Accessing VA MH Services:

We’re Not Your Father’s VA Anymore!

Steve Holliday, Ph.D, ABPP-CN

V17 Chief Mental Health Officer

210-694-6223

VA in Texas

• VISN 17 - Covers 4 VA Health Care Systems along IH-35 from Dallas to Brownsville

– North Texas HCS (Dallas & Ft. Worth)

– Central Texas HCS (Waco/Temple/Austin)

– South Texas HCS (San Antonio & Kerrville)

– Valley/Costal Bend HCS (Harlingen, Laredo, & CC)

• VISN 16 – Houston & East Texas

• VISN 17 – El Paso & West Texas

Eligibility • OEF/OIF Vets have full eligibility for 5 years

• Served >180 days or Service-connected

• Must have Honorable or General D/C

–Bad D/Cs can be upgraded

• Co-Pays at Higher Incomes Unless SC

• Eligible Vets Receive All VHA Services

• Incarcerated Vets NOT eligible for VA Care

– Except for Outreach Visits by VJOs & RSs

– SC Vets Must Report Incarcerations!

MH Uniform Services Plan

• Based on President’s MH Commission & Recovery Model

• Emphasis on MH/PCC and Suicide Prevention

• Mandates Core MH Services at Each Site

• Standardized MH Care Throughout USA

• Significantly Enhanced MH Staff/Capacity

• Mandates Evidence-Based MH Services

• Site Visits Track Implementation & Access

Rehabilitation/Recovery Model • Recovery is possible for everyone (even SMI)

• It’s the Vet’s Recovery Plan; Not the Doc’s – Uses Understandable, Non-stigmatizing Language

– Based on Vet’s Needs, Strengths & Life Goals

• Use of Certified Peer Counselors

• Include Consumers in MH Planning/Mgmt

• Meaningful Work is the Best Therapy

• Building Support Systems in the Community

• Educating to Reduce Stigma/Facility Recovery Coordinators

VA MH Continuum of Care • ED & Acute Inpatient MH Services • Co-located MH in Primary Care Clinics • Outpatient Mental Health Clinics • Residential Rehabilitation Programs (RRTPs)

– Domiciliary (Doms)… Unique to VA – General, Homeless , PTSD, MST, SUD RRTPs

• Community-based MH Specialty Care – PTSD/MST/SUD Clinics – MHICM Teams for SMI – Homeless Programs (including Justice-involved Vets) – Vocational Programs – Telehealth & Home Health – Suicide Prevention

Bonham Dom Room

MH in Primary Care • Co-located Mental Health in Primary Care

– Reduces Stigma for Seeking MH Care

– Rapid Access for MH Screening/Services

– Treatment for Mild MH issues

• Adjustment Issues/Managing Stress

• Uncomplicated Depression & Anxiety D/Os

• Harm Reduction/ME for SUDs

– Referral to MHC/Specialized Tx Programs

• Up to 80% of Cases Managed in PCC

• Healthy Behaviors/Disease Mgmt

Outpatient MH Clinics • BHIP Teams for Extended Outpt. MH Care

• MH Treatment Coordinator for Each Vet

• EB Psychotherapies & Medications for – Depression

– PTSD and MST

– Anxiety Disorders

– Psychotic Disorders

– Couples Therapy

• Refer to Specialty MH Care Programs & Back to Primary Care When Stable

Evidence-Based Treatments • Evidence-Based Psychotropic Medications

– Opiate Safety Initiative, e.g. Benzos + Opiates – Addressing Over/Under Medication with New Metrics

• Evidence-Based Psychotherapies – PE/CPT/ACT for PTSD – CBT for Depression – SUD – ME, 12-SFT, New Medications – Couples/Marital Therapy – SST, PST and MHICM for SMI – DBT and CAMS for Suicide Attempts (VISN 17 only)

• National Training Programs in EBTs – One-week intensive workshop (national experts) – 6-12 Months of weekly case supervision – Train the Trainer Model for future staff

Substance Use Treatment

• Universal Screening Annually (CRs in CPRS)

• Building Motivation/Education in PCC & MHCs

• Inpatient/Outpatient DETOX

• Outpatient SUD Program (1 day/week)

• Intensive Outpatient SUD Program (3-5 days)

• SARRTP (28 Day Residential)

• SUD Tracks in Doms (90-Day Residential)

• Meds for SUD (Bup, Naltrexone, Methadone)

Ending Homelessness! • VA Secretary’s 5-Year Plan – $3.2 Billion

• From 160K to ZERO Homeless Vets!

