More than 6,000 veterans die by suicide every year—more than the total number of combat deaths in Iraq and Afghanistan combined.
In recently released Improving the Quality of Mental Health Care for Veterans: Lessons from Rand Research , RAND researchers say the overwhelming message from 10 years of research, including a comprehensive evaluation of the US Department of Veterans Affairs (VA) mental health system and a congressionally mandated analysis of VA health care vs other health care systems, is, We could do more to save the lives of veterans.
RAND research has found that the VA outperforms other health systems on most measures of health care, including mental health care. The report also acknowledges that the VA and US Department of Defense (DoD) have both invested heavily in public-awareness campaigns and efforts to better identify those at risk of suicide, but “the research shows it’s not enough.”
Improving the Quality of Mental Health Care for Veterans has 6 recommendations:
1. Increase the number of highly trained mental health providers within the VA and in private practice. The VA has continued to hire more providers, integrate mental health into primary care settings, and expand the use of telemental health. However, quality varies “considerably” across facilities, the report says, with best practices not universally delivered.
Moreover, fewer than half of all veterans get their care at the VA. Most use local hospitals and health clinics. RAND research has shown those community health providers are often not prepared to address the needs of veterans. Few community providers even ask their patients if they ever served, the researchers say. Recently, the report notes, the VA has taken steps to help private providers serve veterans more effectively, by providing toolkits, training programs, and other resources.
2. Reduce barriers to care by educating veterans about treatment and expanding access to high-quality treatment. The report notes that patients may believe that admitting a mental health problem is a “sign of weakness,” or that they may be skeptical about the effectiveness of treatment.
3. Adopt and enforce appropriate, consistent quality-of-care standards by creating incentives and disincentives that support best practices.
4. Improve monitoring and performance measurement for VA community care programs. According to the report, “Little is known about the timeliness or quality of care that veterans receive through these programs as mandated.”
5. Continue to develop and test new models of care, particularly as new interventions become available and show promise. The report lists examples of evidence-based practices that have proven effective, including narrative exposure therapy for PTSD, mindfulness-based therapies for depression, and behavioral couples therapy for alcohol use disorder.
6. Strengthen the evidence base for understanding the effectiveness of complementary and alternative therapies for mental health conditions.
The research also supports the concept that policies that change the environment and attitudes can reduce and prevent suicides. For instance, a RAND essay advocates policies that promote better sleep and address a “culture of stress.” Policies that promote safe gun storage, encourage health care providers to ask their patients about guns, and remove guns from those at highest risk could help: Nearly 70% of veterans who die by suicide use a firearm. And because sexual assault within the military is a major risk factor for suicide among female veterans, a zero-tolerance policy on sexual assault could make a difference for thousands of service members.