Patient-Centered Mental Health Care for Female Veterans

Abstract

Objective-Mental health services for women vary widely across the Veterans Health Administration (VHA) system, without consensus on the need for, or organization of, specialized services for women. Understanding women's needs and priorities is essential to guide the implementation of patient-centered behavioral health services.Methods-In a cross-sectional, multisite survey of female veterans using primary care, potential stakeholders were identified for VHA mental health services by assessing perceived or observed need for mental health services. These stakeholders (N=484) ranked priorities for mental health care among a wide range of possible services. The investigators then quantified the importance of having designated women's mental health services for each of the mental health services that emerged as key priorities.Portions of this article were presented at the annual research meeting of the Academy Health, Baltimore, June 23-25, 2013.The authors report no financial relationships with commercial interests. U.S. Department of Veterans Affairs VA Author ManuscriptVA Author Manuscript VA Author ManuscriptResults-Treatment for depression, pain management, coping with chronic general medical conditions, sleep problems, weight management, and posttraumatic stress disorder (PTSD) emerged as women's key priorities. Having mental health services specialized for women was rated as extremely important to substantial proportions of women for each of the six prioritized services. Preference for primary care colocation was strongly associated with higher importance ratings for designated women's mental health services. For specific types of services, race, ethnicity, sexual orientation, PTSD symptoms, and psychiatric comorbidity were also associated with higher importance ratings for designated women's services.Conclusions-Female veterans are a diverse population whose needs and preferences for mental health services vary along demographic and clinical factors. These stakeholder perspectives can help prioritize structural and clinical aspects of designated women's mental health care in the VHA.Implementation of patient-centered behavioral health services in primary care is improving the quality of mental health care in the Veterans Health Administration (VHA) (1) and may be especially effective in improving the quality of care for underrepresented populations (2-5). For example, a patient-centered approach helps address the unique mental health needs of women in VHA care, who constitute only 6% of all veteran users in a predominantly male system (6,7) but who are one of the most rapidly growing subpopulations of patients within the VHA (8). Historically, women utilizing VHA services have faced gender disparities in access to and quality of primary care, preventive services, and mental health care (9,10), which led to the implementation of comprehensive primary care for female veterans across the system (11,12). Mental health services for women still vary across the VHA, without consensus on the need for, or org...

Gender Differences in Demographic and Health Characteristics of the Million Veteran Program Cohort

“…For example, behavioral health interventions (including promoting physical activity and weight loss, smoking cessation, and mental health services) may be adapted to best address women's needs and preferences (e.g., offering access to women-only programs, same-gender providers, gender-specific treatment guidelines, and gender-sensitive care; see deKleijn et al, 2015). Studies on gender-specific behavioral health services and preferences have shown that women veterans reported strong preferences for having designated women's services for PTSD, depression, and coping with chronic medical conditions (Kimerling et al, 2015), as well as weight management (Goldstein et al, 2017).…”

Patient Activation and Mental Health Care Experiences Among Women Veterans

“…Some disparities exist for inpatient care, where women report poorer experiences as compared to men for care experiences that may be sensitive to patient activation, such as shared decision making, communication about medications, and communication of discharge information (Hausmann et al 2014). Women veterans report distinct gender-related preferences regarding mental health services (Kimerling et al 2014), such as preferences for female providers, women-only groups, or designated women’s treatment settings. These preferences vary as a function of demographic and service characteristics, the conditions being treated, and comorbidities.…”

Access to Mental Health Care Among Women Veterans

“…15 To date, few studies have examined the impact of perceptions of mental health care on mental health utilization. Negative perceptions about the gender sensitivity of VA health care are associated with unmet need for care among women veterans.…”