Improving VA mental health care for Veterans starts with listening


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As a patient, I look for the best care possible that contributes to my health and well-being. That means finding health care professionals who listen to my concerns and needs and go the extra mile to help me identify the best treatment options. I look for providers whose approach goes beyond fixing a single, immediate problem that brought me into their office that day, and who involve me in establishing an individualized care plan that works for me.

That’s why, as a physician, I’m committed to using measurement based care (MBC) in mental health.  We are standardizing MBC in mental health care across the VA system as part of our continued effort to improve our approach to your well-being — and ensure that you and your providers work together to establish a treatment plan that meets your unique needs.  It’s your care, your way.

So, how does it work? Measurement based care will empower you to work closely with your VA clinicians to establish an individualized plan for your mental health.  There are three key parts of to this type of care.  First, your mental health provider will work with you to gather information about how you’re feeling. You will then discuss that information and, finally, use it to track your progress and make decisions about your care plan.  It’s a lot like having your blood pressure and weight checked every time you see your doctor. These measures will help you and your provider see how you are doing over time.

You may be wondering, what does MBC mean for meMeasurement based care will be the standard across VA health care systems, so you may notice changes in your mental health appointments. Your provider will give you the chance to fill out one or two brief questionnaires that align with your existing treatment goals.  The questionnaires may ask about depression, anxiety, PTSD, substance use, or just generally how you are doing in your day-to-day life.  Together, you and your provider will talk about your responses and look at how you can apply them as a team to improve your treatment plan.  After some time, you’ll fill out the same surveys again to help you see your progress.  That’s the great thing about measurement based care: it gives you the opportunity to make decisions about your care and treatment and to continue adjusting your care to your needs over time.

Does measurement based care work? MBC may already be familiar to many Veterans. It’s been implemented as part of routine care for 174 programs across 59 VA medical facilities and clinics around the country so far.  Because MBC can successfully improve patient care, we’re working to standardize this approach across VA to provide every Veteran with individualized and effective mental health care.  Here’s what we know:

  • It’s effective. Studies show that applying measurement based care to routine care substantially improves mental health outcomes for patients. We’re working now to analyze initial results from VA medical facilities that have implemented MBC as part of their mental health treatment standards.
  • It’s empowering. MBC equips you with the information you need to make shared decisions with your mental health providers. This approach ensures that clinicians are talking with you about what is important to you in your treatment.  It also provides you with concrete data to track your progress, assess your goals, and identify ways to improve your care — all with the aim of providing you with quality, personalized treatment that works for you.
  • It’s change you can see. MBC requires providers to regularly check in with patients to assess their wellness through tools like questionnaires. That means both the patient and the clinician are thinking about and recording progress and can use that information to identify where changes might be needed to improve your care and get you on a happier, healthier path.  Through measurement based care you and your providers create and share a road map to your health goals.

Many patients and their VA care providers already have told us that this approach is making a difference in their own mental health care plans.  In the Victor J. Saracini Clinic, Frank worked with his primary care physician and a mental health specialist at VA to establish a plan that’s helped to manage his anxiety and create a better path forward.  He reflects on his experience:

“Before I started the program, I was confused about what to do and confused about my feelings. I now understand my symptoms and I feel much more organized in my thoughts and goals. Seeing a graph of my progress from each visit is very motivating. I feel good knowing that I’m well-monitored, and I feel that VA cares about me.”

Frank’s provider Trisha, a mental health specialist and registered nurse, also noticed the impact of measurement based care on Frank’s recovery. She adds:

“Measurement based care helps guide treatment direction, provides a common understanding of symptoms, and allows reflection on areas that may need improvement or more attention.  The provider is able to closely monitor the Veteran’s safety and receives continuous feedback about which interventions have been beneficial.  All of this provides individualized care and empowers the Veteran to achieve his/her goals through a collaborative approach to treatment.”

Our top priority is ensuring that you have access to effective care.  We’ll be working with your local health care providers to put measurement based care in place as part of routine care throughout VA.

