Special Feature: The Cost and Quality of VA Mental Health Services
U.S. veterans have higher rates of serious mental health and substance use disorders than civilians. Prolonged and repeated deployments to Afghanistan and Iraq have magnified these problems. RAND assessed the cost, quality, and capacity of VA care for these disorders.
How much health care is used by veterans with mental health and substance use disorders, and how much does it cost?
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Veterans with mental illness and substance use disorders represent a large and growing population with severe and complex disorders. Despite representing only 15 percent of the U.S. Department of Veterans Affairs' (VA's) patient population in 2007, veterans with these problems accounted for one-third of all VA medical costs.
What is the VA's capacity to deliver mental health and substance use care to veterans?
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Basic and specialized mental health services were reported to be widely available, and services have been expanding. The study found that therapies which are linked to improved outcomes have increased substantially, as have suicide prevention services.
What is the quality of mental health care received by veterans, and how does the quality compare with that delivered in the private sector?
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It is generally as good as or better than care delivered by private plans. The team found that the VA had higher levels of performance than private providers for seven out of nine indicators. However, care is given at less than existing capacity, and less than a third of those targeted for specialized therapy receive it.
How does quality given by the VA vary?
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Quality of care varies across regions and populations. Overall, no regional network is above or below the average, but treatment rates varied as much as 20% across networks. Veterans over age 65, veterans under age 35, and veterans who resided in rural areas were less likely to receive appropriate services.
Are veterans satisfied with the care they receive?
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Overall, veterans' perceptions of VA mental health services were quite favorable: on a 10 point scale, 42% of veterans rated VA mental health care at 9 or 10, and 74% reported being helped by counseling or treatment received in the prior 12 months. Still, only 32 percent perceived improvement in their problems or symptoms.
More Research on Veterans' Mental Health
Assessing the Performance of Military Treatment Facilities — 2011
Discusses the potential usefulness and limitations of using utilization and cost metrics to evaluate the performance of U.S. Department of Defense military treatment facilities.
Insights from Early RAND Research on Deployment: Effects on U.S. Service Members and Their Families — 2011
Testimony presented before the Senate Veterans' Affairs Committee on July 27, 2011.
What Is the Impact of Using Evidence-Based Treatments for Posttraumatic Stress Disorder and Depression in Veterans? — 2011
If all veterans suffering from major depression and posttraumatic stress disorder were to receive evidence-based treatments, policy simulations suggest that cost savings generated would be $138 million (15 percent) over two years.
Promoting Psychological Resilience in the U.S. Military — 2011
Many programs are available to increase psychological resilience among service members and families, but little is known about their effectiveness. This report reviews existing programs to identify evidence-informed factors for promoting resilience.
Insights from Early RAND Research on Deployment: Effects on U.S. Service Members and Their Families — 2011
Testimony presented before the Senate Veterans' Affairs Committee on July 27, 2011.
Prescription Sharing, Alcohol Use, and Street Drug Use to Manage Pain Among Veterans — 2011
About one-third of veterans report using alcohol, street drugs, or medication prescribed for others to manage pain.
How Is Deployment to Iraq and Afghanistan Affecting U.S. Service Members and Their Families? An Overview of Early RAND Research on the Topic — 2011
Brings together and summarizes the findings of six RAND studies that laid the groundwork for ongoing research on how deployment to Iraq and Afghanistan has affected service members and their families.
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