Quality of Veterans' Care

The quality of mental health care veterans receive can be the difference that helps them recover.

Close up of a doctor reviewing a chart with a patient, stethoscope in the foreground, photo by joyfotoliakid/Adobe Stock

Photo by joyfotoliakid/Adobe Stock

Each part of a veteran’s journey brings them one step closer to the ultimate goal: to feel better.

But once they make it to their provider’s door, one factor can make or break their recovery: the quality of care they receive.

RAND research shows that the best chance for veterans’ mental health to improve and fully recover lies in receiving high-quality care.

But what determines whether care qualifies as “high-quality”?

High-quality health care is defined as care that is safe, patient-centered, effective, equitable, timely, and efficient.

RAND researchers have studied the quality of mental health care received by veterans across the systems that deliver this care. They’ve found that not only does high-quality care improve veterans’ outcomes, it’s cost-effective as well.

RAND’s Invisible Wounds report estimated that if all post-9/11 veterans received high-quality care for post-deployment mental health problems such as PTSD and depression, societal costs for these conditions could be reduced by $1.2 billion (in 2007 dollars).

By contrast, poor quality of care is less likely to lead to recovery and can even discourage veterans from seeking further care.

That makes high-quality care imperative for veterans’ well-being. It also means that the stakes for policymakers and providers to deliver high-quality care is high.

Defining High-Quality Care

High-Quality Care Definitions
The Criteria What It Means
Safe Avoiding injury to patients
Patient-centered Providing care that responds to patient preferences, needs, and values
Effective Providing evidence-based services to those who could benefit, and not to those unlikely to benefit
Equitable Providing care that does not vary in quality across patient gender, race/ethnicity, socioeconomic status, etc.
Timely Reducing wait times for patients
Efficient Avoiding waste of all types (e.g., equipment, supplies, ideas, energy)

Source: Resources and Capabilities of the Department of Veterans Affairs to Provide Timely and Accessible Care to Veterans

Recommended Policy Action

Adopt and enforce better quality standards.

Policymakers can help encourage the use of evidence-based, high-quality treatment by setting and enforcing consistent standards across all payers for delivery of mental health services.

Evidence-Based Practices

Much RAND research has focused on determining whether care is effective, meaning treatments have been shown to work based on scientific research and clinical experience.

Evidence-based practices are high-quality care in action. These are specific treatments that are proven to be effective and have been peer-reviewed by scientists and clinicians. For providers, these are first-line treatments that have the best chance of improving patients’ health.

If care is evidence-based, then veterans and their providers can be confident that it will help with recovery.

Evidence-Based Practices for Veterans' Mental Health Conditions

Conditions and Evidence-based Practices
Condition Evidence-based Practices
  • Prolonged exposure
  • Cognitive processing therapy
  • Eye movement desensitization and reprocessing
  • Specific cognitive behavioral therapies (CBTs) for PTSD
  • Brief eclectic psychotherapy
  • Narrative exposure therapy
  • Written narrative exposure
Major Depression
  • Acceptance and commitment therapy
  • Behavioral activation/behavioral therapy
  • CBT
  • Interpersonal psychotherapy
  • Mindfulness-based therapies
  • Problem-solving therapy
Alcohol Use Disorder
  • Behavioral couples therapy for alcohol use disorder
  • CBT for substance use disorders
  • Community reinforcement approach
  • Motivational enhancement therapy
  • 12-step facilitation

Source: Improving the Quality of Mental Health Care for Veterans

More research on evidence-based practices

Effectiveness of Alternative Therapies

Treatments such as meditation and acupuncture have piqued interest in mental health circles, and most VA mental health programs now offer complementary and alternative medicine.

RAND researchers have studied the effectiveness of these treatments. Some, such as mindfulness-based cognitive behavioral therapy as a treatment for depression, have shown positive effects.

However, the evidence base for these treatments in mental health care is underdeveloped, and the strength of evidence is weak.

Evidence for the Effectiveness of Alternative Therapies

An effective therapy will have strong evidence of a positive effect.

Here is what the evidence shows for whether and how different alternative therapies affect veterans’ health issues. Lack of evidence doesn’t necessarily mean a therapy doesn't work–just that it hasn't been studied enough.

Major Depression PTSD Substance Use Disorder
Mindfulness-based Cognitive Behavioral Therapy moderate evidence, positive effect -Lack of evidence -Lack of evidence
Mindfulness-based Relapse Prevention Therapy -Lack of evidence -Lack of evidence weak evidence, moderate effect
Needle Acupuncture weak evidence, no effect weak evidence, positive effect weak evidence, moderate effect
Omega-3 Fatty Acid weak evidence, moderate effect -Lack of evidence -Lack of evidence
St. John's Wort weak evidence, moderate effect weak evidence, no effect -Lack of evidence
Needle Acupuncture weak evidence, positive effect
St. John’s Wort weak evidence, no effect
Major Depression
Needle Acupuncture weak evidence, no effect
St. John's Wort weak evidence, moderate effect
Omega-3 Fatty Acid weak evidence, moderate effect
Mindfulness-based Cognitive Behavioral Therapy* moderate evidence, positive effect
Substance Use Disorder
Needle Acupuncture** weak evidence, moderate effect
Mindfulness-based Cognitive Behavioral Therapy* weak evidence, moderate effect

* as adjunctive for reducing depressive symptoms and preventing relapse

** for withdrawal and anxiety

Source: Improving the Quality of Mental Health Care for Veterans

More research on alternative therapies