1. VETERAN access to MENTAL HEALTH SERVICES
Department of Mental Health
G.V. (Sonny) Montgomery, V. A. Medical Center
September 2016

2. Objectives
Increase Veterans connection and strengthen information systems, which form the backbone of the VA, Community and Veteran connections.
Identify the stakeholders in our extended community and begin to integrate treatment and services for our Veterans and their families.
Promote follow-up and continued collaboration through mental health service providers and the stakeholders.
Bring the voice of the Veteran and their families to the summit.

3. Voice of the Veteran
“My wife kept trying to get me to get help. I kept saying that I was fine. I am a stubborn jackass. It took her saying that she was going to leave from me to get help” – Veteran, California
VA Center of Innovation, 2016

4. Voice of the Veteran
“When my [buddy] mentioned to me that I should think about talking to somebody, it turned a key: if somebody else is externally identifying that I might be struggling, it’s probably a good idea for me to do that .” — Veteran, Florida
VA Center of Innovation, 2016

5. Voice of the Veteran “ If I’m 15 minutes late , my appointment
is canceled. If you’re
two hours late ,
I still have to wait. ”
VA Center of Innovation, 2016

6. Voice of the Veteran “ I KEPT HAVING TO TELL MY STORY OVER AND
OVER AND OVER AGAIN. ”
VA Center of Innovation, 2016

7. Voice of the Veteran “
What they don’t understand is that people work. You want me to take off work to see a therapist? ”
VA Center of Innovation, 2016

8. Voice of the Veteran “ I felt I was inconveniencing a lot of people. ”
VA Center of Innovation, 2016

9. Department of Veterans Affairs Mission Statement
To fulfill President Lincoln's promise "To care for him who shall have borne the battle, and for his widow, and his orphan" by serving and honoring the men and women who are America's veterans.

10. VHA Core Values
Integrity: Act with high moral principle. Adhere to the highest professional standards. Maintain the trust and confidence of all with whom I engage.
Commitment: Work diligently to serve Veterans and other beneficiaries. Be driven by an earnest belief in VA’s mission. Fulfill my individual responsibilities and organizational responsibilities.
Advocacy: Be truly Veteran-centric by identifying, fully considering, and appropriately advancing the interests of Veterans and other beneficiaries.
Respect: Treat all those I serve and with whom I work with dignity and respect. Show respect to earn it.
Excellence: Strive for the highest quality and continuous improvement. Be thoughtful and decisive in leadership, accountable for my actions, willing to admit mistakes, and rigorous in correcting them

11. MyVA Transformation Objectives Improving the Veteran Experience
Improving the Employee Experience
Improving Internal Support Services
Establishing a Culture of Continuous Improvement
Enhancing Strategic Partnerships 2

12. Make the Connection
In November 2011, VA launched an award-winning, national public awareness campaign called Make the Connection, which is aimed at reducing the negative perceptions associated with seeking mental health care and informing Veterans, their families, friends, and members of their communities about VA resources (

13. Under Secretary for Health’s Top 5 Priorities
Veterans First: Trust in VA Care
Improved Access
Increased Employee Engagement
Building a High-Performing Network
Consistency of Best Practice

15. Under Secretary for Health’s Top 5 Priorities
Veterans First: Trust in VA Care
Improved Access
Increased Employee Engagement
Building a High-Performing Network
Consistency of Best Practice

16. Veterans Choice Program

17. Veterans Choice Program Overview
The Department of Veterans Affairs strives to ensure quality, timely care for all Veterans.
In an effort to increase Veterans’ access to health care, VA implemented the Veterans Choice Program (VCP) – a program that allows eligible Veterans to use approved health care providers outside of the VA network.
The Veterans Choice Program was implemented as part of the Veterans Access, Choice, and Accountability Act of 2014 (VACAA).

18. Veterans Choice Cards
VA mailed all Veterans a Veterans Choice Card. The Choice Card allows you to choose to receive care outside of VA if you qualify for the new program.
The Choice Card does not replace the identification card you already use to access other VA benefits.
If you are satisfied and wish to continue with your current VA care, there is nothing you need to do at this time. You should save your Choice Card in case you would like to use the program in the future.
Don’t worry if you did not receive or have misplaced your Choice Card. Call to find out if you are eligible for the program and to make an appointment.

