evolving policy: focus on access ira.katz2@va.gov

Evolving Policy: Focus on Access

Ira.Katz2@va.gov

Mental Health in VA

• It’s about caring for Veterans

• It’s also about politics

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

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

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

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

Operationalizing:

When will this be implemented?

• Within a few weeks

• Staging– Implementation for all veterans

• or

– Initial implementation for returning veterans

Operationalizing:

What are possible “unanticipated consequences”?

Operationalizing:

What are possible “unanticipated consequences”?

• Improving access at the expense of quality and continuity

• Consequences related to missing targets

• Increasing stigma

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