Transforming the Mental Health of Veterans

By Sam Shore, MSSW
Director, Texas Mental Health Transformation Project
Department of State Health Services

As a recipient of a Mental Health Transformation federal grant from the Substance Abuse and Mental Health Services Administration, Texas is charged with building a solid foundation for delivering evidence-based mental health and related services, fostering recovery, improving quality of life, and meeting the multiple needs of mental health consumers across the life span. As directed by the Governor of Texas, DSHS serves as the administrative home of the grant in Texas. The Governor directed 14 state agencies and consumers/family members to form the Mental Health Transformation Working Group. At its August 2008 meeting, the Transformation Working Group recommended that DSHS coordinate a subgroup to identify the behavioral health needs of veterans returning to Texas from Operation Enduring Freedom in Afghanistan and Operation Iraqi Freedom, and to describe gaps and provide recommendations.

Texas has the third largest population of veterans in the United States and contributes a significant number of the military service members deployed as part of Operation Enduring Freedom in Afghanistan and Operation Iraqi Freedom. According to the RAND Corporation’s Invisible Wounds of War report, up to 15% and 14% of service members returning from Operation Enduring Freedom in Afghanistan and Operation Iraqi Freedom are affected by post-traumatic stress disorder or major depressive disorder, respectively. These conditions require ongoing behavioral health services and supports for veterans as well as their families.

Many federal, state, and private organizations provide behavioral health services for veterans. At the federal level, the U.S. Department of Veterans Affairs has primary responsibility for combat veterans who have been discharged from active duty. Veterans Affairs offers comprehensive health care coverage for veterans, including inpatient and outpatient mental health and substance abuse diagnosis and treatment. Veterans Affairs also offers counseling and reintegration services at hundreds of Veteran Centers across the country, including 15 in Texas. All combat veterans and their families are eligible for Veteran Center services at no charge for military-related issues, including confidential screening, counseling, and linkage to other services.

At the state level, multiple state, federal, and private partners have joined together in a memorandum of understanding under the name “Partners Across Texas.” This partnership is an interagency and multi-organizational collaboration to enhance support for Texas veterans and their families. A variety of services are available from agencies, such as the Texas Veterans Commission, Texas Military Forces, Health and Human Services Commission, Department of Assistive and Rehabilitative Services, and Texas Workforce Commission, along with DSHS. State services ensure that veterans are linked to federal benefits and are supported, as they attempt to return to work and deal with the physical, psychological, and emotional impacts of combat experience. As part of Partners Across Texas, the Texas Information and Referral Network (2-1-1 Texas) and the TexVet: Partners Across Texas website (www.texvet.com) provide comprehensive information about services in Texas for veterans and their family members.

At the local level, there are 37 DSHS-funded community mental health centers that serve as a foundation for the locally managed public system of care for Texans with serious mental illness. The centers provide an array of behavioral health services that veterans or their family members may need, including crisis services and case management. Many other individuals and systems also interact with veterans at the community level, including the criminal justice system, courts, employers, hospitals, schools, and community groups.

Based on the identified gaps and the resources currently available, the Mental Health Transformation Working Group Returning Veterans Subgroup recommended the following:

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Data. Collaborate with federal and state partners to gather comprehensive data on the behavioral and physical health status of Operation Enduring Freedom in Afghanistan and Operation Iraqi Freedom veterans and their families.
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Service utilization. Develop outreach strategies utilizing the Texas Information and Referral Network (2-1-1 Texas), 12-Step Groups, peer support services, and the TexVet: Partners Across Texas website.
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Quality and effectiveness of services. Provide education and training to medical and behavioral health service providers, information and referral specialists, law enforcement officers, and others to increase understanding of veterans’ behavioral health issues.
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Health care coverage and access. Explore options to address gaps in health care coverage and access, especially for families of Operation Enduring Freedom in Afghanistan and Operation Iraqi Freedom veterans. Evaluate the costs to help pay health insurance premiums for families of these veterans, and encourage Veterans Affairs to refer veterans to qualified community providers when there are gaps between needed behavioral health services, and those available at the Veterans Affairs facility nearest to the home of the veteran.
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Coordination and communication. Cultivate partnerships among multiple federal, state, and local entities to foster improved coordination. Build upon partnerships established in the “Partners Across Texas” memorandum of understanding, and coordinate recommendations with other efforts at the state and national levels.

Given the great number of Texas veterans, these partnerships must be maintained and strengthened. The Mental Health Transformation Working Group will move forward with these recommendations, and address the behavioral health needs of veterans and their families.
For more information

* Behavioral Health Services for Returning Veterans and Their Families: Services, Gaps, and Recommendations. A 2008 Report of the Returning Veterans Subgroup of the Mental Health Transformation Working Group, www.mhtransformation.org.
* Invisible Wounds of War: Summary and Recommendations for Addressing Psychological and Cognitive Injuries. A 2008 Report by the RAND Corporation, http://www.rand.org/pubs/monographs/2008/RAND_MG720.1.pdf.
* TexVet: Partners Across Texas, (www.texvet.com)