Investigation of Initiatives to Provide Mental Health Care for Veterans

In consideration of the known gaps in access to mental health care for veterans, there have been many initiatives that have been put in place to address and bridge these gaps. One initiative in particular is called Healthcare, Evaluation, Advocacy, and Legislation (HEAL), which helps by connecting veterans to case-managers provided by the private veterans’ group called AMVETS, or American Veterans, a federally chartered veteran’s organization and corporation. AMVETS has partnered with the Department of Veterans Affairs (VA) in an attempt to help U.S. veterans who suffer from mental illness and have had issues with accessing and/or utilizing healthcare services. This initiative has many elements to it, which involves reaching out to veterans through various public forums and hiring the case managers to assist in getting veterans connected to healthcare services by working with the VA to coordinate services, and is not limited to services within the VA, but outside as well. Additionally, the initiative included the introduction of a telephonic hotline, allowing veterans to reach out to licensed clinicians if they choose to do so themselves.

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The ultimate goal of this initiative is to help veterans with medical needs receive the help they need by connecting them with healthcare services to include mental health as well as specialized services that deal with other illnesses or disorders like traumatic brain injuries and post-traumatic stress (PTSD). The AMVETS Heal Program believes that our vets have earned their right to quality healthcare, and they intend to ensure all veterans have the access and assistance they need. War and prolonged exposure to combative environments certainly takes its toll and inflicts permanent damage to the human psyche which manifests itself by developing illnesses and disorders such as depression, anxiety, PTSD and the likes, which is why veterans are at a higher risk of suicide than their civilian counterparts (Fox, 2018). The HEAL program created their goals in an effort to address and lessen the barriers that veterans face when accessing healthcare, and more importantly in obtaining the quality of care they deserve, especially when it comes to socioeconomic issues such as addiction and suicide (amvets.org).

The way in which they plan on meeting this goal includes increasing access to healthcare, whether inside or outside of the VA, for all veterans and especially the ones suffering from particularly bad health situations to decrease the likelihood of veteran suicides and move toward a multifaceted system that is effective and consistent with a focus on continuous improvement in the delivery systems and services. AMVETS hired experienced clinical specialists and registered nurses to assist with the program by helping veterans overcome the aforementioned barriers to healthcare access and connecting them to much needed services. By improving appointment wait times, offering work and housing related help, and making it easier for veterans to receive and utilize all sides of health services, AMVETS believes that the overall health of veterans can progress and improve, and in doing so may also reduce the social, societal, and cultural stigma surrounding mental health.

 Many factors were considered throughout the inception and development of the HEAL Program, but the biggest in particular is the suicide factor that may result from the failure to receive proper care. AMVETS grasped the reality of vets’ vulnerability and increased susceptibility to homelessness, joblessness, mental illness, substance abuse, and suicide, and was also very aware of the mental illness stigmas within the military and societal cultures that posed a great barrier to vets accessing and receiving much-needed care. With that in mind, AMVETS’ mission, according to their Strategic Plan, was to network with other local, county, state, and federal agencies/governments as well as the community on a voluntary basis to ensure each veteran had the support they needed to mitigate and eliminate any potential negative outcomes of not receiving the appropriate care (amvets.org). As mentioned previously, the goal is to connect veterans with healthcare services to manage and treat any mental and physical needs both in and outside of the VA; in addition to this, the program collaborates with healthcare providers within the private sector as well to guarantee all avenues are explored.

Another consideration of this initiative was the proper implementation of the hotline. Despite the massive costs, it was important to the program that all hotline staff were registered, licensed clinicians offering professional guidance and assistance to those who opted to utilize the free service. According to AMVETS Chief Strategy Officer, Sherman Gillums Jr., “staffing up with clinicians is worth the expense because the expertise is meaningful to those who are more at risk.” The cost to make this happen is roughly $700,000.00 (Athitakis, 2018), which is what sets this particular initiative apart from some of the others. By creating a hotline that guarantees each call to be received by health care professionals with the expertise in clinical matters, it offers a feeling of comfort and safety knowing that there are professionals on the other end that have the tools and resources to truly assist in meeting their needs. They are also working toward creating chat and electronic mail options in an effort to widen the ability for vets to obtain resources.

One last consideration for the development of this initiative was to take the proper steps and precautions to ensure that any barriers that may have hindered veterans’ ability to access healthcare were addressed and eliminated. In the efforts to acquire equity and quality of care, it was important that barriers such as appointment wait times, technological barriers, stigmas, and other potential barriers surrounding the lack of community awareness and participation were seen to in order to make the initiative a success, which is why partnerships and collaborations with other agencies and departments were vital throughout the programs beginnings and continuous development.

There are many resources that are required to fund this initiative, but the biggest resources are those that come from the partnerships and collaborations with state and local governments, who take on vital roles in the organization and finance aspects, as well as the delivery of veteran services within the program. The HEAL Program also coordinates with resources such as Objective Zero, Veterans Crisis Line, VA Office of Mental Health, Cohen Veterans Network, and VA Veterans Experience Office (American Veterans Department of Illinois, 2018). According to AMVETS Strategic Plan, the “behavioral health treatment and service funds flow from the state health authority or single state agency to counties or regions within the state, and these funds are then awarded to various service providers to deliver care.” (amvets.org). In addition to counties, territories, states and other local governments, funding and resources also come from local communities by charities and collecting donations to support veteran-related programs. Scholarships and grants are also awarded/allocated to the program/organization.

