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IG Report Castigates VHA Data on Veterans' Access to Mental Health Services
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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.” 

To address concerns that veterans may not be able to access the mental health care they need in a timely manner, the OIG had been asked to examine how accurately the VHA records wait times for mental health services for both initial (new patients) and follow-up (established patients) visits. The OIG also investigated whether the wait time data that the VA collects accurately depicts veterans’ ability to access those services. 

According to the April 23, 2012, report, “Veterans Health Administration Review of Veterans’ Access to Mental Health Care,” the OIG’s conclusions in this area were sobering:

  • VHA’s measurement of a first-time patient’s access to a full mental-health evaluation was not a meaningful measure of waiting time.
  • VHA was not providing all first-time patients a full mental-health evaluation within 14 days.
  • VHA overstated its success in providing veterans new and follow-up appointments for treatment within 14 days.
  • VHA schedulers did not consistently follow procedures.
  • Mental health staff vacancies may be affecting VHA’s ability to meet timeliness goals.

Following are excerpts from the report’s executive summary.  


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. 

  • VHA’s Measurement of a First-Time Patient’s Access 
    to a Full Mental Health Evaluation 
    Was Not a Meaningful Measure of Waiting Time

 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. 

  • VHA Was Not Providing All First-Time Patients 
    a Full Mental-Health Evaluation Within 14 Days

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. 

Our analysis projected that VHA provided only 49 percent (approximately 184,000) of its evaluations within 14 days. On average, for the remaining patients, it took VHA about 50 days to provide them with their full evaluations. 

  •  VHA Overstated Its Success in Providing Veterans 
    New and Follow-Up Appointments for Treatment 
    Within 14 Days

We found that VHA did not always provide both new and established patients their 
appointments within 14 days of the patients’ desired date—VHA’s goal for timely patient access to care. VHA defines the desired date as the date on which the patient or the provider wants the patient to be seen without regard to schedule capacity. We reviewed patient records … [and] projected nationwide that in FY 2011, VHA:

  • Completed approximately 168,000 (64 percent) new-patient appointments for treatment within 14 days of their desired date; thus, approximately 94,000 (36 percent) appointments nationwide exceeded 14 days. [In contrast,] VHA data showed that 95 percent received timely care.
  • Completed approximately 8.8 million (88 percent) follow-up appointments for treatment within 14 days of the desired date; thus, approximately 1.2 million (12 percent) appointments nationwide exceeded 14 days. …VHA data showed that 98 percent received timely care for treatment.

  • VHA Schedulers Did Not Consistently Follow Procedures

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. 

  • Mental Health Staff Vacancies May Be Affecting 
    VHA’s Ability to Meet Timeliness Goals

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. 

Based on our interviews at four medical centers, staff in charge of mental health services reported VHA’s greatest challenge has been to hire and retain psychiatrists. 

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. 

Although VHA collects and reports mental health staffing and productivity data, the complexity of the computations and inaccuracies in some of the data sources limits the usability of productivity information to fully assess current capacity, determine optimal resource distribution, evaluate productivity across the system, and establish mental health staffing and productivity standards. 


The Inspector General’s office issued four recommendations to the Under Secretary for Health:

  1. Revise the current full mental health evaluation measurement to ensure the measurement is calculated to reflect the veteran’s wait time experience upon contact with the mental health clinic or the veteran’s referral to the mental health service from another provider to the completion of the evaluation.
  2. Re-evaluate alternative measures or combinations of measures that could effectively and accurately reflect the patient experience of access to mental health appointments.
  3. Conduct a staffing analysis to determine if mental health staff vacancies represent a systemic issue impeding the Veterans Health Administration’s ability to meet mental health timeliness goals, and if so, develop an action plan to correct the impediments.
  4. Ensure that data collection efforts related to mental health access are aligned with the operational needs of relevant decision-makers throughout the organization.

Read the entire report. DoD photo by Cpl. Reece Lodder, U.S. Marine Corps.

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