• Enhanced Existing Homeless Services – HUD-VASH Vouchers

– Enhanced VA SUD and MH Capacity

– Enhanced RRTP/Doms & Contract Beds

– Enhanced Jail/Prison Diversion & Outreach

• New Initiatives/Services – Homeless Hot Line

– Emergency Funding to Prevent Homelessness

Justice-Involved Veterans

• VA Prison Re-Entry Program

– State/Federal Prisons

– Enrolling Eligible Veterans

– Appointments for Care After Release

– Case Management until connected

• Veterans Justice Outreach Program

– County/Local Jails Re-Entry Outreach

– Liaison with local Veterans Courts

– Educate local Law Enforcement/Others

Vocational Rehabilitation

• VBA Educational Benefits (30%+ SC)

• Incentive Therapy (IT)

• Compensated Work Therapy (CWT)

• Supported Community Employment

• Job Search Assistance

• Assistance with VA/SSDI Claims (VSOs)

• Volunteer Positions

Tele Health Services

• Telemental Health Services

– EBTs from the Hospitals to Remote Clinics

– Cross coverage for Smaller MHCs

– “Health Buddies” to Monitor SMI at Home

– Home-based TMH for Highly Rural Vets

– Reduces Barriers of Distance & Stigma

• New Technology

– Anonymous Chat Rooms (Suicide Hot Line)

– Mobile Apps for PTSD and Suicide Prevention

– MyhealthEvet, Secure Email with Providers

Health Buddy

Distance Consultation

Suicide Prevention • National Suicide Hotline 1-800-273-TALK (8255)

– Staffed by Trained MH Providers 24/7

– Over 3000 Rescues in Past Year

– Arrange for Immediate Help

– Live Hand Off to Local VA Facilities for F/U

• Facility Suicide Prevention Coordinators – Suicide Risk Assessments

– Maintains List of High Risk Patients/Chart Flags

– Develops/Implements Suicide Safety Plans

– Investigates Attempts/Completed Suicides

– Educates Staff and Community

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Warning Signs • Observable signs of serious depression

Unrelenting low mood Pessimism Hopelessness Desperation Anxiety, psychic pain, inner tension Withdrawal Sleep problems

• Increased alcohol and/or other drug use • Recent impulsiveness and taking unnecessary risks • Threatening suicide or expressing strong wish to die • Making a plan

Giving away prized possessions Purchasing a firearm Obtaining other means of killing oneself

You can help. . .

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• Show you care Take ALL talk of suicide seriously

If you are concerned that someone may take their life, trust your judgment!

Listen Carefully

Reflect what you hear

Use language appropriate for age of person involved Do not worry about doing or saying exactly the

"right" thing. Your genuine interest is what is most important.

You can help. . .

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• Be Genuine Let the person know you really care. Talk

about your feelings and ask about his or hers. "I'm concerned about you…about how you feel."

"Tell me about your pain."

"You mean a lot to me and I want to help."

"I care about you, about how you're holding up."

"I don't want you to kill yourself."

"I'm on your side…we'll get through this."

You can help. . .

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Ask about suicide • Don't hesitate to raise the subject.

Talking with people about suicide won't put the idea in their heads. Chances are, if you've observed any of the warning signs, they're already thinking about it. Be direct in a caring, non-confrontational way. Get the conversation started.

You can help. . .

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You do not need to solve all of the person's problems;

Just engage them

Are you thinking about suicide?

What thoughts or plans do you have?

Are you thinking about harming yourself, ending your life?

How long have you been thinking about suicide?

Have you thought about how you would do it?

Do you have __? (Insert the lethal means they have mentioned.)

Do you really want to die? Or do you want the pain to go away?

You can help. . .

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Intervention Step Three: •Get help but do NOT leave the

person alone Know referral resources

Reassure the person

Encourage the person to participate in helping process

Outline safety plan

You can help. . .

IT’S YOUR CALL VA Suicide Prevention Outreach Campaign

Presentation to Suicide Prevention Coordinators 03.13.2011

The Best Care Anywhere By Phillip Longman

Ten years ago, veterans hospitals were dangerous, dirty, and scandal-ridden. Today, they're producing the highest quality care in the country. Their turnaround points the way toward solving America's health-care crisis.

Washington Monthly

The Best Medical Care in the U.S.

