Evaluating Statewide Infrastructure for Veterans Mental Health Services

Background and Purpose: As large numbers of service members return to their communities and civilian lives, they face significant challenges accessing timely health care for unaddressed service-related injuries, including mental health injuries. Accessing VA mental health care may not be viable due to stigma, distance or wait times. One promising model for helping veterans succeed in accessing care is to connect them with military peers who can offer support, guidance on accessing care, and linkage to community resources. The purpose of this project was to develop a framework with which to annually describe and evaluate Texas’ mental health service infrastructure for veterans, particularly services offered outside of the VA and through the newly created Military Veteran Peer Network (MVPN).

Methods: A mixed methods design utilized surveys, interviews, and focus groups. Researchers administered online surveys to all representatives across the state in each of the following groups: MVPN Coordinators (n=36), MVPN members (N=1693), community-based trauma therapists (N=106), Local Mental Health Authority (LMHA) Jail Diversion Coordinators (N=35), Veteran Justice Outreach Specialists (N=17), Veterans Court Coordinators (N=23), and Veteran County Service Officers (N=242). Regionally representative structured interviews and focus groups were then conducted with a subset of each of these groups. Data collected examined existing program infrastructure, the extent and value of training received, service delivery relationships, communication among the groups and other service providers, services offered by respondents (including trauma specific interventions), and gaps or barriers to accessing services needed by veterans. Quantitative analysis of survey data informed development of interview and focus group questions. Qualitative content analysis of text from focus groups and interviews was conducted by two coders, with acceptable reliability in coding. After coding, categories were identified, frequencies of themes were developed, and comparisons across types of providers, regional areas, and MVPN chapters were made.

Results and Implications: An array of services and programs are offered to serve veterans across Texas, yet access barriers and additional service and basic needs gaps were identified. Analysis yielded service prevalence as well as access barriers or gaps in services that varied by region and correlated to the existence of established mental health service infrastructure (e.g., VA facilities, LMHA service areas, and other local community resources). Level of communication across service groups regarding military concerns was moderate. A low level of standardized assessment methods for identifying trauma and traumatic brain injury was identified. Themes regarding ineffective program infrastructure, staff training needs, and unmet service and basic needs of veterans were common across respondent groups. These needs included employment assistance, financial assistance, transportation, housing and easier access to mental health care. Differences in perspectives among respondent groups working within different service delivery systems (e.g., state, VA) as well as differences across regions of the state are described, with particular attention to comparisons between urban and rural area need and available resources. Programmatic weaknesses were identified that could lead to reduced impact of the program. Recommendations include developing specific research methods to conduct ongoing evaluation of service networks, particularly the peer network.