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Mental Health Care Services for Women Veterans Provided in the Department of Veterans Affairs

By: VA’s Center for Women Veterans, Women Veterans Health Strategic Health Care Group Summit

Held every four years, the National Summit on Women Veterans Issues focuses on current initiatives for women veterans, issues of concern to the women veterans community, and on how these issues might be addressed through legislative, programmatic and outreach activities. The Center for Women Veterans sponsored the first National Summit on Women Veterans Issues in 1996.  

MH Strategic Plan Adopted 2004

Implement President’s New Freedom Commission on MH Report within VA

Principal components:

Expanding access and capacity
Integrating MH and primary care
Transforming system to focus on recovery & rehabilitation
Implementing evidence-based care
Returning veterans
Suicide Prevention
MHSP Implementation
Over $850 million invested since FY05 in specific Mental Health Enhancement Initiatives (MHEI)

Increasing basic MH funding, e.g., over $3.2 billion total for mental health services in FY08

Over $530 million in proposed VA MHEI budget for FY09 and over $3.8 billion in basic funding

Over 3,900 new mental health staff hired since FY 2005; total mental health staff in the system almost 17,000
Uniform MH Services Handbook (UMHSH)

Final step in implementation of the Mental Health Strategic Plan

Defines mental health services that must be available for all veterans and locations for providing them (medical facilities, CBOCs, fee basis/contract care)

Approved by the Undersecretary for Health, June 13, 2008; Full implementation mandated by the end of FY09

Contains specific gender-related requirements
Mandates in Uniform MH Services Handbook
Mental health services must be provided to female veterans at a level on par with male veterans at each facility.  MH RRTP clinicians must possess training and competencies to meet the unique mental health needs of women veterans.

Women and men being treated for military sexual trauma must have the option of being assigned a same-sex mental health provider, or opposite-sex provider if the trauma involved a same-sex perpetrator.

Patients treated for other mental health conditions must have the option of a consultation from a same-sex provider regarding gender-specific issues.

Special attention must be given to meeting the unique needs of women veterans, especially in the areas of SMI [Serious Mental Illness], sexual trauma, homelessness, and interpersonal violence.

All VA facilities must have environments that can accommodate and support women and men with safety, privacy, dignity, and respect.

All inpatient and residential care facilities must provide separate and secured sleeping accommodations for women.  

Each VISN [Veterans Integrated Service Network] must provide availability to residential care programs able to meet the needs of women veterans either through special programs or specific tracks in general residential care programs.  A number of these programs are available as national resources; every VISN must arrange processes for referral, discharge, and follow-up.
VHA Action For Women Veterans’ Mental Health Services Since 2004

Military Sexual Trauma

MST Coordinator in every VA facility
Mandated MST screening done in primary care
Follow-up of positive screens to explore mental and physical health consequences
Provide care for MST-related health problems, free of charge regardless of priority category

National MST Recovery Team
Provides education and mentoring to MST coordinators and providers nation-wide
Tracks screening and follow-up provision of care
Of female veterans screened since 2002, 19.9% screened positive for MST

Of female veterans with a positive MST screen, 59.2% received treatment for a mental health diagnosis related to the MST
Female-focused outpatient PTSD care available at all VAs
Increasing number of female-focused residential care sites for PTSD available
29 sites with female-only tracks available at last count

Mandated availability of evidence-based psychotherapies for PTSD at all facilities

Cognitive Processing Therapy and Prolonged Exposure Therapy

Both were developed initially for women rape victims and were successfully adapted for other stress experiences, including combat

Over 1,200 staff trained to date in at least one of these approaches; training actively ongoing
Residential and Inpatient Environment
Keyless locked entry systems installed
Female therapist must be available
Increasing use of women-only groups as component of treatment
Sites offer a chance to increase comfort in an environment for both men and women
Moving Forward
Understanding more about the strengths and resilience of women veterans

Learning about, being sensitive to, following closely the lifetime experience of women who have been in combat