Despite hearing far too often only about the problems our veterans face, the majority of transitioning veterans return home safely-free of mental health problems-and quickly reintegrate into the communities where they will continue to serve.
Unfortunately, when the media and conventional wisdom propagate the false notion that veterans as a group are broken, it contributes to the stigma many veterans feel about getting help and often prevents them from seeking care when they do need it.
But when veterans do need health care-whether it's for a physical or a behavioral health issue-they and their families do have some unique needs.
The New York State Health Foundation (NYSHealth) has long made it a priority to ensure that returning veterans and their families in the state get the care and services they need and want in their communities. We commissioned a 2011 study by the RAND Corporation that found more than half of veterans in New York State-in line with the rest of the country-prefer to receive care outside of the US Department of Veterans Affairs (VA) system.
It has rarely been discussed, but one of the biggest hurdles a veteran in need of care must overcome is finding resources that both they and their family can use. Among those veterans who experience mental health or substance use issues, nearly one-half of their spouses expressed difficulty dealing with their partners' behavioral health needs. Research also shows that having a partner with post-traumatic stress disorder (PTSD) can increase the risk of the other partner developing a mental health problem, so both veterans and their spouses may require care for behavioral health issues. Because the majority of veterans don't rely on the VA for their health care needs, and most family members don't qualify for care through the VA, there is a need for all to obtain high-quality care in one location-especially since most families will likely end up using both public and private services.
Alleviating this barrier was the driving force behind the public-private partnership between Northwell Health (the nation's fourteenth-largest health care system) and the Northport VA Medical Center on Long Island, which resulted in the creation of the Unified Behavioral Health Center (UBHC) in 2012. This innovative approach aimed to co-locate and coordinate behavioral health services, both public and private, in one location that serves both veterans and their families. The idea is that veterans and their family members can show up at the same door; veterans are directed to the left, civilians to the right, and everyone gets the care he or she needs. To date, the UBHC has provided more than 7,000 behavioral health encounters and serves as a model for others to study and potentially replicate.
We were excited by the opportunity to understand how and whether this new model of care was working in New York State, and so we again tapped the RAND Corporation to conduct an evaluation.
The evaluation, released in late October 2016, was designed to address four questions:
- What resources and treatment options were available for providing care in the UBHC?
- What barriers and facilitators to implementing this model of care did the center encounter?
- What services were delivered, and what were the characteristics of the patients who received these services?
- How did receiving care affect patients' health outcomes?
You can read the report and a related brief here, but, to summarize, RAND found, “Overall, the UBHC has successfully implemented a promising public-private partnership model for providing behavioral health care for veterans and their families in the same facility.” Patients have “consistently expressed satisfaction with their experiences… and the care they received,” and both adult and child patients have displayed fewer behavioral health problems and have seen decreases in symptoms.
But the praise didn't come solely from the clients. According to RAND, UBHC staff members reported taking special pride in healing veterans and their families as a result of this collaborative model of care.
Of course, there were also hurdles along the way, and important lessons that others trying to replicate the model can learn from. Unanticipated regulatory issues upfront, limitations of the initial financing and revenue model, and a lack of clear institutional procedures to support collaboration all created challenges for the successful implementation and ongoing sustainability of the model. The partnership is not perfect and could benefit from improving its collaborative approach, infrastructure, and technology. However, this approach is a huge step in the right direction to providing high-quality care for our veterans, regardless of whether it is public or private.
If there is one thing I've learned from being a veteran, it is that we cannot solve the problems we face as a community by ourselves. The VA, despite all of the goodwill and compassion of its employees and leadership, will never on its own be able to provide a solution to the myriad problems faced by the incredibly diverse population the agency serves-nor should it. The problems our veterans face are not solely those of the VA or of the veteran community; rather, they are the problems of every citizen in the United States, and we must solve them-together.
And in my new role working in philanthropy (I've been at NYSHealth for only a couple of months), I'm starting to see how health foundations can and should be a part of that equation. We can fund reports that don't just sit on a shelf but actually inform policy and practice. We can be changemakers, not just grantmakers. And we can consider the health care needs of veterans and their families not only on Veterans Day, or when we hear of terrible tragedies stemming from a lack of good care, but as part of our overall commitment to improving health in the communities we serve.
Related reading:
New York State Health Foundation, Veterans' Health page.
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