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About VA Mental Health
Guiding Principles
Finding Care
Treatment Settings & Services
Special Programs
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Guiding Principles
The Guide to VA Mental Health Services for Veterans and Families (also available in Spanish : Guia de Servicios de Salud Mental que el Departamento de Asuntos de Veteranos Ofrece a los Veteranos y sus Familias) is intended for Veterans, Veteran family members, members of Veterans Services Organizations, or members of other groups interested in VA mental health care. You can use this handbook to learn what mental health services your local or regional VA health care facility has pledged to provide to Veterans.
The following information has been pulled from the guide, and is intended to serve as a brief overview. Please see the Guide for more detailed information.
- Focus on Recovery - Recovery empowers the Veteran to take charge of his/her treatment and live a full and meaningful life. This approach focuses on the individual’s strengths and gives respect, honor, and hope to our nation’s heroes and their families.
- Coordinated Care for the Whole Person - VA health care providers coordinate with each other to provide safe and effective treatment for the whole person—head to toe. Having a healthy body, satisfying work, and supportive family and friends, along with getting appropriate nutrition and exercising regularly, are just as important to mental health as to physical health.
- Mental Health Treatment in Primary Care - Primary Care clinics use Patient Aligned Care Teams (PACTs) to provide the Veteran’s healthcare. A PACT is a medical team that includes mental health experts.
- Mental Health Treatment Coordinator - Veterans who receive specialty mental health care have a Mental Health Treatment Coordinator (MHTC). The MHTC’s job is to understand the overall mental health goals of the Veteran.
- Around-the-Clock Service - Emergency mental health care is available 24 hours per day, 7 days per week at VA medical centers. If your VA does not have a 24-hour emergency room, it must provide these services through a local, non-VA hospital. Telephone evaluations at VA medical centers and the national crisis hotline are also available 24/7.
- Care that is Sensitive to Gender & Cultural Issues - VA health care providers receive training about military culture, gender differences, and ethnic issues in order to better understand each Veteran.
- Care Close to Home - VA is moving closer to where Veterans live by adding more rural and mobile clinics and working with other health care providers in the community.
- Evidence-Based Treatment - Evidence-based treatments are treatments that research has proven are effective for particular problems. Mental health providers receive training on a wide variety of proven treatments. Mental health providers must offer evidence-based treatments to Veterans.
- Family & Couple Services - Sometimes, as part of a Veteran’s treatment, some members of the Veteran’s immediate family or the Veteran’s legal guardian may be included and receive services, such as family therapy, marriage counseling, grief counseling, etc.
Finding Care
- If you have a mental health emergency (like wanting to hurt yourself or someone else), go to the nearest hospital emergency room or call 911. If it is not a VA hospital, you may be able to move to a VA facility depending on your circumstances. If you are feeling suicidal, you can also call, text, or chat online with the Veterans Crisis Line. The Veterans Crisis Line connects Veterans in crisis and their families and friends with qualified, caring Department of Veterans Affairs responders through a confidential toll-free hotline, online chat, or text. To speak with a responder by phone, call 1-800-273-8255 and Press 1. To chat online go to www.veteranscrisisline.net. To text with a responder, send a text message to 838255. These confidential support options are available 24 hours a day, 7 days a week, 365 days a year.
- If you have a mental health problem and have never been seen in a VA hospital or clinic, you can:
- Call VA general information hotline at 1-800-827-1000 or visit VA’s website at www.va.gov. You will be able to find the address and phone number of a VA hospital or clinic near you.
- Begin the process of finding mental health care through a VA Readjustment Counseling Service Veterans Center (Vet Center).
- Veterans who are homeless can get help finding mental health care at a Veterans drop-in center, or by contacting the National Call Center for Homeless Veterans at 1-877-424-3838, or by visiting the VA’s Homeless Veterans Website at www.va.gov/homeless.
- If you are already using VA medical services, ask your primary care provider to arrange for you to see a VA mental health provider.
Please see the Guide for information on How You Know If You Have A Mental Health Problem (page 9) and What Will Happen When You Request Mental Health Services (page 10).
Treatment Settings & Services
VA offers a range of treatments and services to improve the mental health of Veterans.
VA offers treatments in a variety of settings, including:
- Short-term, inpatient care;
- Outpatient care in a psychosocial rehabilitation and recovery centers (PRRC);
- Regular outpatient care, which may include telemedicine services;
- Residential Rehabilitation Treatment Programs (RRTP);
- Primary care;
- Residential care;
- Supported work settings.
