMMA ROONEY, Senior Program Assistant

SHARYL NASS, Senior Board Director

ALEXANDRA ANDRADA, Director, Forum on Mental Health and Substance Use Disorders

FORUM ON MENTAL HEALTH AND SUBSTANCE USE DISORDERS

MARGARITA ALEGRIA (Co-chair), Harvard Medical School

ROSALIE LICCARDO PACULA (Co-chair), University of Southern California

KIRSTEN BERONIO, Center for Medicaid and CHIP Services

CARLOS BLANCO, National Institute on Drug Abuse, National Institutes of Health

CARLA M. CANUSO, Janssen Research & Development, LLC

CHRIS M. CROWE, U.S. Department of Veterans Affairs

W. PERRY DICKINSON, University of Colorado

ANTHONY T. ESTREET, National Association of Social Workers

RICHARD FRANK, Brookings Institution

HOWARD H. GOLDMAN, University of Maryland School of Medicine

ROBERT K. HEINSSEN, National Institute of Mental Health

KRISTIN KROEGER, American Psychiatric Association

JAN LOSBY, Centers for Disease Control and Prevention

R. KATHRYN McHUGH, Harvard Medical School

BENJAMIN MILLER, Stanford School of Medicine

ANNIE PETERS, National Association of Addiction Treatment Providers

KATHY PHAM, American College of Clinical Pharmacy

JOE PYLE, Scattergood Foundation

DEIDRA ROACH, National Institute on Alcohol Abuse and Alcoholism

MARY ROARY, Substance Abuse and Mental Health Services Administration

BARBARA ROLAND, Indian Health Service

TISAMARIE B. SHERRY, U.S. Department of Health and Human Services

RUTH SHIM, University of California, Davis

MATTHEW TIERNEY, University of California, San Francisco, Office of Population Health

Reviewers

This Proceedings of a Workshop was reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the National Academies of Sciences, Engineering, and Medicine in making each published proceedings as sound as possible and to ensure that it meets the institutional standards for quality, objectivity, evidence, and responsiveness to the charge. The review comments and draft manuscript remain confidential to protect the integrity of the process.

We thank the following individuals for their review of this proceedings:

Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the content of the proceedings nor did they see the final draft before its release. The review of this proceedings was overseen by HUGH H. TILSON, University of North Carolina. He was responsible for making certain that an independent examination of this proceedings was carried out in accordance with standards of the National Academies and that all review comments were carefully considered. Responsibility for the final content rests entirely with the rapporteurs and the National Academies.

Acknowledgments

The National Academies of Sciences, Engineering, and Medicine (the National Academies) are grateful for the support of the U.S. Department of Veterans Affairs (VA), which sponsored this workshop, and that of the many annual sponsors of the National Academy of Sciences. The National Academies wishes to thank all the members of the planning committee, who collaborated to ensure a workshop complete with informative presentations and rich discussions. Finally, the forum wants to thank the speakers and moderators, who generously shared their expertise and time with workshop participants.

Support from the many sponsors of the Forum on Mental Health and Substance Use Disorders is critical to its work. The sponsors include the Centers for Medicare & Medicaid Services; the National Institutes of Health (National Institute on Alcohol Abuse and Alcoholism, National Institute on Drug Abuse, and National Institute of Mental Health); American College of Clinical Pharmacy; American Psychiatric Nurses Association; American Psychiatric Association; American Psychological Association; Centers for Disease Control and Prevention; Council on Social Work Education; Janssen Research & Development, LLC; National Academy of Medicine; Office of the Assistant Secretary for Planning and Evaluation; Think Bigger Do Good Policy Series (a partnership of the Scattergood Foundation, Peg’s Foundation, Patrick P. Lee Foundation, and Peter & Elizabeth Tower Foundation); VA; and Well Being Trust.

Contents

ACRONYMS AND ABBREVIATIONS

1INTRODUCTION

Organization of the Workshop

Organization of the Proceedings

Overview of Mental Health Care Services in the Veterans Health Care System

2EXPERIENCES OF VETERANS ACCESSING MENTAL HEALTH SERVICES

Iraq and Afghanistan Veterans of America (IAVA)

Cohen Veterans Network

Dovetail Landing

Discussion

3LEVERAGING VA’S STATUS AS A NATIONAL HEALTH CARE SYSTEM

International Exemplars

Improving Mental Health Care Quality in the United States: Intermountain Health Care

Discussion

4IMPROVING AND SUSTAINING ACCESS TO MENTAL HEALTH SERVICES

Innovative Strategies to Improve and Sustain Access

Discussion

The Role of Technology

5OPPORTUNITIES FOR IMPROVING MENTAL HEALTH CARE THROUGH PARTNERSHIPS

Population Health Approaches

Leveraging Industry Partnerships

Discussion

6TAKING INNOVATIVE STRATEGIES TO SCALE: ACHIEVING INSTITUTIONAL ADOPTION

Improving Access with Community Health Workers

Using Pharmacists as Entry Points

Digital Health Innovations

Discussion

7REFLECTIONS AND FUTURE CONSIDERATIONS

Planning Committee Remarks

Future Considerations for VA

REFERENCES

Appendix A Statement of Task

Appendix B Workshop Agenda

Acronyms and Abbreviations