Behavioral Health Workforce and Private Sector Solutions to Addressing Veterans’ Access to Care Issues

Abstract

Behavioral health conditions pose a significant burden on the health and well-being of American veterans. Service-related behavioral health conditions, such as posttraumatic stress disorder, are especially prevalent and cause significant disability. In recent months, new concerns have been raised about whether the Veterans Health Administration can adequately address the challenges in meeting the need for veterans' care, especially in behavioral health. 1 Concern in policy circles is running high about systemic issues within the Department of Veterans Affairs (VA) system that may limit veterans' access to behavioral health care.To address this issue, policymakers are proposing a range of policy solutions. Many of these solutions include allowing veterans to seek care from private sector health care professionals (eg, psychiatrists, psychologists, and social workers). In 2014, President Obama signed into law the Veterans Access, Choice, and Accountability Act (hereafter referred to as the Veterans Choice Act). As part of this act, the VA was given increased funding to purchase care in the private sector for veterans with poor access to care in VA facilities. Most recently, the Commission on Care, a "blue-ribbon" panel required by the Veterans Choice Act to study the future of the VA health care system, suggested transforming the VA into an integrated care system that is part provider and part payer for private sector care, emphasizing the veteran's choice of where to receive care. 2 Other proposed solutions from policymakers and presumptive presidential candidates focus on improving a veteran's access to private sector providers.Despite growing political support and legislative demand for such private sector solutions, there is reason to believe that the current civilian behavioral health workforce is not fully equipped to meet the unique behavioral health care needs of the veteran population, especially those with service-related conditions. Policymakers must be mindful of the challenges already facing the private sector behavioral health workforce when proposing aggressive private sector solutions to strengthen veterans' access to behavioral health care.Nearly all published and anecdotal evidence suggests thatthereisasignificantshortageofbehavioralhealthprofessionals across the United States. 3 Furthermore, these shortages are not evenly distributed across the population, with particular shortages in rural areas. Shortages of behavioralhealthprofessionalsinruralareasaffecttheveteran population severely. A recent RAND Corporation study found that veterans living more than 40 miles from a VA facility often did not live any closer to civilian psychiatrists and psychologists. 4 Therefore, allowing those vet-VIEWPOINT