1. VA Mental Health Services: We’re Not Your Father’s VA Anymore! Steve Holliday, Ph.D, ABPP-CN Chief Mental Health Officer Substance Abuse Coordinator Veterans Administration, VISN 17

2. VISN 17 Covers 4 VA Health Care Systems along IH-35 from Brownsville to Dallas – North Texas HCS (Dallas & Ft. Worth) – Central Texas HCS (Waco/Temple/Austin) – South Texas HCS (San Antonio & Kerrville) – Valley/Costal Bend HCS (Harlingen, Laredo, & CC) VISN 16 – Houston & East Texas VISN 17 – El Paso & West Texas

4. VISN 17

5. Justice-Involved Veterans Conference Yesterday VA Prison Re-Entry Program – State/Federal Prisons – Enrolling Eligible Veterans – Appointments for Care After Release – Case Management until connected Veterans Justice Outreach Program – County/Local Jails Re-Entry Outreach – Liaison with local Veterans Courts – Educate local Law Enforcement/Others

6. Eligibility Issues Not Eligible for VA Care while Incarcerated – Except for brief outreach visits OEF/OIF Vets have full eligibility for 5 years Must have Honorable or General D/C – Bad D/Cs can be upgraded Served >180 days or Service-connected Co-Pays at Higher Incomes Unless SC

7. MH Levels of Care Outpatient Mental Health Clinics Acute Inpatient MH Services Residential Rehabilitation Programs – Domiciliary (Doms) – Homeless, PTSD, SUD RRTPs Community-based MH Specialty Care – PTSD/MST – MHICM Teams – Homeless Programs – Vocational Programs – Telehealth & Home Health

8. Bonham Dom Room

9. New Initiatives Mental Health Uniform Services Mandate Mental Health in Primary Care Psychosocial Recovery & Rehabilitation Telemental Health Services Evidence-Based MH Therapies Suicide Prevention Ending Homelessness Electronic Medical Record Performance Measures to Improve Quality

10. Outpatient MH Clinics Routine Outpatient MH Care MH Case Management Psychotropic Medications Evidence-based Psychotherapies for – Depression – Mild PTSD/Anxiety Disorders – Psychosis – Marital/Couples’ Counseling

11. Substance Abuse Treatment Building Motivation/Education in PCC & MHCs Outpatient SUD Program Intensive Outpatient SUD Program SARRTP (28 Day Residential) SUD Tracks in Doms (90-Day Residential) Buproprion/Methadone Programs Inpatient/Outpatient DETOX

13. Homeless Programs Ending Homelessness in 5 years! Health Care for Homeless Veterans Contact Emergency Shelters Homeless Domiciliaries Grant and Per Diem Transitional Housing HUD/VASH Vouchers (10,000 more coming) Emergency Cash Assistance to prevent Homelessness

14. Vocational Rehabilitation VBA Educational Benefits (30%+ SC) Incentive Therapy (IT) Compensated Work Therapy (CWT) Supported Community Employment Job Search Assistance Assistance with VA/SSDI Claims (VSOs) Volunteer Positions

15. MH Uniform Services Plan Based on President’s MH Commission Supports Recovery Model Emphasis on MH/PCC and Suicide Prevention Mandates Core MH Services at Each Site Standardized MH Care Throughout USA Significantly Enhanced MH Staff/Capacity Mandates Evidence-Based MH Services Tracks MH Outcomes and Staffing

16. MH in Primary Care Co-located Mental Health in Primary Care – Reduces Stigma for Seeking MH Care – Rapid Access for MH Screening/Services – Treatment for Mild MH issues Adjustment Issues/Life Stress Uncomplicated Depression & Anxiety D/Os Harm Reduction/ME for SUDs – Referral to MHC/Specialized Tx Programs Up to 80% of Cases Managed in PCC Healthy Behaviors/Disease Mgmt

18. Rehabilitation/Recovery Model Recovery is possible for everyone (even SMI) It’s the Vet’s Recovery Plan; Not the Doc’s – Uses Understandable Language – Based on Vet’s Strengths, Goals – Peer Counselors/Technicians as Role Models Include Consumers in MH Planning/Mgmt Meaningful Work is the Best Therapy Building Support Systems in the Community Educating to Reduce Stigma/Facility Recovery Coordinators

