Chairman Miller, Ranking Member Michaud, and members of the Committee, thank you for allowing Paralyzed Veterans of America (PVA) to submit a statement for the record concerning the Department of Veterans Affairs’ (VA) mental health services. Overcoming barriers to quality mental health care for veterans is extremely important as the number of veterans enrolled in the VA health care system continues to grow, and the newest generation of veterans and their families acclimate to civilian life after war.   PVA thanks the Committee for their continued oversight and hard work on this important health care issue. 

The increased demand for VA mental health services has put greater emphasis on the areas in which VA can improve upon its delivery and approach to providing quality mental health care. In the past year, both the VA Office of Inspector General and the Government Accountability Office have released reports identifying issues that preclude veterans from receiving timely, quality VA mental health care.  Such issues include inadequate staffing of VA mental health professionals, unreasonable wait times for appointments, and inaccurate reporting of mental health metrics and program outcomes. 

In August 2012, the President issued an Executive Order #13625, “Improving Access to Mental Health Services for Veterans, Service Members, and Military Families.” The Executive Order focuses on suicide prevention, mental health research and development, VA mental health staffing, and partnerships between the VA and mental health community providers.  PVA believes that the aforementioned report findings, and the Executive Order substantiate the need for Congress, the Administration, VA leadership, and the veteran community to work together to develop innovative approaches for  providing VA mental health care that meets the evolving needs of all veterans.

As we work to improve VA mental health care, PVA believes that it is important to recognize that VA is the best health care provider for veterans.  Providing primary care and specialized health services is an integral component of VA’s core mission and responsibility to veterans.  In the area of mental health it is vital that veterans receive care that is tailored to their unique experiences and needs as veterans.  The VA has made tremendous strides in the quality of care and variety of “veteran specific” mental health services.  These improvements include incorporating mental health into VA’s primary care delivery model, increasing the number of Vet Centers, launching mental health public awareness campaigns, and creating call centers that are available to veterans 24 hours a day, 7 days a week.  While these improvements were much needed and have helped many veterans, we agree with this Committee that more must be done. 

The VA must focus on recruiting and retaining qualified mental health professionals to meet the growing mental health care demand.  Last year, the VA announced its plan to increase the mental health workforce by an additional 1,900 mental health professionals.  In response to this hiring goal, PVA recommends that the VA conduct a comprehensive analysis of the mental health care needs of veterans, and create a mental health strategic plan for staffing to accurately assess current staffing needs and appropriately place newly  hired employees. 

In addition to increased staffing, PVA recommends that the VA work to improve and expand current mental health services that have proven beneficial to veterans such as peer to peer support programs.  As recommended in the FY 2014 Independent Budget, VA medical centers should work to hire veterans as peer counselors to provide individual counseling, as well as reach out to veterans to promote the importance of mental health, and help veterans currently receiving VA mental health services sustain treatment.  Additionally, as the VA works to improve and increase access to mental health care, it must identify and adapt to the varying needs of the different generations of veterans.  The VA must work to address the mental health needs of veterans returning from the most recent conflicts, as well as the larger population of disabled veterans who are dealing with severe illnesses and catastrophic injuries.

To meet the varying mental health needs of veterans, the VA must work with veterans, veteran service organizations, and stakeholders in the community to create innovative ways to provide quality mental health services.  In fact, the President’s Executive Order mandates enhanced partnerships between the VA and community mental health providers to ensure that veterans are able to receive care in a timely manner.  Specifically, it states that the VA and the Department of Health and Human Services shall establish pilot projects to contract with community based providers to help meet veterans’ mental health care needs in a timely manner.  While PVA understands the urgent nature of providing veterans with timely mental health care, we believe that the quality of that care is equally important.   

As it relates to contracted care, mental health services are unique in that it is difficult to move from one provider to another after trust and a rapport have been established.  It is important to consider that when veterans are referred to providers outside of the VA for mental health care, they may not return to the VA for those services, and ensuring that veterans seek additional mental health services through the VA may become more difficult.   When developing community partnerships with non-VA providers there must be a balance that allows VA to provide contracted services for mental health care without discouraging veterans from utilizing other VA mental health services, or VA’s primary care and specialized services that are readily available to them.  Therefore, PVA strongly recommends that the first phase of implementation of the Executive Order should require VA to work closely with veteran service organizations to determine the guidelines and policies under which the VA may provide a veteran with mental health care in the community setting.  Specifically, PVA believes that before the VA provides veterans with care through contracted services, mechanisms must be in place to ensure care coordination, and allow VA to monitor the quality of care provided.  The VA must also make certain that the professionals providing the care meet VA standards and are familiar with cultural norms of military service and experiences of veterans.   

While PVA believes that the greatest need is still for qualified VA mental health professionals to provide veterans with the care they need, veterans should not have to wait for such essential care.  The VA must work to hire and officially assign mental health staff, improve administrative processes that lead to lengthy wait times, and   develop ways to increase access to VA mental health services while maintaining VA’s high quality of care and providing care that is centered on the unique needs of veterans.  When veterans have timely access to quality mental health care services they in turn have the opportunity to establish productive personal and professional lives. 

PVA would like to once again thank this Committee for the opportunity to provide a statement for the record, and we look forward to working with you to improve VA mental health services for our veterans. 

Information Required by Rule XI 2(g)(4) of the House of Representatives

Pursuant to Rule XI 2(g)(4) of the House of Representatives, the following information is provided regarding federal grants and contracts.

Fiscal Year 2013

No federal grants or contracts received.

Fiscal Year 2012

No federal grants or contracts received.

Fiscal Year 2011

Court of Appeals for Veterans Claims, administered by the Legal Services Corporation — National Veterans Legal Services Program— $262,787.