DoD/VA Integrated Mental Health Strategy

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Agenda

• Background on Department of Defense (DoD)/Veterans Affairs (VA) mental health collaboration

• Mission and overview of the DoD/VA Integrated Mental Health Strategy (IMHS)

• Examples of specific IMHS Strategic Actions• Discussion and questions

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Recommendations and Mandates

SOC/JEC

To improve the care and services offered to Service members and Veterans, over 400 recommendations and mandates were created by:

Recomendations and Mandates

Commission• Veterans’ Disability Benefits

Commission (VDBC), August 2007• Presidential Commission on Care

for America’s Returning Wounded Warriors (PCCWW), July 2007

Task Force• Task Force on Returning Global

War on Terror Heroes (GWOT), April 2007

• Mental Health Task Force (MHTF), June 2007

Review Group• Independent Review Group (IRG),

April 2007

Congress• National Defense Authorization Act

(NDAA) for years 2007 - 2011

SOC/JEC

DoD/VA Mental Health Summit

IMHS

Recommendations and Mandates

Reporting of Joint Health Initiatives

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Joint health initiatives are reported to the SOC and the JEC

Senior Oversight Committee (SOC) Joint Executive

Council (JEC)

Health Executive Council (HEC)

Overarching Integrated Product

Team (OIPT)

Joint, DoD and VA TBI Recommendations and

Mandates

Joint, DoD and VA PH Recommendations and

Mandates

Joint TBI Recommendations and

Mandates

Joint PH Recommendations and

Mandates (IMHS)

DoD/VA Secretaries

Joint Executive Council (JEC)

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• Mandated by Congress to oversee joint DoD/VA initiatives in February 2002

• JEC created the Health Executive Council (HEC) to manage all health related DoD/VA initiatives

• HEC the chartered the Psychological Health (PH)/Traumatic Brain Injury (TBI) Work Group to manage PH and TBI recommendations and mandates

SOC/JEC

DoD/VA Mental Health Summit

IMHS

Recommendations and Mandates

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Wounded, Ill, and Injured Senior Oversight Committee (SOC)

• Established by the DoD and VA Secretaries in May 2007

• Co-chaired by DoD/VA Deputy Secretaries, and includes:– Service Secretaries, – Vice/Chairman - Joint Chiefs of Staff

SOC/JEC

DoD/VA Mental Health Summit

IMHS

Recommendations and Mandates

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IMHS Timeline

• Oct 2009: DoD and VA Joint Mental Health (MH) Summit

• January 2010: SOC asks for the development of joint DoD/VA mental health strategy

• November 2010: HEC approved IMHS and assigned to the HEC PH/TBI Work Group for monitoring and oversight

• October 2011: Currently completing Year 1 of IMHS

SOC/JEC

DoD/VA Mental Health Summit

IMHS

Recommendations and Mandates

IMHS Mission

The Departments will advance an integrated and coordinated public health model to improve the access, quality, effectiveness, and efficiency of mental health services for all Active Duty Service members, National Guard and Reserve members, Veterans, and their families.

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Integrated Mental Health Strategy

IMHS includes 28 Strategic Actions to:• Expand access to behavioral health care in

DoD and VA• Ensure quality and continuity of care across

the Departments• Advance care through community

partnership, education, and successful public communication

• Promote resilience and build better behavioral health care systems for tomorrow

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SOC/JEC

DoD/VA Mental Health Summit

IMHS

Recommendations and Mandates

Strategic Goal 1: Expanding Access to Care

Strategic Action #2: Expanding Integration of Mental Health into Primary Care Settings

• Extend delivery of evidence-based mental health care to primary care settings.

• Develop coordinated training and dissemination efforts focused on co-located collaborative care and combined or “blended” approaches.

• Joint DoD/VA conference was held in September 2011.

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Strategic Goal 1: Expanding Access to Care

Strategic Actions #3 and #4: Expanding Access to Vet Centers

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• Extend access to VA’s Readjustment Counseling Service to Active Duty Service members who have returned from OEF/OIF/OND

• Explore the feasibility and utility of adding additional Mobile Vet Centers to current fleet as needed

Strategic Goal 1: Expanding Access to Care

Strategic Action #6: Joint Telemental Health Services

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• Develop technical, business and clinical processes for implementing joint DoD and VA telemental health services

• Initial pilot sites are being identified to deliver tele-pain management with a behavioral health focus

Strategic Goal 2: Ensuring Quality and Continuity of Care

Strategic Action #13: inTransition• To enhance continuity of care

for Service members as they transition from DoD to VA systems

• To increase awareness of inTransition program among MH providers, Service members and families

