VA leads the way on remote mental health revolution

Key Takeaways

Along with virtually everyone else, mental health providers pivoted to provide remote service as the COVID-19 pandemic started in 2020. The U.S Department of Veterans Affairs started preparing in 2002. 

“The COVID-19 response really accelerated our use of telemental health in an artificial way, but it allowed people who hadn’t used it before to see how safe and effective it was,” said Kendra Weaver, senior consultant for clinical operations at the VA’s Office of Mental Health and Suicide Prevention. She spoke to the Veterans and Military Services Committee March 11.

The VA’s telemental health services started in the 1960s but migrated to the computer in the 21st century and was more formalized with a working group and guidance on how to do telehealth as video visits became more feasible in the late 2010s. 

The VA started providing telemental health services directly to veterans in their homes in 2013, and in 2016, service was directed to a regional network of service hubs in underserved areas, usually in rural areas, and in the same year, the VA started lending out tablets for veterans to use for telehealth visits. In 2018, the VA had the authority to provide telehealth anywhere in the United States and it debuted its current user interface.

This long history of telehealth applications has given the VA plenty of feedback and opportunities to study service delivery.

“Telehealth both to home and clinic-based telehealth are just as effective as in-person care for treating mental health,” Weaver said. “Providers and patients are very happy with it; they’re very satisfied and they can develop the same sorts of therapeutic relationships over video as they can in-person and we can keep people in therapy for the same lengths of time.”

Before the pandemic, the VA delivered telehealth services to more than 230,000 veterans over 786,000 visits in FY2019, mostly in rural areas, and by the end of FY 2020, those numbers grew to 550,000 veterans in 2.4 million visits.

In addition to a streamlined service delivery plan, Weaver credited VA leadership’s constant communication with practitioners and system-wide dedication to safety and continuity of care. 

“Do whatever you need to do to make sure we’re still seeing our veterans,” she said. “Everyone came together to meet the mission at the time.”

During the pandemic, the VA introduced additional tools, including a suicide prevention dashboard for monitoring high risk veterans, a mobile COVID coach app and increased tablet distribution. Prior to the pandemic, less than 2 percent of the VA’s mental health treatment was done remotely by video, now it has reached 31 percent.

Switching gears, Coconino County, Ariz. Supervisor Matt Ryan shared his county’s experience with the Department of Defense’s Readiness and Environmental Protection Initiative Partnership (REPI), which aims to mediate land-use conflicts surrounding military installations, which are found in roughly 500 counties, with grants and technical assistance. 

The county contains a naval observatory in Flagstaff and a national guard training facility, all part of a joint land use study by the county and the military.

“We’ve worked out quite a bit, we have coordinated objectives,” he said. “While doing that, we’re looking at the economic impacts. Military bases bring in revenue to the area, they really help our community. In the meantime, we’re coordinating some of our plans associated with economic development together with our military installations, and we have small businesses that benefit from them and we have industrial opportunities.”