Approximately 4 million U.S. service members took part in the wars in Afghanistan and Iraq. Shortly after troops started returning from their deployments, some active-duty service members and veterans began experiencing mental health problems. Given the stressors associated with war, it is not surprising that some service members developed such mental health conditions as posttraumatic stress disorder, depression, and substance use disorder. Subsequent epidemiologic studies conducted on military and veteran populations that served in the operations in Afghanistan and Iraq provided scientific evidence that those who fought were in fact being diagnosed with mental illnesses and experiencing mental healthâ€"related outcomesâ€"in particular, suicideâ€"at a higher rate than the general population. This report provides a comprehensive assessment of the quality, capacity, and access to mental health care services for veterans who served in the Armed Forces in Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn. It includes an analysis of not only the quality and capacity of mental health care services within the Department of Veterans Affairs, but also barriers faced by patients in utilizing those services.

Introduction -- The Veterans Health Administration -- The Veterans Health Administration's Mental Health Services -- Clinical management of mental health conditions at the Veterans Health Administration -- Methodology -- Department of Veteran's Affairs mental health services: need, usage, and access and barriers to care -- Dimensions of quality in mental health care -- Mental health workforce and facilities infrastructure -- Timely access to mental health care -- Patient-centered care and the veteran experience -- Effective mental health care -- Efficient mental health care -- Equitable mental health care -- Health technology for mental health care -- Quality management -- Findings, conclusions, and recommendations -- Appendices. Supporting the documentation for the survey -- Supporting documentation for the site visits: questionnaires and NVivo codes.

U.S. veterans have elevated rates of serious mental health and substance use disorders. Among veterans of the Afghanistan and Iraq conflicts, prolonged, repeated deployments have magnified these problems and contributed to rising rates of suicide, occupational problems, and family difficulties. Among veterans of earlier conflicts, the prevalence of mental health problems, especially post-traumatic stress disorder (PTSD), is also high. Meeting the health care needs of this clinically complex and vulnerable population is the responsibility of the Veterans Health Administration (VHA), a unit within the U.S. Department of Veterans Affairs. In 2006, the VHA commissioned a comprehensive evaluation of its mental and substance use treatment system. The evaluation took place during implementation of the VHA's five-year Mental Health Strategic Plan, a large initiative to expand and improve mental health care. To support the initiative, the VHA increased funding for mental health by $1.4 billion annually between FY 2005 and FY 2008. The goal of the evaluation was to assess whether, for the population of veterans with mental health and substance use disorders, the VHA was meeting the goal of maximizing these veterans' physical, mental, and social functioning. The study addressed the following questions: How much health care is used by veterans with mental health and substance use disorders, and how much does it cost? What is the VA's capacity to deliver mental health and substance use care to veterans? What is the quality of mental health care received by veterans, and how does the quality compare with that delivered in the private sector? How does quality vary across geographic regions of the United States and for different groups of veterans? Are veterans satisfied with the care they receive?

This history of psychological care through the VA tells how VA psychologists pioneered research in such areas as pyschopharmacology, care of elderly people, and psychological care aspects in treatment of tuberculosis, and how they helped establish a number of trends for such mental health services as group therapy, compensated work therapy, and other rehabilitation programs.

Approximately 4 million U.S. service members took part in the wars in Afghanistan and Iraq. Shortly after troops started returning from their deployments, some active-duty service members and veterans began experiencing mental health problems. Given the stressors associated with war, it is not surprising that some service members developed such mental health conditions as posttraumatic stress disorder, depression, and substance use disorder. Subsequent epidemiologic studies conducted on military and veteran populations that served in the operations in Afghanistan and Iraq provided scientific evidence that those who fought were in fact being diagnosed with mental illnesses and experiencing mental healthâ€"related outcomesâ€"in particular, suicideâ€"at a higher rate than the general population. This report provides a comprehensive assessment of the quality, capacity, and access to mental health care services for veterans who served in the Armed Forces in Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn. It includes an analysis of not only the quality and capacity of mental health care services within the Department of Veterans Affairs, but also barriers faced by patients in utilizing those services.

