1. Evolving Policy: Focus on Access Ira.Katz2@va.gov

2. Mental Health in VA It’s about caring for Veterans It’s also about politics

3. Access as a Focus Important –In population-based care –In an integrated health system Complementary –To quality of care –To continuity and chronic disease models Related –To capacity –To allocation of care resources Access is readily understandable

4. Veterans requesting or referred for Mental Health Services will be evaluated within 24 hours.

5. Operationalizing: What kind of evaluation? Triage –To determine whether emergent or urgent care is needed? Danger to self Danger to others Medical need? –To determine the appropriate setting for further evaluation and care? Emergency department Inpatient General mental health Specialty services SUD services –To facilitate arrangements for further care? Address questions and concerns Arranging follow-up within two weeks

6. Operationalizing: How should it be conducted? By a professional –Mental health –Primary care provider? In person or, when necessary, by telephone May be fee-based

7. Operationalizing: When will this be implemented? Within a few weeks Staging –Implementation for all veterans or –Initial implementation for returning veterans

8. Operationalizing: What are possible “unanticipated consequences”?

9. Improving access at the expense of quality and continuity Consequences related to missing targets Increasing stigma

10. Operationalizing: What else is being planned? Follow-up on missed appointments Fee basing (components of) care Clerical and program support NRM funding to improve access and safety Suicide prevention hotline Expansion of Vet Centers Coordination with VBA Certification of C&P examiners