1. DoD/VA Integrated Mental Health Strategy

2. 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

3. Recommendations and Mandates
Recomendations and Mandates
To improve the care and services offered to Service members and Veterans, over 400 recommendations and mandates were created by:
Recommendations and Mandates
SOC/JEC
SOC/JEC
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
After the release of the report, DoD established eight groups, called Lines of Action, and tasked out responsibility to them and other existing offices to work to implement the recommendations of this Task Force and several other task forces released around that 2007 timeframe. Most of these recommendations have joint DoD/VA implications. Line of Action 2, Psychological Health and Traumatic Brain Injury (referred to as "LoA2"), was established within the Office of Health Affairs and is co-chaired FHP&R. LoA2 tracks the implementation of these recommendations, along with subsequent actions arising from NDAAs in FY08 through FY11 and House and Senate Committee Reports (currently more than 200 actions). We are required to gather information on all these actions by USD(P&R) in the forum of the Overarching Integrated Product Team (OIPT) and report on the status of the implementation and completion of all the recommendations that they assigned to LoA2 (which is currently over 200 actions).
DoD/VA Mental Health Summit
IMHS

4. Reporting of Joint Health Initiatives
Joint health initiatives are reported to the SOC and the JEC
DoD/VA Secretaries
Senior Oversight Committee (SOC)
Joint Executive Council (JEC)
Overarching Integrated Product Team (OIPT)
Health Executive Council (HEC)
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)

5. Joint Executive Council (JEC)
Recommendations and Mandates
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

6. Wounded, Ill, and Injured Senior Oversight Committee (SOC)
Recommendations and Mandates
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
SOC established to address the care and services provided wounded, ill and injured Service members
After the release of the report, DoD established eight groups, called Lines of Action, and tasked out responsibility to them and other existing offices to work to implement the recommendations of this Task Force and several other task forces released around that 2007 timeframe. Most of these recommendations have joint DoD/VA implications. Line of Action 2, Psychological Health and Traumatic Brain Injury (referred to as "LoA2"), was established within the Office of Health Affairs and is co-chaired FHP&R. LoA2 tracks the implementation of these recommendations, along with subsequent actions arising from NDAAs in FY08 through FY11 and House and Senate Committee Reports (currently more than 200 actions). We are required to gather information on all these actions by USD(P&R) in the forum of the Overarching Integrated Product Team (OIPT) and report on the status of the implementation and completion of all the recommendations that they assigned to LoA2 (which is currently over 200 actions).
IMHS

7. IMHS Timeline Oct 2009: DoD and VA Joint Mental Health (MH) Summit
Recommendations and Mandates
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
Oct 2009: DoD and VA Joint Mental Health (MH) Summit to address MH care needs of Military personnel, Veterans, and their families
After the release of the report, DoD established eight groups, called Lines of Action, and tasked out responsibility to them and other existing offices to work to implement the recommendations of this Task Force and several other task forces released around that 2007 timeframe. Most of these recommendations have joint DoD/VA implications. Line of Action 2, Psychological Health and Traumatic Brain Injury (referred to as "LoA2"), was established within the Office of Health Affairs and is co-chaired FHP&R. LoA2 tracks the implementation of these recommendations, along with subsequent actions arising from NDAAs in FY08 through FY11 and House and Senate Committee Reports (currently more than 200 actions). We are required to gather information on all these actions by USD(P&R) in the forum of the Overarching Integrated Product Team (OIPT) and report on the status of the implementation and completion of all the recommendations that they assigned to LoA2 (which is currently over 200 actions).
Note that oversight of the IMHS was transferred from SOC to JEC/HEC
IMHS

8. 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.

9. Integrated Mental Health Strategy
Recommendations and Mandates
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
SOC/JEC
DoD/VA Mental Health Summit
IMHS

10. 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.

11. Strategic Goal 1: Expanding Access to Care
Strategic Actions #3 and #4: Expanding Access to Vet Centers
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

12. Strategic Goal 1: Expanding Access to Care
Strategic Action #6: Joint Telemental Health Services
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

13. 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

14. 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

15. 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

16. 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

17. 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

18. 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
In April 2011, the first in a suite of VA/DoD mobile apps was launched – the PTSD Coach.
This app can be downloaded free from iTunes and the Droid Marketplace
Launch was announced by Secretary Shinseki on whitehouse.gov and in a VA/DoD press release
This app already has been downloaded over 16,000 times in 43 countries
The app has received very positive feedback from Veterans, their family members, and staff.

19. 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

20. 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
Note that toll-free calling is now available (as of Oct 1) from 6 countries in Europe

21. 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
Note that toll-free calling is now available (as of Oct 1) from 6 countries in Europe

22. 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
Note that toll-free calling is now available (as of Oct 1) from 6 countries in Europe

23. IMHS Status Report - Sample
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.

24. 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
Success of the IMHS will depend on how well we engage and communicate with stakeholders at all levels