Mental Health Care Practice

Choice Program Expansion Jeopardizes High-Quality VHA Mental Health Services

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Last summer, the Department of Veteran Affairs (VA) published the most comprehensive analysis of veteran suicide in our nation’s history. That study examined 55 million records from every state and revealed that in 2014, an average of 20 veterans died by suicide each day.1 Six of the 20 were recent users of Veterans Health Administration (VHA) services; the other 14 had not used VHA services in the prior 2 years.

Policy makers are currently deliberating whether expanding the Veterans Choice Program (VCP) is a judicious way to prevent these tragic deaths, especially for veterans who do not use the VHA. One proposal, presented at a congressional committee hearing in October 2017, advocates expanding the VCP.2 Its core tenet—allowing veterans to seek mental health care from VCP providers without needing VHA preauthorization—is similar to provisions in other subsequent VCP bills regarding Access to Walk-In Carefor episodic physical and mental health care.3

The original Veterans Choice Act of 2014 was enacted with $10 billion supplemental funding for the VCP as well as $5 billion to augment VHA staffing. In contrast, these recent proposals include no supplemental allocations. Veterans could bypass VHA approval, obtain VCP services on their own; the VHA would be sent the bill and payment would be taken from the VHA facility’s budgets.

The set of proposals serves as a reminder of the need for further reflection and discussion about how the nation can best address the crisis of veteran suicide and, more broadly, how to optimize access to evidence-based, integrated mental health care services.

This article critiques the myths underlying the proposals’ rationale, gives factual evidence on veterans’ suicide prevention and comprehensive mental health care issues, and concludes with a cautionary warning about the risk of VCP expansion adversely impacting veterans.


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