Evaluating policies to improve access to mental health services in rural areas.

PURPOSE: The United States Department of Veterans Affairs (VA) has gradually implemented policies to increase access to mental health care outside of VA medical centers. Most notably, this included requirements to offer mental health services at VA-administered community-based clinics in 2008 and increased access to VA-paid care in the community beginning in 2014. Our objective was to understand how mental health service use patterns changed for rural VA patients during this time. METHODS: We developed a longitudinal cohort of all rural patients who used VA services between 2002 and 2019 (N = 3,345,862). We examined individual, health care, and contextual predictors of mental health service use as well as modalities of mental health service use during policy-relevant time periods using descriptive statistics. FINDINGS: Access to mental health services increased with each policy change. The annual percentage of rural VA patients accessing mental health services increased from 11.4% in the earliest years (2002-2004) to 19.8% in the latest years (2017-2019). The most rapid period of increase followed a requirement for availability of mental health services at VA-administered community clinics. Increasing access to VA-paid care in the community had less effect. By the end of the evaluation, gaps remained in the delivery of care to elderly patients over the age of 75. CONCLUSIONS: Rural patients use mental health services when they become available. Access was the highest with a combination of changes to both delivery modalities and payment methods. Continued, and perhaps different efforts are required to address a persistent disparity for older patients.

Awareness of Suicide Prevention Programs Among U.S. Military Veterans.

To assess U.S. veterans' awareness and participation in suicide prevention programs offered by the Department of Veterans Affairs (VA). A nationally representative sample of 1002 veterans was surveyed online in 2018. The majority of veterans reported knowing about Vet Centers (72%), the Veterans Crisis Line (65%), and the VA Center for Suicide Prevention (54%). However, only 5% had attended a community event related to veteran suicide and 2% had used VA's Virtual Hope Box. Veterans aware of the Veterans Crisis Line had more medical conditions and were more likely to report VA as their primary healthcare provider. Veterans aware of VA's Center for Suicide Prevention were younger, male, had more medical conditions, and more likely to screen positive for posttraumatic stress disorder, generalized anxiety disorder, and past homelessness. History of suicidal ideation or attempt was not associated with awareness of suicide prevention programs. VA's suicide prevention programs reach a broad segment of the veteran population, including those with and without histories of suicidality. More targeted outreach may be needed for veterans most at-risk for suicide who are unaware of available resources.