VA Mission Act Could Have Positive Impact on Veteran Mental Health
One of the provisions in the newly-passed Veterans’ Administration Mission Act concerns telemedicine and could have a positive impact on veteran mental health. The $52 billion reform bill gives legislative authority to the Anywhere-to-Anywhere telemedicine program launched last summer by former VA Secretary David Shulkin, MD. The Act was signed by President Trump on June 6, 2018.
With the VA Mission Act, Congress is attempting to make it easier for military veterans to access private medical care and to address issues with continuity of care. The legislation allows the sharing of veteran medical records with non-VA healthcare providers, including prescription drug information. Advocates in the federal and private healthcare sectors applaud the promise of better interoperability to improve patient care.
“For many years, we’ve seen veterans and their providers frustrated because veteran health records were not accessible to private sector providers due to an administrative issue,” said The Sequoia Project CEO Mariann Yeager in a statement. “[It] provides an important fix that will unlock veteran health records to enable the providers who care for veterans to make better informed decisions and coordinate care regardless of whether they are treated at a VA medical facility or in the private sector.”
What is Anywhere-to-Anywhere?
The Anywhere-to-Anywhere provision allows VA providers to treat patients across state lines with a telemedicine platform, no matter if the patient is in a VA medical facility or not. This removes the hurdle of geography and the burden of travel on veterans, as well as the criticality of specialty provider shortages at the VA.
“The American Medical Association (AMA) believes every veteran deserves timely, accessible, high quality health care—whether within or outside the VA system. The bipartisan leadership from the Veterans Affairs committees in both chambers produced a bill that is worthy of our veterans.” — David O. Barbe, MD, President, American Medical Association
The positive impact on veteran mental health may be significant. Approximately 50% of returning service members who need treatment for mental health conditions seek it, but only slightly more than half who receive treatment receive adequate care, according to the Substance Abuse and Mental Health Services Administration (SAMHSA).
There is a stigma in the military around seeking mental healthcare. The privacy of accessing a psychiatrist via teleconference may increase the number of veterans who seek treatment.
“The value placed on the actions of the group to achieve military objectives above all else, the cultures of reliance upon each other, masculinity, self-sufficiency, and the stigmas of going sick or shirking work have been noted to affect help-seeking behaviors.1”
Veterans may not want to risk being seen at the local VA hospital with no obvious physical injury, or they may know the VA psychiatrists socially and fear exposure. Mental health treatment often requires multiple, scheduled visits over time. Employers can tacitly or overtly discourage time off for these visits. There may be few psychiatrists available locally, due to specialist shortages.
Telepsychiatry’s impact on veteran mental health
TelePsychiatry can provide more convenient and socially acceptable access for veteran mental health treatment, as well as making it easier to keep appointments. Engagement with patients will improve compliance to care plans and adherence to medication. This in in turn could help prevent veteran homelessness, often caused by mental health or substance abuse issues, or even suicide. Approximately 22 veterans take their lives each day. Three out of five veterans who died by suicide were diagnosed as having a mental health condition.
“The Mission Act is a tremendous step forward in changing the way the VA engages with patients in need of mental healthcare,” says Anton Arbatov, MHA, FACHE, US Army veteran and SOC Telemed’s lead for government relations. “Increasing access to care through mitigation of administrative barriers and improving access to out-of-network providers, while increasing the capacity of VA clinical resources and removing geographical barriers through telemedicine, allows for the creation of a broader and more effective engagement and care platform that can serve to dramatically improve on the status quo”.
It is estimated that 13 percent of all veterans currently prescribed opioids are addicted. In order to try to curb opioid abuse among veterans, the VA will be required to create a process to ensure that non-VA providers can access relevant patient medical records, including all prescribed medications. The VA will also participate in the Prescription Drug Monitoring Program (PDMP).
An additional benefit to the legislation is to optimize the productivity of VA physicians nationwide. The VA does not have the ability to pay physicians the same as their non-VA counterparts, which means there are significant specialist shortages in some areas. With veterans allowed to seek treatment across state lines, underutilized physicians in some areas can help close gaps in other areas. This should improve the morale and welfare of both physicians and patients.
If you are a veteran in need of support, please visit the Veterans Crisis Line or call 800-273-8255, Ext 1 to connect you with qualified Department of Veterans Affairs (VA) responders through a confidential toll-free hotline, online chat, or text.
1”Stigma as a Barrier to Seeking Health Care Among Military Personnel With Mental Health Problems”, Epidemiologic Reviews, January 1, 2015 37(1):144