Op-ed: To honor veterans this Veterans Day, increase their access to mental health care
This op-ed is written by Aaron Smith, the vice president of implementation and veteran integration at the Meadows Mental Health Policy Institute and a U.S. Navy veteran.
As a nation, we reserve Memorial Day to honor America’s military men and women who lost their lives in service to their country. But Veterans Day, we sometimes forget, is not a day to honor the dead. It is a day to honor the living.
On this Veterans Day, let’s celebrate the veterans still with us by committing to do more to save the lives of those who are at risk of suicide.
Currently we are losing 17 veterans a day in this country to what President Biden has called the “silent scourge of suicide.” In 2020, the suicide rate among U.S. veterans was 31.7 per 100,000, 57.3% greater than nonveterans, and suicide was the second leading cause of death for veterans under the age of 45.
Given this sobering reality, the Department of Veterans Affairs has made the prevention of suicide a top priority. Earlier this year, in a much-heralded move, the VA announced that veterans in acute suicidal crisis can now seek emergency care at any VA or non-VA health care facility for emergency care at no cost, including 30 days of inpatient care and 90 days of outpatient, regardless of whether they are enrolled in the VA system.
This is an important step, one that will undoubtedly save lives. But there is still more work to do. We must refocus care to identify and serve veterans in need before an emergency by expanding mental health screenings and access to psychiatric care.
The VA’s move applies only to former service members who are at imminent risk of self-harm. But we should not wait for the point of crisis to treat veterans experiencing a mental health concern. More upstream solutions — such as providing veterans access to mental health care in primary care — are needed to connect veterans to care before crisis, particularly veterans who are not using VA services.
One proven approach is the Collaborative Care Model, which brings physical and mental health care and treatment together within the same primary care provider’s office and has been validated in more than 80 studies around the world.
Under this model, a PCP leads a team of professionals, including a consulting psychiatrist and a case manager, all working together to coordinate care and ensure access to the best treatment available for a patient’s needs. Every routine check-up can include screening for mental health conditions like depression, anxiety, and substance use, just like screening for common physical markers like blood sugar and cholesterol level. When a need is detected, the PCP can immediately consult with the mental health specialist and quickly determine a treatment plan the patient can begin that day.
Implementing collaborative care for veterans in the community can begin as simply as asking, “Have you or a loved one ever served in the military?” The intake process would then include universal screening for depression and suicide risk using brief, evidence-based screening questions. By identifying the veteran at intake, and identifying a potentially life-threatening mental health issue, the medical team can then provide appropriate care.
By embedding mental health specialists within the primary care system in this way, collaborative care is an efficient, cost-effective solution that communities can use to care for veterans, especially those receiving care outside of the VA.
However, the uptake of this model has been too slow, due in part to worries about start-up costs associated with implementation.
To address this barrier, members of the U.S. Senate and House of Representatives have introduced the Connecting Our Medical Providers with Links to Expand Tailored and Effective (COMPLETE) Care Act, S. 1378/H.R. 3519. The COMPLETE Care Act would improve access to behavioral health care in the primary care setting by incentivizing providers to implement integrated care models, such as the Collaborative Care Model.
The Meadows Mental Health Policy Institute, where I work, has studied the impact that greater access to collaborative care would have on suicide rates, and the data was clear and encouraging: If every American with depression had access to collaborative care, as many as 14,000 lives could be saved every year.
Our nation should never lose a veteran to suicide simply because we failed to ask the right questions. By implementing collaborative care, primary care physicians can transform community health care and create a healing pathway for our veterans. They deserve no less.