 


IMAGE: Dr. Harold KudlerDr. Harold Kudler is VA’s acting assistant deputy under secretary for Patient Care Services, and most recently served as chief consultant for Mental Health Services for the Veterans Health Administration.  Before moving into VA’s Central Office, he was the associate director of VA’s Mid-Atlantic Mental Illness Research, Education, and Clinical Center for Deployment Mental Health.  His previous work on behalf of VA includes coordinating mental health services for a three-state region, co-chairing VA’s Special Committee on PTSD, serving as medical lead for the VISN 6 Rural Health Initiative, and co-leading the development of the joint VA/Department of Defense Guideline for the Management of Posttraumatic Stress.

 

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Comments

  1. Gretchen P Reinhardt    

    Based on my treatment experiences since 2002 with VA as a 100% disabled vet, I don’t believe a word of this. My first psychiatrist of 8 years SECRETLY documented me as an alcoholic, and then my PCP SECRETLY listed me an a chronic alcoholic in VA’s Active Problems list.

    The VA admitted to this embarrassing blunder 4 months later, but kept the flag on me. When I asked to talk to my PCP about this (after discovering it in my records), I was Patient Record Flagged for the next 6.5 years as a Violent vet (most of the time for my complaints about the DBC its self).

    This very abusive and retaliatory treatment by VA has totally destroyed my mental health treatment, as I trust no one now, and refuse to be screened for anything now.

    The VA flag is recently gone, but the damage isn’t. 6.5 years of VA’s blackmail treatment was anti-treatment. Suicide attempts were encouraged, mocked, and criminalized.

  2. David Anthony Woody    

    You have a huge gap in care regarding veterans Near-Death Experiences that are being misdiagnosed as mental illness and it’s costing you a lot of money you could use for other purposes.

    CLOSING THE “GAP OF CARE” FOR OUR WOUNDED SOLDIERS AND VETERANS
    Injured soldiers having had Near Death Experiences (NDEs) awaken in the hospital traumatized, in pain and often confused and very emotional about experiences they do not understand. Recalling vivid memories of being out of their bodies and visiting transcendent realms. They seek answers to their many questions, hoping for comfort and support. When their questions go unanswered or are casually dismissed, they withdraw emotionally and do not discuss their NDE further, leaving them in an emotional limbo.

    The first assistance for service members who have had NDEs should be provided by medical personnel or chaplains trained to deal with those who have experienced NDEs. However, because of lack of training, that care is often not available, and the impact of this crucial gap of care should not be minimized. It is traumatizing, exacerbating the effects of already devastating injuries, as well as PTSD, and magnifying feelings of confusion, fear, isolation and hopeless despair. Veterans may carry these feelings for a lifetime.

    In order to help close this gap of care, IANDS is supporting the production of a new video, Understanding Veterans’ Near-Death Experiences, which will provide reliable information about NDEs to military care providers, including veterans’ hospitals, clinics, and centers, as well as to individual veterans and their families. All service members and veterans deserve to understand what has happened to them and to have greater peace in their lives. You can help.

  3. David Ross    

    We use it in Canada, in the Canadian Operational Stress Injury network.
    (Very small compared to our Southern colleagues, but scrappy – verrrry scrappy!)
    When used in a Motivational Interviewing style, and if the system is set up to administer and score the self-report measures, its an asset, particularly to keep Vets engaged and reduce drop-out.

    1. Arnold Cabral    

      My firm as a Concerned Veteran please call your Senators and Representative try to convince them that to contact the the Board of Veteran Affairs Committee passed a New Veteran Disabled Benefit Law which is if a Disabled Veteran who is collecting 100 percent service connected definitely need to get G4 implants from a Cosmetic Dentistry Dentist because isn’t absolutely not one works at a Veteran Medical Center plus they haven’t even one has a contract with Veteran Affairs Admistation but their is Private Clinics knows how to put G4 implants but unfortunate they want all the money up as a Concerned Veteran the money should come from the Federal Government. .Semper Fi

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