19. Veterans Choice Program
The Department of Veterans Affairs strives to ensure quality, timely care for all Veterans.
In an effort to increase Veterans’ access to health care, VA implemented the Veterans Choice Program (VCP) – a program that allows eligible Veterans to use approved health care providers outside of the VA network.
The Veterans Choice Program was implemented as part of the Veterans Access, Choice, and Accountability Act of 2014 (VACAA).

20. supports personalized, proactive, patient‐centered care including:
VHA is committed to providing a uniform package of mental health services
that is Veteran‐centered, recovery‐oriented and evidence‐based and that
supports personalized, proactive, patient‐centered care including:

21. Break Out Topics Choice and My VA Access:
Same-Day Mental Health Access
 Specialty Clinic/Services Access
 Community Access/Services
Community Partners / Support after Discharge
 Wrap Up – Pulling Together the Partnership

22. Uniform Mental Health Services
 Integration into Primary Care  Inpatient Care  Residential Care  Specialty Outpatient Care  24 hours, 7 days a week Care  Gender‐sensitive Care  Care Transitions  Evidence‐based psychotherapies
 Suicide Prevention Coordinators  Telemental Health  Evidence‐based Treatments  Rehabilitation and Recovery Services  Therapeutic and Supported Employment Services  Disaster Preparedness  Collaboration with Homeless Programs and Services for Justice Involved Veterans

23. Mental Health Services in VA:
Outpatient Sub-Specialty Care Services
PTSD care teams: Substance Use Disorder (SUD) specialist on, or accessible to, every team.
Mental Health Intensive Care Management (MHICM): Interdisciplinary teams who provide community‐based mental health care for Veterans with serious mental illness who have intensive needs, including those with co‐occurring SUD.
RANGE/ E‐RANGE teams extend MHICM services to rural areas.

24. Mental Health Services in VA: Outpatient Sub-Specialty Care Services
Psychosocial Rehabilitation and Recovery Centers are outpatient transitional learning centers with curriculum‐based programming designed to support recovery and integration into meaningful self‐determined community roles for Veterans with serious mental illness and severe functional impairment.
• SUD care: Mental Health professionals and peer supports
– Ambulatory withdrawal management (Detox)
– Outpatient clinics for SUD
– Intensive Outpatient services for SUD
– Evidence‐based pharmacotherapy (medication assisted treatment)

25. The number of Veterans receiving specialized mental health treatment from VA has risen each year, from over 900,000 in fiscal year (FY) 2006 to more than 1.6 million in FY 2015.

26. Women Veterans

27. Redesigning Primary Care Delivery for Women Veterans
Increase focus on quality of care issues and comprehensive longitudinal care for women veterans
Gender specific care is primary care.
Defining Comprehensive Primary Care for Women Veterans:
Availability of complete primary care from one primary care provider at one site.
The primary care provider should, in the context of a longitudinal relationship, fulfill all primary care needs, including acute and chronic illness, gender-specific, preventive, and mental health care.

28. Homeless Veterans

29. Who are Homeless Veterans?
23% of the homeless population are Veterans
13% of all sheltered homeless adults are Veterans
47% of homeless Veterans served during the Vietnam Era
33% were stationed in a war zone
89% received an honorable discharge
Reference:
How many homeless Veterans are there?
In a March 6, 2008 news release the Department of Veterans Affairs (VA) announced that the number of Veterans homeless on a typical night has declined 21 percent in the past year, thanks to the services offered by VA and its partners in community- and faith-based organizations, plus changing demographics and improvements in survey techniques. The reduction of homeless Veterans from more than 195,000 to about 154,000. VA provides health care to about 100,000 homeless Veterans, and compensation and pensions to nearly 40,000 annually. The Department offers homeless Veterans employment assistance and help obtaining foreclosed homes and excess federal property, including clothes, footwear, blankets and other items. The Department has already approved funding for more than 12,000 beds in transitional housing programs, and provides about 5,000 Veterans each year with residential services in VA hospital-based programs. Other factors in the decline of homeless Veterans include the substantial reduction in the number of poor Veterans -- from 3 million in 1990 to 1.8 million in and improvements in counting homeless people.
Reference:
Who are homeless Veterans?
The U. S. Department of Veterans Affairs (VA) says the nation's homeless Veterans are mostly males (4 % are females). The vast majority are single, most come from poor, disadvantaged communities, 45% suffer from mental illness, and half have substance abuse problems. America’s homeless Veterans have served in World War II, Korean War, Cold War, Vietnam War, Grenada, Panama, Lebanon, Operation Enduring Freedom (Afghanistan), Operation Iraqi Freedom, or the military’s anti-drug cultivation efforts in South America. Forty-seven percent of homeless Veterans served during the Vietnam Era. More than 67% served our country for at least three years and 33% were stationed in a war zone.
Reference: National Coalition for Homeless Veterans