Examples of common mental health treatments for Veterans include:
Treatments for Depression and Anxiety
- Antidepressant medications, anti-anxiety medications, and medications to improve sleep and other problems
- Talk therapies (also called psychotherapies), such as:
- Cognitive behavioral therapy (CBT) to help individuals understand the relationship between thoughts, emotions, and behaviors, learn new patterns of thinking, and practice new positive behaviors (relaxation techniques, using calming tapes to improve sleep, exercising, or socializing with friends)
- Acceptance and commitment therapy (ACT) to help people overcome their struggles with emotional pain and worries. It helps them recognize, commit to, and achieve what’s important to them
- Interpersonal therapy (IPT) to help people promote positive relationships and resolve relationship problems.
Treatments for Substance Use Disorders (SUD)
- Medications to decrease cravings for alcohol and medications to ease withdrawal (“detox”) from alcohol and drugs. Medications like buprenorphine and methadone can also be used as therapeutic substitutes for illegal drugs (heroin) or addictive prescription pain medications.
- Talk therapies (also called psychotherapies), such as:
- Motivational enhancement therapy to help the individual strengthen his/ her commitment to recovery
- Cognitive behavioral therapy to help the individual identify the risks for relapse and learn new coping skills to avoid relapse.
- Opioid Treatment Programs (OTPs) help Veterans who misuse Opioids. Opioids include illegal substances, such as heroin, and legally prescribed medications such as some prescription pain medications.
- Residential treatment programs for substance use disorders allow Veterans to receive intensive treatment in a supervised residential setting.
- Work therapies.
Treatments for Posttraumatic Stress Disorder (PTSD)
- Antidepressant medications, anti-anxiety medications, mood stabilizing medications, and other medications to ease nightmares, irritability, sleeplessness, depression, and anxiety
- Talk therapies (also called psychotherapies):
- Cognitive behavioral therapy (CBT) to help individuals understand the relationship between thoughts, emotions, and behaviors, learn new patterns of thinking, and practice new positive behaviors
- Cognitive processing therapy (CPT), a form of CBT that involves correcting negative thought patterns so that memories of trauma don’t interfere with daily life. It may also include writing about one’s traumatic experience. Clinical guidelines strongly recommend CPT for PTSD treatment.
- Prolonged Exposure Therapy (PE) to help people reduce fear and anxiety triggered by reminders of the trauma. This is done by confronting (or being exposed to) trauma reminders in a safe treatment environment until they are less troubling. In this way, individuals can stop avoiding and reacting to trauma reminders and live their lives more fully in the present with greater freedom from the past. Clinical guidelines strongly recommend PE for PTSD treatment.
- Residential Rehabilitation Treatment Programs provide intensive, specialized treatment for posttraumatic stress disorder within a structured, 24/7 care setting.
Treatments for Serious Mental Illnesses (Schizophrenia, Schizoaffective Disorder & Bipolar Disorder)
- Antidepressant medications, mood stabilizing medications, antipsychotic medications and other medications to stabilize mood, organize thoughts, reduce hallucinations, and ease related symptoms. If a Veteran with severe schizophrenia or schizoaffective disorder does not improve after trying two antipsychotic medications (and giving them enough time to work), the antipsychotic medication clozapine should be considered. Clozapine is a very effective medication.
- Psychosocial Rehabilitation and Recovery Services to optimize functioning.
- Work therapies to promote and support recovery.
- Social skills training.
- Residential Rehabilitation Treatment Programs allow for intensive treatment for Veterans with severe mental illness within a structured, supervised setting.
- Mental Health Intensive Case Management (MHICM). A team of mental health physicians, nurses, psychologists, and social workers that treat Veterans in their homes and community. MHICM helps Veterans experiencing symptoms of severe mental illness cope with symptoms and live more successfully at home and in the community.
Special Programs
VA recognizes that some groups of Veterans have special mental health needs. In response to these needs, VA has developed special programs tailored for these groups. VA special programs include:
Services for Women Veterans
- VA offers a full range of mental health services for women Veterans, including outpatient, residential and inpatient services. Available outpatient services include assessment and evaluation, medication management, and individual and group psychotherapy. Specialty services are available to target problems such as PTSD, substance abuse, depression, conditions related to military sexual trauma (MST), and homelessness. In addition to the mixed gender residential and inpatient resources, VA has regional or national resources that provide treatment to women only or that have separate tracks for women. All VAs maintain treatment environments that can accommodate and support women with safety, privacy, dignity and respect.
