Department of Veterans Affairs- Veterans Health Administration

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Presented by: Ira Katz, MD, PhD, Senior Consultant

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Department of Veterans Affairs- Veterans Health Administration

  1. 1. Department of Veterans Affairs Veterans Health Administration Office of Mental Health Services Ira Katz, MD, PhD, Senior Consultant
  2. 2. Department of Veterans Affairs <ul><li>Veterans Health Administration </li></ul><ul><li>Veterans Benefits Administration </li></ul><ul><li>National Cemetary Administration </li></ul><ul><li>Veterans Health Administration </li></ul><ul><ul><li>21 Veterans Integrated Services Networks </li></ul></ul><ul><ul><li>153 Medical Centers </li></ul></ul><ul><ul><li>765 Community-Based Outpatient Clinics </li></ul></ul><ul><ul><li>~250 Vet Centers </li></ul></ul>
  3. 3. VA / Veteran Population Facts <ul><li>23.8 million veterans </li></ul><ul><ul><li>1.8 million women (and growing) </li></ul></ul><ul><ul><li>Almost 60% of American men > 65 are veterans </li></ul></ul><ul><li>Not all Veterans are eligible for VA health care </li></ul><ul><ul><li>Main factors: OEF/OIF services, Service Connected disability, other disability, or low income </li></ul></ul><ul><li>7.8 million enrolled for health care in Department of Veterans Affairs (VA) </li></ul><ul><ul><li>~ 5.2 million seen / yr (22% of all veterans) </li></ul></ul><ul><ul><li>~ 1.6 million with MH Diagnoses (31% of those seen) </li></ul></ul>
  4. 4. Defining Mental Health (MH) <ul><li>Includes: </li></ul><ul><ul><li>Mental Disorders </li></ul></ul><ul><ul><li>Problem Drinking </li></ul></ul><ul><ul><li>Other Substance Use Disorders </li></ul></ul><ul><ul><li>Homelessness </li></ul></ul><ul><li>Settings: </li></ul><ul><ul><li>Ambulatory </li></ul></ul><ul><ul><ul><li>Primary Care </li></ul></ul></ul><ul><ul><ul><li>MH Specialty </li></ul></ul></ul><ul><ul><ul><li>MH Subspecialty </li></ul></ul></ul><ul><ul><ul><li>Other Specialty </li></ul></ul></ul><ul><ul><li>Residential Rehabilitation </li></ul></ul><ul><ul><li>Inpatient </li></ul></ul><ul><li>Budget for FY 2010 </li></ul><ul><ul><li>Over $5 Billion </li></ul></ul><ul><li>Staffing </li></ul><ul><ul><li>Over 20,000 </li></ul></ul><ul><li>Being extended to include: </li></ul><ul><ul><li>Health Psychology/ </li></ul></ul><ul><ul><li>Behavioral Medicine </li></ul></ul><ul><ul><ul><li>Pain </li></ul></ul></ul><ul><ul><ul><li>Sleep </li></ul></ul></ul><ul><ul><ul><li>Problems with adherence </li></ul></ul></ul>
  5. 5. OEF/OIF Veterans Cumulative from FY02 to Q3 FY09 <ul><li>Total </li></ul><ul><ul><li>1,049,540 </li></ul></ul><ul><li>Seen in VA Medical Centers or Clinics </li></ul><ul><ul><li>480,324 (46% of total) </li></ul></ul><ul><li>With a Mental Health Diagnosis (MH Dx) </li></ul><ul><ul><li>227,205 (47% of those seen in VA) </li></ul></ul><ul><li>PTSD </li></ul><ul><ul><li>120,480 (53% of those with a MH Dx) </li></ul></ul><ul><ul><li>Additional 13,623 Veterans with PTSD were seen in Vet Centers only </li></ul></ul>
  6. 6. Comparing Mental Health Issues in OEF/OIF and All Veterans <ul><li>Men </li></ul><ul><li>Received care: 4.7% </li></ul><ul><li>MH Diagnosis: 6.2% </li></ul><ul><li>PTSD: 14.8% </li></ul><ul><li>Women </li></ul><ul><li>Received care: 11.8% </li></ul><ul><li>MH Diagnosis: 11.6% </li></ul><ul><li>PTSD: 21.3% </li></ul>OEF/OIF PTSD (53%) Depression (36%) Anxiety (29%) All Veterans Depression (52%) PTSD (23%) Anxiety (19%) Proportion of Utilizers from OEF/OIF Most Common Mental Health Diagnoses Among those with any diagnosis
