|IG Report Castigates VHA Data on Veterans' Access to Mental Health Services|
IG Report Castigates VHA Data on Veterans' Access to Mental Health Services
A new report from the Veterans Affairs Office of Inspector General (OIG) finds that the mental health performance data from the Veterans Health Administration (VHA) “is not accurate or reliable.”
VHA policy requires all first-time patients referred to or requesting mental health services receive an initial evaluation within 24 hours and a more comprehensive diagnostic and treatment planning evaluation within 14 days. The primary goal of the initial 24-hour evaluation is to identify patients with urgent care needs and to trigger hospitalization or the immediate initiation of outpatient care when needed. Primary-care mental health providers, other referring licensed independent providers, or licensed independent mental health providers can conduct the initial 24-hour evaluation.
VHA’s Mental Health Performance Data Is Not Accurate or Reliable
VHA does not have a reliable and accurate method of determining whether they are providing patients timely access to mental health care services. VHA did not provide first-time patients with timely mental health evaluations, and existing patients often waited more than 14 days past their desired date of care for their treatment appointment.
In VA’s FY 2011 Performance and Accountability Report (PAR), VHA reported 95 percent of first-time patients received a full mental health evaluation within 14 days. However, this measure had no real value as VHA measured how long it took VHA to conduct the evaluation, not how long the patient waited to receive an evaluation. For example, if a patient’s primary-care provider referred the patient to mental health service on Sept. 15 and the medical facility scheduled and completed the evaluation on Oct. 1, VHA’s data showed the veteran waited 0-days for their evaluation. In reality, the veteran waited 15 days for their evaluation.
Using the same data VHA used to calculate the 95 percent success rate shown in the FY 2011 PAR, we selected a statistical sample of completed evaluations to determine the starting and ending points of the elapsed-day calculation. We conducted an independent assessment by reviewing patient records to review patients’ visit dates, clinical notes, and consult records to identify the exact date of the trigger encounter (the date the patient initially contacted mental health seeking services, or when another provider referred the patient to mental health). We determined when the full evaluation containing a patient history, diagnosis, and treatment plan was completed.
We found that VHA did not always provide both new and established patients their
VHA schedulers were not following procedures outlined in VHA Directives, and, as a result, VHA’s reported waiting time data was not accurate or reliable. For new patients, the scheduling clerks frequently stated they used the next available appointment slot as the desired appointment date for new patients. For established patients, medical providers told us they frequently scheduled the return-to-clinic appointments based on their known availability rather than the patient’s clinical need. For example, providers may not have availability for two to three months, so they specify that as the return-to-clinic time frame.
According to VHA, from 2005 to 2010, mental health services increased their staff by 46 percent and treated 39 percent more patients. Despite the increase in mental healthcare providers, VHA’s mental healthcare service staff still did not believe they had enough staff to handle the increased workload and consistently see patients within 14 days of the desired date.
Measuring Access to VHA Mental HealthCare
No measure of access is perfect or paints a complete picture in isolation, [but] meaningful analysis and decision-making requires reliable data, on not only the timeliness of access but also on trends in demand for mental health services, treatments, and providers; the availability and mix of mental health staffing; provider productivity; and treatment capacity.
The Inspector General’s office issued four recommendations to the Under Secretary for Health:
Read the entire report. DoD photo by Cpl. Reece Lodder, U.S. Marine Corps.