Special Feature: The Cost and Quality of VA Mental Health Services

portrait of a soldier

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?

Veterans with mental health and substance use disorders account for a high share of VA health care costsClick to Enlarge

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?

An increasing number of VA facilities report offering evidence-based careClick to Enlarge

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?

The VA outperformed private plans on seven of nine quality measuresClick to Enlarge

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?

Percentage of acute treatment with antidepressants, by regionClick to Enlarge

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?

Respondents reported that treatments helped, but a smaller number reported that their condition had improvedClick to Enlarge

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.

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