• To increase the number of enrolled Service members

• To obtain and monitor satisfaction ratings from enrolled members 13

Strategic Goal 2: Ensuring Quality and Continuity of Care

Strategic Action #9: Develop a System to Deliver Evidence-Based Psychotherapies• Increased availability of consistent and effective

psychological treatments for PTSD, depression, and other psychological health conditions across both Departments

• Implementation of shared provider support resources such as websites, electronic reporting templates, and training materials for consistency across Departments

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Strategic Goal 2: Ensuring Quality and Continuity of Care

Strategic Actions #10 and 12: Quality Measures for Mental Health and Evaluating Patient Outcomes

• Recommend quality measures for mental health services based on DoD-VA Clinical Practice Guidelines (CPGs) and related evidence-based practices

• Coordinate mechanisms for evaluation of patient outcomes from mental health care services, and the use of outcome data for clinical decision support, quality improvement, program evaluation, and comparative effectiveness studies

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Strategic Goal 3: Community Partnership,

Education, and Communication

Strategic Action #18: Strengthen Community and Governmental Partnerships• Cultivate new and strengthen existing partnerships

with organizations involved in mental health care of Service members, Veterans, and their families

• Provide guidance for civilian health care providers on best practices in recognizing deployment-related psychological issues

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Strategic Goal 3: Community Partnership,

Education, and Communication

Strategic Action #19: Coordinated Mental Health Messaging• Joint effort to promote mental health and seeking

mental health care• Create consistent public mental health messaging

between Departments, from “enlistment to grave”• Develop strategic messaging that targets resiliency,

stigma reduction, and smooth DoD-VA care transition

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Strategic Goal 3: Community Partnership,

Education, and Communication

Strategic Actions #20 and #21: Self Help Strategies and Access to Web Technologies• Self-help resources readily available on

the Internet for Service members, Veterans and families with mental health and behavioral health problems

• Coordinated use of new technologies, including social media, to enhance access and engagement with established DoD and VA resources

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Strategic Goal 4: Promoting Resilience and Building

Better Care for Tomorrow

Strategic Action #16 and #24: Resilience Programming for Service Members, Veterans, and their Families• Identify existing model programs targeting family

resiliency already developed by the Services, community organizations, and VA

• Ensure that VA’s developing programs for promotion of psychological health and prevention of mental health problems are informed by lessons that DoD has learned through the Services’ resilience programs

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Strategic Goal 4: Promoting Resilience and Building Better Care

for Tomorrow

Strategic Action #15: Suicide Risk and Prevention• Coordinate training of VA and DoD staff to ensure

utilization of best suicide prevention practices across the two Departments

• Disseminate materials to Service members and Veterans on suicide prevention resources, programs and tools

• Make crisis intervention services available to all Service members, Veterans, and families through coordination of DoD and VA hotlines

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Strategic Goal 4: Promoting Resilience and Building Better Care

for Tomorrow

Strategic Action #22: Justice Outreach Programs

• Explore the potential benefits of a DoD service modeled on the Veterans Affairs mental health justice outreach program

• A Report on the applicability and adaptability of extending VA justice outreach programs to active duty Service members facing similar legal charges, including recommendations, has been completed and is currently being reviewed by Services

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Strategic Goal 4: Promoting Resilience and Building Better Care

for Tomorrow

Strategic Action #23: Chaplains’ Roles

• Develop collaborative partnerships between DoD and VA staff who are engaged in work at the intersection of mental health and chaplaincy

• Include input and expertise from DoD chaplains in defining the role of VA Chaplain Services and community clergy in mental health care at VA medical centers and clinics

• Joint Mental Health and Chaplaincy Forum held in Washington DC, September 2011

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IMHS Status Report - Sample

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Strategic Goal #1: Expanding access to behavioral health care in DoD and VA

SA is on track for successful, timely completion.

Unmet milestone(s) are unlikely to impact the successful, timely completion of the SA.

Unmet interim milestone(s) may potentially impact the successful, timely completion of the SA.

SA # Strategic Action Status

1 Joint Review of MH Screening Policies and Procedures

2 Integration of MH into Primary Care

3 Vet Center Expansion to OEF/OIF Active Duty

4 Mobile Vet Center Expansion to SMs and Veterans in Rural Areas

5 Sharing Mental Health Staff

6 Joint Telemental Health

7 Identifying Rural Area Providers

8 Mental Health Staffing

Conclusions

• Although both DoD and VA have comprehensive programs to address mental health issues, this plan is focused on issues that are common to the two Departments

• The IMHS reflects an unprecedented level of collaboration between VA and DoD on mental health issues and care