The VA uses the data gathered in its computers to pinpoint problem areas, such as medication errors. The network also allows it to track how closely the medical staff is following evidence-based treatment and monitor deficiencies. Such tracking pays off. When Rand did an extensive study comparing quality of care at the VA with private-sector hospitals, it found that performance measurement played an important role in helping the VA score higher in every category except acute care, where it came in about even.

Business Week

VA Medical System Earns High Customer Satisfaction Ratings

Good news about government is rare enough. What's outright shocking is when that good news is about how nice government employees are. But that is the bottom line of the recently released American Customer Satisfaction Index report on the Department of Veterans Affairs' medical system.

Not only do veterans rate their VA care much higher

overall than the general population rates its hospital experiences, vets also consistently give VA doctors and nurses high scores for "responsiveness" (83 out of a possible 100), courtesy (90), and "respect and dignity afforded patients" (91).

National Journal

VA: From Worst to First! • Moving from Hospitals to the Community

• CPRS & Performance Measures

– Improved Access to Care

– Improved Quality of Care & Outcomes

– Improved Cost Effectiveness

– Improved Patient Satisfaction

• Holding VA Staff Accountable

– Managers’ Performance Plans

– Providers Performance Plans/Incentive Pay

Electronic Medical Record • Follows Veterans Across Sites/Locations of Care

• Digital X-Rays, Consults, Meds, Lab, etc.

• Flags for High-Risk Conditions

• Clinical Reminders for Better Care • MH/SUD Screening that Requires F/U

• Smoking Cessation

• Obesity/Weight Management

• Diabetes

• Hypertension

• Tracks Quality of Care through PMs

• Integration with DoD Medical Records

Next Steps… • Contact your VISN MH Lead

– VISN 16: john.rader@va.gov

– VISN 17: steve.holliday@va.gov

– VISN 18: lori.highberger@va.gov

• Meet your local VJO (see next slide)

• Work with your local MHMR Jail Diversion Committee!

• Work to Establish Veterans’ Courts

• Ask you clients if they are Vets and give us a chance to help!

VJOs in Texas

TEXAS VJO LIST Location VJO NAME Email PHONE

AMARILLO 6010 W Amarillo Blvd, Amarillo, TX 79106 Kathleen Caldwell Kathleen.Caldwell3@va.gov 806-355-9703, Ext. 7543

AUSTIN 1701 Directors Boulevard, Austin, TX 78744 Karen Janda, LCSW Karen.Janda@va.gov 512-433-2017

BONHAM 1201 E. 9th St. Bonham, TX 75418 Melissa Stroop Melissa.Stroop@va.gov 903-583-6262

DALLAS/FT WORTH 4500 S Lancaster Rd, Dallas, TX 75216 Latisha Gaten, LMSW Latisha.Gaten@va.gov 214-857-2252

4500 S Lancaster Rd, Dallas, TX 75216 Kathy Finch, LCSW KathyL.Finch@va.gov 214-857-2260

CORPUS CHRISTI 5283 Old Brownsville Road, Corpus Christi, TX 78405 Edward (Chad) Henderson, Ph.D., LCSW Edward.Henderson2@va.gov 956-490-0440

5283 Old Brownsville Road, Corpus Christi, TX 78405 Yasisca Pujols, Ph.D. Yasisca.Pujols@va.gov 956-291-9202

EL PASO 5001 N Piedras St, El Paso, TX 79930 Ellyn Black Ellyn.Black@va.gov 915-564-6100, Ext. 6159

HOUSTON 2002 Holcombe Blvd, Houston, TX 77030 Loretta Coonan, LCSW COONAN.LORETTAA@va.gov 832-260-1361

SAN ANTONIO 7400 Merton Minter San Antonio, TX 78229 Treva Neiss, LCSW Treva.Neiss@va.gov 210-616-9915

7400 Merton Minter San Antonio, TX 78229 Jill A. Koenig, Ph. D. Jill.Koenig@va.gov 210-617-5300, Ext. 15121

WACO/TEMPLE 4800 Memorial Drive, Waco, TX 76711 Rekita Justice-Logan, LCSW, CCM Rekita.JusticeLogan@va.gov 254-421-7038

Other Resources • www.va.gov/health/

• www.texvet.com – On Line Searchable Database for Vets

– Texas MH, Job, Education, Emergency Services

• 211 Texas – Just Dial 211

– 24/7 Information Line

• Vet Centers – Storefront Locations, Walk-ins

– Veteran and Family Counseling

– GWAT Outreach Staff

Any Questions?