登录
注册
您所在的位置:首页>>快讯>>快讯详情

How to Improve Mental Health Care for Veterans

如何改善退伍军人的心理保健

【标签】: {{b}}
展开
【来源】: 兰德公司
【时间】: 2019-08-15
【阅读】: {{d.SYS_FLD_BROWSERATE}}次

{{d.摘要翻译}}

原文链接: {{d.URL}}
全文阅读:
Veterans, especially those who deployed overseas, face elevated risks of mental health conditions. Veterans who have served since the September 11, 2001, attacks are especially vulnerable. Roughly one in five veterans experiences mental health problems, including posttraumatic stress disorder (PTSD), major depression, and anxiety. Deployment can also increase the risk of unhealthy alcohol and drug use, substance use disorders, and suicidal behavior. If left untreated, these conditions can have long-lasting and damaging consequences, impairing relationships, work productivity, quality of life, and overall well-being for veterans and their families.

RAND Corporation researchers have conducted multiple studies of the quality of mental health care received by veterans across the systems that deliver this care. This brief summarizes the main lessons from this work and shares recommendations for policies and further research.

Why Quality of Care Matters

High quality in health care was defined by the Institute of Medicine in its 2001 report Crossing the Quality Chasm: A New Health System for the 21st Century as care that is safe, patient centered, effective, equitable, timely, and efficient. Much research has focused on understanding the availability and use of treatment that is effective. Effective treatments are those that have been shown to work, based on scientific research and clinical experience. Evidence-based practice (EBP) refers to specific forms of care that meet these criteria (see Figure 2). EBPs have been peer reviewed by scientists and clinicians, and there is empirical evidence for their effectiveness. In some cases, EBPs have been proven to produce significant reductions in symptoms in controlled experimental research studies, which represent the gold standard of scientific evidence for medical treatments. Clinical practice guidelines are systematically developed statements based on scientific evidence that help providers and patients make decisions about appropriate health care practices for specific clinical circumstances, according to the Institute of Medicine's 2011 report Clinical Practice Guidelines We Can Trust. Guidelines are based on reviews of the scientific literature and expert consensus. Treatment recommendations are assigned a grade of A, B, C, or D based on the strength of the scientific evidence, with a grade of A being the equivalent of "strongly recommended."

It is important that veterans who experience mental health conditions and substance use problems receive treatment and get the best quality care available. Evidence-based treatment improves recovery rates. It also reduces the likelihood of other negative consequences that can follow from mental health and substance use conditions, such as health deterioration and problems in relationships and work. Poor-quality care, by contrast, is less likely to lead to recovery. Furthermore, poor experiences with care can discourage veterans from seeking further care. There are also substantial monetary costs associated with substandard and inaccessible mental health care. In 2008, RAND researchers estimated the two-year societal costs of post-deployment mental health problems, such as PTSD and depression, among veterans who had served since the September 11, 2001, attacks to be approximately $6.2 billion (in 2007 dollars) (Tanielian and Jaycox, 2008). The study estimated that if all veterans received high-quality care for these conditions, these costs could be reduced by $1.2 billion (in 2007 dollars). Thus, high-quality care can stem adverse consequences for veterans and families and also reduce the economic burden on society. See the next page for examples of some EBPs.

Systems of Mental Health Care for Veterans

Two medical systems are primarily responsible for meeting veterans' mental health care needs: the VA health care system and nonmilitary, private-sector health care providers. In recent years, these systems have reacted to the growing recognition of the need to expand access and improve the quality of mental health care for veterans by hiring more providers, conducting increased trainings, expanding the use of telemental health services, and creating new programs in the community.

Quality of Mental Health Care in the VA Health Care System

More than 9 million veterans are enrolled to receive care from the VA health care system (see sidebar). To serve this population, VA operates the nation's largest health care system providing both inpatient and outpatient services, with 172 VA medical centers and 1,069 outpatient clinics across the country. In 2018, VA delivered mental health care to an estimated 1.7 million veterans.[1] Compared with nonveterans, veterans are disproportionately older, male, and less healthy. Veterans who use VA health care — VA patients — are typically older than other veterans. Fifty-two percent of veterans who use VA health care are over age 65, while only 39 percent of veterans who are not VA patients are over age 65. VA patients are also more likely than other veterans to have been deployed. Partly as a result of their older age and deployment experience, VA patients have higher rates of mental health conditions and chronic physical conditions than other veterans.

RAND researchers have conducted major studies of VA's capacity for delivering high-quality mental health care, including a comprehensive evaluation of the VA mental health system (Watkins et al., 2011); a congressionally mandated analysis of the quality of VA health care compared with that delivered by other health systems as part of a broader assessment of VA's health care resources and capabilities (Hussey et al., 2015); and an analysis of the purchased care system, in which veterans receive care paid by VA but delivered by private providers (Farmer and Tanielian, 2019).