30. Who are Homeless Veterans?
45% suffer from mental illness
70% suffer from substance abuse problems
58% have health/physical problems
46% are age 45 or older compared to 20% of non-Veteran homeless citizens
Reference:

31. VA Homeless Programs
Every VA medical center has a homeless Veteran services coordinator who is responsible for providing outreach and services for homeless or at-risk Veterans
National Call Center for Homeless Veterans
AID-VET ( )
Homeless Veterans Chat links to Veterans Suicide Prevention Hotline
Reference:
Homeless Veteran Program Coordinators: Go to and click on “Find a Homeless Coordinator” to download a list VA Homeless Veteran Coordinator Offices by state. The Homeless Coordinator at each program can give you information about the services for Homeless Veterans provided through the Veterans Health Administration. Services include outreach, case management, referrals to benefits counselors, linkage to health care, and housing assistance. Each facility is unique and services vary among each medical center.
Reference:

32. VA Homeless Programs Prevention Services Housing and Support Services
Treatment
Employment/Job Training
Benefits/Other Services
Other Resources
Prevention Services
Includes the National Call Center for Homeless Veterans, the Veteran Justice Outreach Program, and the Supportive Services for Veteran Families Program.
Housing Support Services
Includes information and resources to provide permanent or temporary housing and ongoing case management and treatment services for homeless Veterans.
Treatment
Includes healthcare for homeless Veterans, healthcare and other services for Veterans exiting prison, information on Veteran Stand Downs, Drop-In Centers, and VA’s Homeless Veteran Dental Assistance Program.
Employment/Job Training
Includes information on VA’s Compensated Work Therapy program where homeless Veterans earn pay while learning new job skills, relearning successful work habits, and regaining a sense of self-esteem and self-worth.
Benefits/Other Services
Includes information about homeless Veteran Benefit Assistance and other programs, which provide necessary services to homeless Veterans.
Other Resources
Includes the National Center on Homelessness Among Veterans, Project CHALENG, and other Non-VA resources for homeless assistance.

33. Prevention Services National Call Center for Homeless Veterans
Healthcare for Reentry
Veteran Justice Outreach
Supportive Services for Veteran Families Program
National Call Center for Homeless Veterans
VA has founded a National Call Center for Homeless Veterans to ensure that homeless Veterans or Veterans at-risk for homelessness have free, 24/7 access to trained counselors. The hotline is intended to assist homeless Veterans and their families, VA Medical Centers, federal, state and local partners, community agencies, service providers and others in the community. To be connected with trained VA staff member call AID VET ( ). National Call Center Webpage
Healthcare for Reentry
The Health Care for Re-entry Veterans (HCRV) Program is designed to address the community re-entry needs of incarcerated Veterans.  HCRV's goals are to prevent homelessness, reduce the impact of medical, psychiatric, and substance abuse problems upon community re-adjustment, and decrease the likelihood of re-incarceration for those leaving prison.  HCRV Webpage
Veteran Justice Outreach
The purpose of the Veteran Justice Outreach (VJO) initiative is to avoid the unnecessary criminalization of mental illness and extended incarceration among Veterans by ensuring that eligible justice-involved Veterans have timely access to VHA mental health and substance abuse services when clinically indicated, and other VA services and benefits as appropriate.Veteran Justice Outreach Webpage
Supportive Services for Veteran Families Program
The Supportive Services for Veteran Families (SSVF) Program is a new VA program that will provide supportive services to very low-income Veterans and their families who are in or transitioning to permanent housing.  VA will award grants to private non-profit organizations and consumer cooperatives who will assist very low-income Veterans and their families by providing a range of supportive services designed to promote housing stability. For more information, please see the SSVF Program Factsheetand the Proposed Rule. VA anticipates releasing a Notice of Fund Availability (NOFA) sometime in  As additional details about the NOFA and application process become available, they will be posted to this website. Supportive Services for Veteran Families Program Webpage
Reference:

34. Housing and Support Services
HUD – VA Supported Housing Program (VASH)
Grant & Per Diem
Supported Housing
Department of Housing & Urban Development/VA Supportive Housing
The Department of Housing and Urban Development and VA Supported Housing (HUD-VASH) Program provides permanent housing and ongoing case management treatment services for homeless Veterans who require these supports to live independently. HUD has allocated over 20,000 “Housing Choice” Section 8 vouchers to Public Housing Authorities (PHAs) throughout the country for eligible homeless Veterans. This program allows Veterans and their families to live in Veteran-selected apartment units. The vouchers are portable, allowing Veterans to live in communities where VA case management services can be provided. This program provides for our most vulnerable Veterans, and is especially helpful to Veterans with families, women Veterans, recently returning Veterans and Veterans with disabilities. Evaluation of an earlier, similar program demonstrated that most Veteran participants remained permanently housed.  HUD-VASH Website
Grant & Per Diem
The Grant and Per Diem (GPD) Program is offered annually (as funding permits) by the VA to fund community-based agencies providing transitional housing or service centers for homeless Veterans. Under the Capital Grant Component VA may fund up to 65% of the project for the construction, acquisition, or renovation of facilities or to purchase van(s) to provide outreach and services to homeless Veterans. Per Diem is available to grantees to help off-set operational expenses.   Non-Grant programs may apply for Per Diem under a separate announcement, when published in the Federal Register, announcing the funding for “Per Diem Only.”  Grant/Per Diem Website
Supported Housing
Like the HUD-VASH program identified above, staff in VA's Supported Housing Program provides ongoing case management services to homeless Veterans. Emphasis is placed on helping Veterans find permanent housing and providing clinical support needed to keep Veterans in permanent housing. Staff in these programs operate without benefit of the specially dedicated Section 8 housing vouchers available in the HUD-VASH program but are often successful in locating transitional or permanent housing through local means, especially by collaborating with Veterans Service Organizations.

35. Stand Downs Stand Downs for Homeless Veterans
Events to provide outreach to homeless Veterans
Coordinated among local VA Medical Centers, other government agencies and community agencies serving the homeless
For locations of Stand Downs
Homeless Veterans Programs Office:
Stand Downs are one part of the Department of Veterans Affairs efforts to provide services to homeless Veterans. Stand Downs are typically one to three day events providing services to homeless Veterans such as food, shelter, clothing, health screenings, VA and Social Security benefits counseling and referrals to a variety of other necessary services, such as housing, employment and substance abuse treatment.
What is a Stand Down? In times of war, exhausted combat units requiring time to rest and recover were removed from the battlefields to a place of relative security and safety. At secure base camp areas, troops were able to take care of personal hygiene, get clean uniforms, enjoy warm meals, receive medical and dental care, mail and receive letters, and enjoy the camaraderie of friends in a safe environment.
Today, Stand Down refers to a grassroots, community-based intervention program designed to help the nation’s estimated 200,000 homeless Veterans “combat” life on the streets. Homeless Veterans are brought together in a single location for one to three days and are provided access to the community resources needed to begin addressing their individual problems and rebuilding their lives. In the military, Stand Down afforded battle-weary soldiers the opportunity to renew their spirit, health and overall sense of well-being. Today’s Stand Down affords the same opportunity to homeless Veterans.
The first Stand Down was held in San Diego during the summer of The popularity of the event has steadily grown from the original in 1988 to nearly 100 throughout the nation each year. It is estimated that more than 100,000 homeless Veterans have received assistance at Stand Downs.
References: and www1.va.gov/homeless/page.cfm?pg=6

36. Employment/Job Training
Compensated Work Therapy/Transitional Residence (CWT/TR) Program
For disadvantaged, at-risk, and homeless Veterans
Community-based supervised group homes
VA contracts with private industry and public sector
Compensated Work Therapy
In VA's Compensated Work Therapy/Transitional Residence (CWT/TR) Program, disadvantaged, at-risk, and homeless Veterans live in CWT/TR community-based supervised group homes while working for pay in VA's Compensated Work Therapy Program (also known as Veterans Industries). Veterans in the CWT/TR program work about 33 hours per week, with approximate earnings of $732 per month, and pay an average of $186 per month toward maintenance and up-keep of the residence. The average length of stay is about 174 days. VA contracts with private industry and the public sector for work done by these Veterans, who learn new job skills, relearn successful work habits, and regain a sense of self-esteem and self-worth.  CWT Website

37. Building Relationships

39. Our reason for being . . .
To honor America’s heroes!