On Tuesday, March 5th, 2019, President Donald Trump signed an executive order that consists of a Cabinet-level task force meant to assist in tackling the prevention of veteran suicides (CNN, 2019). This measure is called the PREVENT initiative, which is short for President’s Roadmap to Empower Veterans and the National Tragedy of Suicide, and was created to come up with legitimate plans to prevent veteran suicides across the board and to include not just community, local, and state involvement, but also to include the involvement of federal agencies and Congress. The coordination and collaboration with Congress is key in this measure. The task force consists of secretaries from several governmental agencies, including the Department of Veterans Affairs, Department of Defense, the U.S. Department of Health and Human Services, as well as Homeland Security, and will be instrumental in allocating grants to state and local governments while simultaneously keeping an eye on any trends regarding veteran suicides (Krause, 2019). In addition to the already existing partnerships, coordinations, and collaborations that the Heal program has with so many local, state, and federal organizations, this is just one more great addition to the list of resources that will help fund and maintain the AMVETS Heal Program initiative.

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The somewhat newly born AMVETS Heal Program, whose primary purpose is to tackle the trend in suicide rates amongst veterans with no access to healthcare, may still require some improvement. Since its implementation of the hotline, it seems the services they offer have been in high demand. To accommodate the vastly growing need for their services, they extended the hours of operation for the hotline (amvets.org); however, it calls in to question whether the expansion may be enough to make the intended impact.

An even bigger issue the initiative has been presented with are the challenges that have come up since the launch of the program and its partnership with the VA. One reason that many U.S. Veterans fail to obtain and receive healthcare services from the VA is because of the overwhelming enrollment process, which is so convoluted that they are then discouraged from seeking the care they require due to the highly involved eligibility determination processes (Walsh, 2018). This issue has since been spotted by the White House, and in an effort to address it, an executive order was made which now requires vets to be automatically enrolled in mental health care for twelve (12) months.

Despite the efforts, funding, and plethora of resources being applied toward this initiative, there still seems to be no change in the rate of suicides among veterans. In 2015, the Clay Hunt Suicide Prevention for American Veterans Act was enacted following a 2011 suicide of an activist for United States Marine Corps (USMC) veterans (Shane, 2019). This act requires the VA, AMVETS’ main partnership, to provide a report called “VA Mental Health Program and Suicide Prevention Services Independent Evaluation”, which is meant to serve as a thorough analysis and overall review of mental health care and suicide prevention programs on an annual basis. This evaluation was put into place as a way to track the progress, impact, and efficacy of suicide prevention programs, as well as highlight any potential trends surrounding veteran suicides. Up until now, the VA states that the outcome has been generally positive; however, according to the 2018 Annual Report, the suicide rates of veterans have not decreased and there is no evidence toward improvement (amvets.org).

While there may be many improvements to be made within this initiative and the partnerships and collaboration AMVETS has with the VA and other agencies/organizations, it seems as though this particular gap in healthcare has even captured the attention of the White House and other U.S. officials. With the implementation of federally-governed executive orders, measures, and other iniatives, comes additional resources and funding, which will hopefully contribute to the AMVETS Heal Program purpose in bridging this gap and ensuring that U.S. veterans are taken care of.

References:

• Fox, M.. (2018, June 18). Veterans die by suicide at greater rates, VA finds. Retrieved May 28,
  2019, from https://www.nbcnews.com/health/health-news/veterans-more-likely-civilians-
  die-suicide-va-study-finds-n884471
• AMVETS (n.d.). AMVETS Heal Program. Retrieved May 26, 2019, from
  https://amvets.org/vet-heal/.
• Athitakis, M. (2018, May 15). AMVETS Partners With VA to Address Veteran Suicide Crisis.
  Retrieved June 4, 2019, from https://associationsnow.com/2018/05/amvets-partners-va-
  address-veteran-suicide-crisis/
• American Veterans Department of Illinois (2018, October). AMVETS, VA Formally Partner to
  Immprove Veteran Access to Mental Health Care. Illinois Amvets. Retrieved June 5,
  2019, from http://www.ilamvets.org/Portals/0/Newspapers/Oct18web.pdf
• CNN. (2019, March 06). President Trump signs measure aimed at preventing veteran suicides.
  Retrieved June 5, 2019, from https://www.wpsdlocal6.com/2019/03/06/president-trump-
  signs-measure-aimed-at-preventing-veteran-suicides/
• Krause, B. (2019, march 06). New Veterans Suicide Executive Order Signed By President.
  Retrieved June 5, 2019, from https://www.disabledveterans.org/2019/03/06/prevents-
  initiative-veterans-suicide-executive-order/
• Walsh, S. (2018, February 05). VA Faces Challenges As It Tries to Expand Mental Health Care.
  Retrieved June 7, 2019, from https://americanhomefront.wunc.org/post/va-faces-
  challenges-it-tries-expand-mental-health-care
• Shane, L. (2019, March 14). This VA report touts ‘positive outcomes’ from its suicide
  prevention programs – but veteran suicide rates haven’t slowed. Retrieved June 7, 2019,
  from https://www.militarytimes.com/news/pentagon-congress/2019/03/14/va-report-
  cites-positive-results-from-mental-health-programs-despite-no-drop-in-veterans-suicides/