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Mental Healthcare Access for Rural Veterans Lower Than Urban Areas

GAO recommended VA look at mental healthcare access and utilization by region to better understand these geographic health disparities.

A new Government Accountability Office (GAO) study sheds light on the geographic health disparities in mental healthcare access for veterans, prompting calls for the Department of Veterans Affairs (VA) to monitor access to mental healthcare by rurality and not just nationwide.

These findings come as the nation, and especially the VA, stares down a mounting mental health crisis. Civilian patient demand for mental healthcare has reached unprecedented levels.

But when looking at veterans particularly, mental health has long been a concern. Per figures from the VA itself, suicide was the 13th leading cause of death for all veterans and the second leading cause of death for younger veterans under age 45.

The GAO report acknowledged the work VA does in providing mental healthcare to veterans. The agency said VA offers intensive treatment for mental health conditions like schizophrenia and bipolar disorder, two serious illnesses that can impair a veteran’s daily life.

VA has also set up mechanisms to track veteran access to these services, how often veterans utilize mental healthcare services, and even some quality outcomes. But the VA does not track these figures by region or rurality, and that’s led to some geographic health disparities, GAO found.

As of fiscal year 2021, 2.7 million of the 8.3 million veterans enrolled in VA healthcare lived in a rural area, the researchers reported. Moreover, mental healthcare access is a marked need for those living in rural areas. Of the veterans seeking mental healthcare through the VA, 27 percent of them lived in rural areas.

But access to mental healthcare was starkly lower in those rural areas than in urban regions, the GAO researchers found. For example, around 21 percent of those who accessed a VA outpatient Intensive Community Mental Health Recovery program in 2021 lived in a rural area; 79 percent lived in an urban region.

That pattern persisted when looking at other types of intensive mental healthcare that VA offers.

Veterans living in rural areas who did seek out care had to wait longer for it, the report added. In general, VA advises that veterans should not have to wait longer than 30 days for intensive mental health treatment. However, those in rural areas had to wait an average of 34 days, while those in urban areas wait an average of 28 days.

The geographic disparity in mental healthcare access and utilization is likely the result of the broader mental healthcare offerings VA has in urban areas. Nine in 10 of the VA Mental Health Intensive Case Management programs treated mostly those living in urban areas, the GAO researchers said.

The GAO researchers also pointed out that rural veterans likely lived further away from mental healthcare facilities than their urban counterparts and that transportation was likely a bigger barrier for them.

“Further, according to VA, rural veterans are older, tend to be more medically complex, and often have limited internet access at home,” which could stymie efforts to use telehealth to meet mental health needs, the researchers indicated. “Additionally, research shows that rural adults experience higher rates of serious mental illness and higher risk for suicide than urban adults.”

And, as always, staffing has become a serious issue for patient access to care, with the GAO researchers noting that staffing levels at VA mental healthcare facilities are lower in rural regions than urban ones.

GAO urged VA to begin stratifying its mental healthcare access monitoring efforts by region, explaining that doing so will help the agency pinpoint particular issues affecting veteran populations in rural regions.

These findings are yet another story in a long line of mental health needs within the VA. Veterans face a higher rate of mental health needs than civilians, but the agency has not always had the resources to address those needs. In 2019, the VA had to open investigations into its mental healthcare access following a string of crises resulting in veteran suicide.

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