High Quality, Low Consistency

However, the money spent on such care is being spent well, according to the study. Researchers found that the quality of VA mental-health care is generally as good as or better than that delivered by private healthcare plans.

VA outperformed private plans on seven of nine quality measures, including the use of: medication lab tests, lab screening tests, antipsychotics, long-term antipsychotics, long-term mood stabilizers, antidepressants and continuation phase antidepressants.

Where private plans outperformed VA were in treatment initiation and treatment engagement for substance-use disorder. 

The consistency of mental-health and substance-abuse care throughout the VA system has room for improvement, the study found. The difference in care between VA facilities was found to vary by as much as 23%. Performance in certain areas, including whether those with alcohol dependence received pharmacotherapy, was especially low.

One of the largest variations occurred in intensive case management, which is a best practice for treating severe schizophrenia or bipolar disorder. This varied by more than 20% across VISNS, ranging from 35% to 14%. There also was a 20% difference between the highest and lowest performing VISN in filling antidepressant medications.

Most veterans expressed satisfaction with their care at VA. On a 10-point scale, 42% rated VA mental health at 9 or 10, and 74% reported being helped by counseling or treatment they had received in the previous year.

The report notes that, even with the decrease in military operations in Iraq and Afghanistan, the number of veterans seeking mental-health and substance-use disorder treatment will continue to rise in the coming years, and that VA can act as a proving ground for quality care.

The researchers suggested that, if there is this much variation within an integrated system of care such as VA, then the variation outside VA is likely much greater. VA is in a position, the researchers said, to serve as a leader to other health-care systems for improving the quality and consistency of mental-health and substance-use care. The department can support greater standardization of clinical assessment and treatment and help inform the field about the best ways to conduct this type of care.

Veterans Health Administration Mental Health Program Evaluation

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