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December 3, 2019
Veterans Health Administration: Behavioral Health Services
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The Department of Veterans Affairs (VA) provides health
care and health-related services through the Veterans
Health Administration (VHA), one of the largest integrated
health care systems in the United States. The VHA is
divided into 18 Veterans Integrated Service Networks
(VISNs) that comprise over 1,700 sites of care, including
VA medical centers (VAMCs), community-based
outpatient clinics (CBOCs), extended care facilities, and
readjustment counseling centers (Vet Centers). Each of
these sites of care offers behavioral health services. The
term behavioral health comprises mental health and
substance use. Although the VA often refers to mental
health services in its documentation, the VHA also provides
substance use disorder (SUD) services. For this In Focus,
the terms mental health and behavioral health are used
interchangeably.
VHA Eligibilty for Behavoral HeMalth
Services
Eligibility requirements for accessing behavioral health
services at the VHA are generally the same as for accessing
all other health care services at the VHA, with certain
exceptions. Some veterans experiencing an emergent
behavioral health crisis may not meet all eligibility
requirements for VHA care. However, certain former
servicemembers with other than honorable (OTH)
discharges are eligible for an initial assessment and
subsequent care for an emergent behavioral health need as
long as the need persists (38 U.S.C. § 17201). OTH former
servicemembers do not need to meet minimum active duty
requirements to be eligible under this authority and do not
need to be enrolled in VHA care to receive services.
Veterans who are not eligible under this authority (e.g.,
dishonorable discharge) may still be able to receive care
under humanitarian care authorities (38 U.S.C. § 1784), but
in this case, a veteran would be billed for care received.
For more information about VHA eligibility, care provided
under 38 U.S.C. §17201, and conditions of discharge (e.g.,
OTH discharge), see CRS Report R42747, Health Care for
Veterans: Answers to Frequently Asked Questions.
VHA Behavioral Healtdh Services
The VHA is one of the largest behavioral health care
service providers in the United States. Based on the
President's requested funding, the VA expects FY2020
mental health care obligations to be approximately $9.4
billion. In comparison, FY2015 mental health care
obligations were $6.9 billion, an approximate $2.5 billion
increase over five years.
Behavioral health care at the VHA comprises a continuum
of outpatient, residential, and inpatient services for
numerous behavioral health conditions, including
depression, SUD, and post-traumatic stress disorder
(PTSD), among others. Depending on the disorder and its
severity, services can be provided by general practitioners
in a primary care setting or by more specialized providers,
such as a psychiatrist or psychologist, in a specialized
setting (e.g., residential program that focuses specifically on
recovery from SUD). A veteran receiving behavioral health
treatment in a specialized setting is assigned a principal
mental health provider. This provider maintains regular
contact with the patient and coordinates mental health care
amongst providers of different specialties.
According to the VA, in FY2020, the VHA expects to
provide about 15 million visits in outpatient specialty
behavioral health care settings and expects to pay for over
600,000 outpatient specialty behavioral health care visits in
non-VHA facilities (i.e., Veteran Community Care Program
[VCCP]). The VHA also expects to provide approximately
1 million mental health visits in primary care in FY2020.
Otpatent Priaruy Care Services
Generally, mild and/or moderate behavioral health
symptoms and conditions (e.g., depressive, anxious
symptoms) are treated in an outpatient primary care setting.
Compared to some private providers, the VHA is unique in
its delivery of mental health services in a primary care
setting (i.e., primary care-mental health integration [PC-
MHI]). The VHA initiated PC-MHI in 2007. In this model,
a PC-MHI care manager coordinates care with primary care
providers, as well as other PC-MHI mental health experts
(e.g., psychiatrists, psychologists, and clinical social
workers). In 2010, the VHA started implementing Patient
Aligned Care Teams (PACTs), in which PC-MHI providers
work in a team with primary care providers, registered
nurses, and other staff to ensure patient-centered care.
Out'patient Specialty Behavinoral Healt.h Care
S eNrvic \ es
Generally, moderate severity behavioral health symptoms
and conditions are treated in outpatient specialty behavioral
health care settings. These settings include general mental
health clinics or outpatient specialized programs.
A general mental health clinic provides outpatient
behavioral health services beyond those offered in primary
care, but are used by veterans who do not need outpatient
specialized programs. In 2014, the VHA introduced the
Behavioral Health Interdisciplinary Program (BHIP) in
some of its general mental health clinics. The BHIP-
similar to PACTs-assigns patients to an interdisciplinary
team to coordinate and deliver behavioral health care. The
VHA has also implemented outpatient specialized programs
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