19. Tele Health Services Telemental Health Services – EBTs from the Hospitals to Remote Clinics – Cross coverage for Smaller MHCs – “Health Buddies” to Monitor SMI at Home – Home-based Videophones for Highly Rural – Reduces Barriers of Distance & Stigma Future Directions – Anonymous Chat Rooms (Suicide Hot Line) – Peer Support Networks – Secure Email with MH Providers

20. Health Buddy

21. Distance Consultation

22. Suicide Prevention National Suicide Hotline 1-800-273-TALK (8255) – Staffed by Trained MH Providers 24/7 – Over 3000 Rescues in Past Year – Arrange for Immediate Help – Live Hand Off to Local VA Facilities for F/U Facility Suicide Prevention Coordinators – Suicide Risk Assessments – Maintains List of High Risk Patients/Chart Flags – Develops/Implements Suicide Safety Plans – Investigates Attempts/Completed Suicides – Educates Staff and Community

24. Evidence-Based Therapy Evidence-Based Psychotherapy – PE/CPT/ACT for PTSD – CBT for Depression – SUD – ME, 12-SFT, New Medications – Couples/Marital Therapy – SST and MHICM for SMI National Training Program in EBTs – One-week intensive workshop (national experts) – 6-12 Months of weekly case supervision – Train the Trainer Model for future staff Monitor Use for fidelity to EBTs (CPRS)

26. Electronic Medical Record Follows Veterans Across Sites/Locations of Care Digital X-Rays, Consults, Meds, Lab, etc. Flags High-Risk Conditions Clinical Reminders for Better Care MH Screening and Requires F/U Smoking Cessation Obesity Diabetes Hypertension Tracks Quality of Care through Performance Ms Integration with DoD Medical Records Planned

28. Ending Homelessness! Secretaries 5-Year Plan – $3.2 Billion From 160K to ZERO Homeless Vets! Enhanced Existing Homeless Services – 10,000 New HUD-VASH Vouchers this Year – Enhanced VA SUD and MH Capacity – Enhanced RRTP/Doms & Contract Beds – Enhanced Jail/Prison Diversion & Outreach New Initiatives/Services – Homeless Hot Line – Emergency Funding to Prevent Homelessness

30. OEF/OIF Resources www.texvet.com – On Line Searchable Database – Texas MH, Job, Education, Emergency Services – Eligibility Tool Under Development 211 Texas – Just Dial 211 – 24/7 Information Line – Services for Vets/Active Duty Vet Centers – Storefront locations, walk-in service – Veteran and Family Counseling – GWAT Outreach Staff

31. The Best Care Anywhere By Phillip LongmanPhillip Longman Ten years ago, veterans hospitals were dangerous, dirty, and scandal-ridden. Today, they're producing the highest quality care in the country. Their turnaround points the way toward solving America's health-care crisis. Washington Monthly, 2006

32. The Best Medical Care in the U.S. The VA uses the data gathered in its computers to pinpoint problem areas, such as medication errors. The network also allows it to track how closely the medical staff is following evidence-based treatment and monitor deficiencies. Such tracking pays off. When Rand did an extensive study comparing quality of care at the VA with private-sector hospitals, it found that performance measurement played an important role in helping the VA score higher in every category except acute care, where it came in about even. Business Week, 2006

33. VA medical system earns high customer satisfaction ratings Good news about government is rare enough. What's outright shocking is when that good news is about how nice government employees are. But that is the bottom line of the recently released American Customer Satisfaction Index report on the Department of Veterans Affairs' medical system. Not only do veterans rate their VA care much higher overall than the general population rates its hospital experiences, vets also consistently give VA doctors and nurses high scores for "responsiveness" (83 out of a possible 100), courtesy (90), and "respect and dignity afforded patients" (91). National JournalNational Journal February 10, 2006

35. VA: From Worst to First! Moving from Hospitals to the Community CPRS & Performance Measures – Improved Access to Care – Improved Quality of Care & Outcomes – Improved Cost Effectiveness – Improved Patient Satisfaction Holding VA Staff Accountable – Managers’ Performance Plans – Providers Performance Plans/Incentive Pay

36. Next Steps… Contact your VISN MH Lead – VISN 16: kathy.henderson@va.govkathy.henderson@va.gov – VISN 17: steve.holliday@va.govsteve.holliday@va.gov – VISN 18: lori.highberger@va.govlori.highberger@va.gov Meet your local VJO and Re-Entry Specialist Work with you local MHMR Jail Diversion Committee! Work to Establish Veterans’ Courts Ask you clients if they are vets and give us a chance to help!

37. Any Questions?