The Cost and Quality of VA Mental Health Services

U.S. veterans have elevated rates of serious mental health and substance use disorders. Among veterans of the Afghanistan and Iraq conflicts, prolonged, repeated deployments have magnified these problems and contributed to rising rates of suicide, occupational problems, and family difficulties. Among veterans of earlier conflicts, the prevalence of mental health problems, especially post-traumatic stress disorder (PTSD), is also high. Ensuring that these veterans receive the best possible care for mental health conditions has become a national priority. Meeting the health care needs of this clinically complex and vulnerable population is the responsibility of the U.S. Department of Veterans Affairs (VA). In recent years, the VA has made improving mental health care for veterans an institutional priority. In 2006, the VA commissioned a comprehensive evaluation of its mental health and substance use treatment system. The evaluation took place during implementation of the VA’s five-year Mental Health Strategic Plan, a large initiative to expand and improve mental health care. To support the initiative, the VA increased funding for mental health by $1.4 billion annually between FY 2005 and FY 2008. The goal of the evaluation was to assess whether, for the population of veterans with mental health and substance use disorders, the VA was meeting the goal of maximizing these veterans’ physical, mental, and social functioning. The study addressed the following questions: • How much health care is used by veterans with mental health and substance use disorders, and how much does it cost? • What is the VA’s capacity to deliver mental health and substance use care to veterans? • What is the quality of mental health care received by veterans, and how does the quality compare with that delivered in the private sector? • How does quality vary across geographic regions of the United States and for different groups of veterans? • Are veterans satisfied with the care they receive? Key findings: