DoD/VA Integrated Mental Health Strategy

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

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 2007 - 2011 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

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)

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

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

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

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.

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

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.

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

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

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

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

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

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

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

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.

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

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

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

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

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.

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