  7. 7. Welcoming Home a New Generation of Veterans <ul><li>Reintegration is an issue for every Veteran, and for their families </li></ul><ul><li>Some will have more profound needs for mental health care </li></ul><ul><li>VA provides support for reintegration </li></ul><ul><ul><li>Outreach and reintegration support provided by Vet Centers and VA medical centers and clinics </li></ul></ul>
  8. 8. Welcoming Home a New Generation of Veterans <ul><li>Reintegration is an issue for every Veteran, and for their families </li></ul><ul><li>Some will have more profound needs for mental health care </li></ul><ul><li>VA provides support for reintegration </li></ul><ul><ul><li>Outreach and reintegration support provided by Vet Centers and VA medical centers and clinics </li></ul></ul>
  9. 9. Major Complications of Mental Health Conditions <ul><li>Behaviors seen as dangerous or criminal </li></ul><ul><li>Incarceration </li></ul><ul><li>Unemployment </li></ul><ul><li>Homelessness </li></ul><ul><li>Suicide </li></ul>
  10. 10. VA Mental Health Programs <ul><li>Suicide Prevention </li></ul><ul><ul><li>VA mental health enhancements began in 2005, and specific VA suicide prevention programs began in 2007. </li></ul></ul><ul><ul><li>Question: Are there suggestions that these programs may be effective in preventing suicide? </li></ul></ul><ul><ul><li>Answer: Look at the ratio of suicide rates in Veterans (men and women) aged 18-29 who use VA health care services relative to Veterans in the same age group who do not. </li></ul></ul><ul><ul><ul><ul><ul><li>Data on all Veterans from the Centers for Disease Control and Prevention National Violent Death Reporting System. Data on users of VA health care services from the VA Serious Mental Illness Treatment Research and Evaluation Center. </li></ul></ul></ul></ul></ul>
  11. 11. VA/DoD Summit Model
  12. 12. Two Mental Health Strategies Evidence-Based Care for Conditions Readjustment Counseling For Problems Post Traumatic Stress Disorder (PTSD) Cross-referrals -> Readjustment issues and Peer Support ← Stepped care Vet Centers Medical Facilities
  13. 13. Mental Health Services: Integrated and Specialty Care Specialty MH and SUD Service Integrated MH- Primary Care Services General MH and Specialty Services. Specialty services include: PTSD specialty care Substance Use Disorder programs Homeless programs Recovery-oriented services for seriously mentally ill Focus on improved access for care for common mental illnesses including: Depression Anxiety disorders Problem drinking Evidence-Based Psychotherapy Clinical Neuroscience
  14. 14. Public Health Model: VA’s Vision <ul><li>Paths to mental health services: </li></ul><ul><ul><li>Vet Centers </li></ul></ul><ul><ul><li>Primary Care </li></ul></ul><ul><ul><li>Police </li></ul></ul><ul><ul><li>Courts </li></ul></ul><ul><ul><li>Families and friends </li></ul></ul><ul><ul><li>Housing issues </li></ul></ul><ul><ul><li>Community providers </li></ul></ul><ul><ul><li>Community organizations and agencies </li></ul></ul><ul><ul><li>Employers </li></ul></ul><ul><ul><li>Clergy </li></ul></ul><ul><ul><li>Call centers </li></ul></ul><ul><ul><li>Web-based resources </li></ul></ul>

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