A man walks past the headquarters building at the Department of Veterans Affairs in Washington, DC, May 23, 2014

commentary

(The RAND Blog)

August 13, 2014

Improving the Experience of Veterans Seeking Mental Health and Substance Use Care

A man walks past the headquarters building at the Department of Veterans Affairs in Washington, DC, May 23, 2014

Photo by Larry Downing/Reuters

by Kimberly A. Hepner

On August 7th, 2014, President Obama signed a $16.3 billion bill (HR3230) to overhaul the health care provided by the Veterans Health Administration (VHA). Following reports of long wait times at some VHA health care facilities, the legislation aims to improve access to care by hiring more clinicians, building and leasing more medical facilities, and allowing veterans to seek private care outside the VHA. The bill also requires the VHA to do more to make the public aware of its performance in reducing wait times, delivering care, and improving clinical outcomes.

Veterans struggling with mental health disorders (such as depression and PTSD) and substance use disorders—a group of patients that has been growing for over a decade—deserve timely, high-quality care. Without appropriate care, these veterans face greater risk of deteriorating health, increased unemployment, homelessness, and even suicide. Veterans dealing with a mental health or substance use disorder may find their difficulties aggravated by having to navigate a complex health care system and deal with the stigma of seeking care.

In 2009, we surveyed over 5,000 veterans who received VHA behavioral health care. This data, the only of its kind, can provide a useful baseline to compare with data on future performance. This could help highlight areas for improvement and stress the importance of ongoing assessment of veterans' experiences in receiving mental health and substance use care from the VHA.

At the time of the survey, half of the respondents said they always received routine appointments as soon as they wanted, and less than half (42 percent) reported being highly satisfied with their VHA mental health care. While three-quarters of veterans reported being helped by the treatment they received, only a third reported their symptoms had improved. These results suggest that, according to patients, improvements in timeliness of care, satisfaction with care, and effectiveness of care are needed.

The survey also showed that veterans with substance use disorders had worse experiences in receiving care when compared with veterans with mental health disorders. Veterans with a substance use disorder reported lower satisfaction with care and indicated that their treatment was less helpful. They were also less likely to report that staff listened to them and respected their decisions. The reason for this difference isn't clear, but research has demonstrated that some clinicians have negative biases toward patients with substance use disorders. If clinicians are less equipped to deal with these patients, it could lead to interactions that are less warm or providing lower quality of care.

Patient-centered care is one approach to care that is respectful and responsive to the needs of individual patients. While making the receipt of care a positive experience is a worthy objective on its own, research suggests that positive patient perceptions of care are related to key health care processes (e.g., adherence to treatment regime) and may be related to improved health and mental health outcomes. Therefore, it is essential that these veterans have positive experiences when seeking and receiving care.

The recent legislation is an important step toward improving VHA care. Attention to veterans' experiences in receiving care, particularly veterans in need of mental health and substance use care, should be an essential component to ongoing efforts to improve quality.


Kimberly A. Hepner is a senior behavioral scientist and a licensed clinical psychologist at the nonprofit, nonpartisan RAND Corporation.

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