"In fiscal year 2010, the Department ofVeterans Affairs (VA) provided healthcare to about 5.2 million veterans.Recent legislation has increased manyOperations Enduring Freedom (OEF)and Iraqi Freedom (OIF) veterans'priority for accessing VA's health care,and concerns have been raised aboutthe extent to which VA is providingmental health care to eligible veteransof all eras. There also are concernsthat barriers may hinder some veteransfrom accessing needed mental healthcare.GAO was asked to provide informationon veterans who receive mental healthcare from VA. In this report, GAOprovides information on (1) how manyveterans received mental health carefrom VA from fiscal years 2006 through2010, (2) key barriers that may hinderveterans from accessing mental healthcare from VA, and (3) VA efforts toincrease veterans' access to VAmental health care. GAO obtained datafrom VA's Northeast ProgramEvaluation Center (NEPEC) on thenumber of veterans who receivedmental health care from VA. Thenumber of veterans represents aunique count of veterans; veteranswere counted only once, even if theyreceived care multiple times during afiscal year or across the 5-year period.GAO also reviewed literature publishedfrom 2006 to 2011, reviewed VAdocuments, and interviewed officialsfrom VA and veterans service..."

The Veterans Health Administration does not have a reliable and accurate method of determining whether they are providing patients timely access to mental health care services. VHA did not provide first-time patients with timely mental health evaluations and existing patients often waited more than 14 days past their desired date of care for their treatment appointment. As a result, performance measures used to report patient's access to mental health care do not depict the true picture of a patient's waiting time to see a mental health provider. Although no measure of access is perfect or paints a complete picture in isolation, meaningful analysis and decision making requires reliable data, on not only the timeliness of access but also on trends in demand for mental health services, treatments, and providers; the availability and mix of mental health staffing; provider productivity; and treatment capacity. A series of timeliness and treatment engagement measures might provide decision makers with a more comprehensive view of the ability with which new patients can access mental health treatment.

This report summarizes a four-year evaluation of mental health services provided by the Veterans Administration (VA) for veterans with schizophrenia, bipolar disorder, post-traumatic stress disorder, major depression, and substance use disorders. The population of veterans with the diagnoses included in the study comprises a large and growing number of veterans with severe and complex general medical and mental disorders and accounts for a disproportionately large proportion of utilization and costs for the VA. Study veterans represented 15.4 percent of all veterans who used VA services in 2007 but accounted for 32.9 percent of the costs due to higher utilization of inpatient and outpatient services. Across the country, VA facilities report substantial capacity for treating seriously mentally ill veterans. Although capacity has increased since the implementation of the Mental Health Strategic Plan in 2005, important gaps remain. The proportion of veterans receiving recommended care varies widely, and there is variation in many of the performance indicators assessed with regard to specific populations, services, and locations. In most instances, VA care performance is as good as or better than that reported by other groups or shown by direct comparisons with other systems of care, but the level often does not meet implicit VA expectations. Most performance indicators did not show substantial improvement from FY 2004 through FY 2007, but recent structural enhancements and increased availability of services may yield improvements in the future, and the number of veterans in the study cohorts who were served during the study period increased annually. Veterans' perceptions of VA services were favorable, although they did not perceive significant improvement in their conditions. Opportunities for further investigation are identified, along with specific problem areas and strategies for improving performance and methods to enhance capacity for quality monitoring and improvement.

Praised by instructors and students alike, PROGRAM EVALUATION: AN INTRODUCTION helps your students evaluate services and programs that they will encounter in their professional practice. In the process of learning evaluation techniques and skills, students will become proficient at critically analyzing evaluation studies conducted by others. The authors present and simplify all the essentials needed for a critical appreciation of evaluation issues and methodology. The text's student-friendly writing style and clear presentation of concepts, as well as its hands-on and applied focus, will guide students on how to gather evidence and demonstrate that their interventions and programs are effective in improving clients' lives.