VA has almost a dozen residential or inpatient programs that provide treatment to women only or that have separate tracks for men and women. Mixed gender inpatient units or residential treatment centers must ensure safe and secure sleeping and bathroom arrangements, including, but not limited to, door locks and proximity to staff. Each regional VA network (called a VISN) must have residential care programs able to meet the needs of women Veterans. However, the needs for some types of sub-specialty care (for example, women with PTSD) may be limited, and women Veterans who need these services may be referred to regional or national resources.
Family Services
- VA offers family services for Veterans and their family members. These include family education, brief problem-focused consultation, family psychoeducation, and marriage and family counseling. Family education provides families with the information they need to partner with the treatment team and support the Veterans’ recovery. For brief family consultation the family meets with a mental health provider as needed to resolve specific issues related to the Veteran’s treatment and recovery. Family psychoeducation is a part of recovery services for Veterans with serious mental illness. It focuses mainly on supporting the Veteran’s well-being and functioning. The overarching goal of marriage and family counseling is to reduce relational distress and strengthen couple and family relationships.
- Coaching Into Care Resources: VA works with Veterans’ family members and friends who notice Veterans having difficulties. VA supports their efforts to help the Veteran. Coaching Into Care is a free and confidential telephone coaching service. It helps callers discover new ways to talk with a Veteran about their concerns and about treatment options. Callers can reach the service at (888) 823-7458. More information can be found at www.mirecc.va.gov/coaching.
Readjustment Counseling Services (Vet Centers)
- VA operates 300 community-based counseling Vet Centers. Many providers at Vet Centers are Veterans of combat themselves. Vet Centers provide readjustment counseling and outreach services to all Veterans who served in any combat zone. Military sexual trauma counseling and bereavement counseling are also provided. Services are available for family members for military related issues, and bereavement counseling is offered for parents, spouses, and children of Armed Forces, National Guard, and Reserves personnel who died in the service of their country. Veterans have earned these benefits through their service, and all are provided at no cost to the Veteran or family.
Military Sexual Trauma Services
- Both women and men can experience military sexual trauma (MST), and for some, the experiences can affect their health even many years later. Because MST is an experience, not a diagnosis, Veterans who experienced MST can benefit from the range of treatment options VA has available to treat conditions commonly associated with MST, including posttraumatic stress disorder (PTSD), depression, substance abuse, and others. VA also has MST-specific outpatient, inpatient, and residential services available to assist Veterans in their recovery. It’s important to know that VA provides all treatment for MST-related mental and physical health conditions free of charge. A service-connected disability rating is not required, and Veterans may be able to receive MST-related care even if not eligible for other VA services. Veterans do not need to have reported the incident or have other documentation that it occurred.
Services for Veterans Who are Homeless
- VA offers special programs and initiatives to help homeless veterans live as self-sufficiently and independently as possible. VA is the only Federal agency that provides substantial hands-on assistance directly to homeless persons including:
- National Call Center for Homeless Veterans: 1-877-4AID VET (877-424-3838) or www.va.gov/HOMELESS/NationalCallCenter.asp
- Outreach to Veterans living on the streets and in shelters who otherwise would not seek help
- Drop in centers where Veterans who are homeless can shower, get a meal, and get help with a job or getting back into society
- Medical treatment for physical and mental disorders, including substance abuse
- Emergency housing referral
- Transitional housing in community-based programs
- Referral to permanent housing through the use of rental assistance vouchers with case management
- Long-term assistance, case management, and rehabilitation
- Employment assistance
- Residential treatment
Services for Veterans Involved with the Criminal Justics System (Justice-Involved Veterans)
- An eligible Veteran who is not currently incarcerated can access VA health care regardless of any criminal history, including incarceration. Only when an otherwise eligible Veteran is currently incarcerated, or in fugitive felon status, is he or she not able to access VA health care. VA has two programs serving Veterans across the criminal justice system. Their shared goal is to provide the earliest possible intervention to link Veterans to the full array of VA services that will promote treatment while preventing homelessness and further contact with the criminal justice system.
- Veterans Justice Outreach (VJO) program: outreach and linkage to VA medical, mental health, and homeless services for justice-involved Veterans. Every VA medical center has at least one VJO Specialist, who serves as a liaison between VA and the local criminal justice system.
