From the U.S. Government Accountability Office, www.gao.gov Transcript for: VA Mental Health Access and Wait Times Description: Audio Interview by GAO staff with Debra Draper, Director, Health Care Related GAO Work: GAO-16-24: VA Mental Health: Clearer Guidance on Access Policies and Improved Reliability of Wait-Time Data Needed. Released: October 2015 [ Background Music ] [ Narrator ] Welcome to GAO's Watchdog Report, your source for news and information from the U.S. Government Accountability Office. It's October 2015. Between 2005 and 2013, the number of veterans receiving mental health care from the Veterans Health Administration increased by 63 percent. A team led by Debra Draper, a director in GAO's health care team, recently reviewed veterans' access to mental health care in light of this increase in demand. Jacques Arsenault sat down with Debra to talk about what they found. [ Jacques Arsenault: ] What kinds of mental health resources does the VA offer for vets? [ Debra Draper: ] Well, the VA provides a range of mental health services to veterans and this includes services for post-traumatic stress disorder, depression, and substance abuse. I think one thing of interest is that between 2005 and 2013, the number of veterans receiving mental health care from VA increased about 63 percent, which is three times the increase of veterans seeking other health care services. [ Jacques Arsenault: ] Now your report focused on wait times, how long veterans have to wait to get appointments for these services. What did you find there? [ Debra Draper: ] First of all, let me say that veterans needing mental health services are particularly vulnerable and this includes some number that may be a risk for suicide, so receiving timely mental health care is really critical. So we found a couple of things. One, we found the VA has conflicting policies around this wait time measures and these are important because, you know, they cause confusion in the field and it really affects how they prioritize care for veterans. So one policy states that veterans are to be seen within 14 days and another says within 30 days. We also found that some veterans experience long wait times to attain mental health care and this information or the information the VA reports shows an average time, but that doesn't really reflect how long every veteran waits to receive care, because we have found that there are some particularly long waits. And one of the issues is that VA doesn't track the amount of time from the initial request, when a veteran first requests care, to the time that the appointment is scheduled and that time can be quite lengthy. [ Jacques Arsenault: ] So, what's behind the wait times? What are some of the challenges that VA faces in trying to provide timely care? [ Debra Draper: ] Well, there are a number of issues and I'll just talk about a couple. One is that really have sufficient mental health professionals to provide care and in the past several years, VA has really tried several initiatives to recruit more mental health professionals but with the demand for care increasing that it's really hard to keep pace. Another issue with around appointment scheduling and wait times is that the software system that they use is antiquated, inefficient, and really prone to user error, so it really doesn't provide good information to really monitor progress. [ Jacques Arsenault: ] Now on that point about monitoring, I know your team looked at how VA monitors the way that it provides these services in medical centers across the country. How are they doing? [ Debra Draper: ] Well, there continues to be weaknesses in VA's monitoring efforts and also including for mental health care. We've done previous work looking at monitoring of wait times. For example, one of the issues that we found is how VA calculates wait times. It's changed over time. So the data is not always comparable from one facility to another, which makes monitoring and oversight more challenging. And also another issue is the definitions that VA uses that goes into the wait time calculations have changed and they really haven't provided users of that information with updated information about those definitions. [ Jacques Arsenault: ] Let me ask you then, what recommendations is GAO making in this report to VA? [ Debra Draper: ] We're making a number of recommendations. One is to clarify its policies around access and that includes what measures it should use, whether it's the 14 days or the 30 days. We've also recommended that they issue guidance on certain types of appointments and this includes things like walk-in appointments. We've also recommended they issue guidance on the definitions used to calculate wait times and communicate that information to all stakeholders, whether internal or external. [ Jacques Arsenault: ] And finally, for veterans and the American people, what would you say is the bottom line of this report? [ Debra Draper: ] Well, I think that VA still has work to do, to reduce the amount of time veterans are waiting to receive mental health care and to improve the overall experiences of veterans waiting for care. As we've found in other related work, which we have again found in this work, veterans' experiences seeking health care, including mental health care, varies considerably from one facility to another. So reducing some of that variation would also help improve veterans' overall experiences seeking care from VA. 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