- Health Care for Reentry Veterans (HCRV) program: outreach and reentry planning assistance for Veterans incarcerated in state and federal prisons.
Services for Older Veterans
- VA Community Living Centers (CLCs) for Veterans needing temporary assisted care until they can return home or find placement in a nursing home
- Home-Based Primary Care that includes a mental health professional as part of the team providing care to Veterans in their homes
- Screening for dementia like Alzheimer’s disease and/or other problems that interfere with memory
- Assessments that help decide whether the Veteran can safely live at home and make informed medical decisions
Other
- VA Psychology Training Council's (VAPTC) - The VA Psychology Training Council's (VAPTC) mission is to represent VA matters of training in psychology and shape the future of professional psychology training at all levels from practicum to postdoctoral. The VAPTC is sponsored and funded by VA Mental Health Services (MHS).
- 2016 Interagency Task Force on Military and Veterans Mental Health - Annual Report - On August 31, 2012, President Obama signed Executive Order 13625 directing the Departments of Defense (DoD), Veterans Affairs (VA), and Health and Human Services (HHS), in coordination with other federal agencies, to take steps to ensure that Veterans, Service members and their Families receive the mental health and substance use services and support they need. This report provides an update on steps taken, to include: strengthening suicide prevention efforts across the Military Services and in the Veteran community; enhancing access to mental health care by building partnerships between VA and community providers; increasing the number of VA mental health providers serving our Veterans; and promoting mental health research and development of more effective treatment methodologies.
- Mental Health Transparency Report - November 24, 2014 - This report is designed to give Veterans, their families, and the broader community information about the mental health treatment programs offered by the Department of Veterans Affairs (VA). It documents the rapid growth in demand for VA mental health services during the past decade, some of the challenges this has created, and ways in which VA has responded. VA measures the resources available to address Veterans’ mental health needs, and this report highlights some of these, including budgeting for mental health care, staffing and space for mental health programs, and use of technology to improve access to treatment. The report also presents information about Veterans’ experience of care, including the types and amount of mental health services received and Veterans’ opinions about access and quality of care. VA has ongoing efforts to use this information to address areas of concern and improve the quality of VA mental health treatment.
- DoD-VA Integrated Mental Health Strategy Summary Report - The Departments of Defense and Veterans Affairs partnered in 2010 to address the mental healthcare needs of military personnel, veterans and their families. Through this partnership, the departments outlined the DoD-VA Integrated Mental Health Strategy which included 28 strategic actions to promote early recognition of mental health conditions; delivery of effective, evidence-based treatments; implementation and expansion of preventative measures;, and education, outreach and partnerships with other providers, agencies, and organizations. Please click below for more information.
- Veterans Health Administration Mental Health Program Evaluation: Capstone Report - This is the first public report of the conclusions of a comprehensive program evaluation of mental health services in VHA conducted under a contract awarded by VA’s Office of Policy and Planning (OPP-008). The study began in 2006 and was concluded in November 2010. It concludes that as of 2008, most quality indicators showed good care that was comparable to or better than the care for comparable privately insured patients, but that there was room for improvement, especially to reduce variability across the system and to ensure delivery of evidence-based treatments. The evaluation is considered the largest and most comprehensive systematic assessment of a mental health system ever undertaken.
- Mental Health Liaison Roster - Provides a listing of the Mental Health Liaisons at each VISN. When emailing the liaisons, please do not include any personal health information or SSNs.
- Department of Veterans Affairs (VA)/Community Mental Health (CMH) Partnership Pilots - EXECUTIVE SUMMARY: On August 31, 2012, President Barack Obama signed the Executive Order (EO) 13625: Improving Access to Mental Health Services for Veterans, Service Members, and Military Families. The goal of this Executive Order was “to build an integrated network of support capable of providing effective mental health services for Veterans, service members, and their families.”
This report summarizes the findings from these pilots and provides recommendations and key considerations for future community partnerships. Evaluation of the pilots included gathering data from Veterans about their experiences and from key staff at each of the participating VISNs and VA Central Office (VACO) as well as a review of key documents associated with the pilots. Pilot sites were able to select a model of care to best meet the needs of local Veterans. All sites used one of two broad approaches: Non-VA care or VA telemental health (TMH), with most sites choosing to provide Non-VA care to Veterans.
