Introduction
Specific Gap and Population Affected
Mental healthcare access for American veterans is a major gap in healthcare access for a crucial population of this country, especially one that has served its people diligently. Mental healthcare is provided by the World Health Organization as an essential part of health without which wellness is not fully achieved. The gap existing within mental healthcare for veterans is equity to access. All veterans cannot equally access mental health resources, personnel, and facilities, despite meticulous mechanisms being instituted to ensure they all access care (VA, 2019). Veterans are a crucial part of the American population as they served in various wars at the demand of their leaders, and by extension, their citizens. Veterans dedicated their lives to the protection of the sovereignty of their nation and to installing peace and democracy across the globe, in many needy nations. Upon retirement, veterans suffer various mental health challenges caused by the lifestyle adopted in the camps and experiences lived during the war.
History of the Gap
Equity in the provision of mental healthcare for veterans has been a recurring issue in the American healthcare system without permanent solutions. The deficiency in access to mental healthcare for veterans was recognized in 1970 after a group called Vietnam Veterans Against the War congregated. They agreed that there were discrepancies in the provision of mental healthcare for Vietnam war veterans and consequently lobbied for change. These veterans were guided by the diagnostic criteria which placed many of them as victims suffering from post-traumatic stress disorder (PTSD). The most care they could receive for their challenges was the group sessions they held to narrate their experiences and console each other (VA, 2019). Fast forward through the years there have been many wars, including the Persian Gulf and Iraq wars, characterized by mediocre care for professionals. The recent developments in trying to address the equity to access have included the digitalization of mental healthcare. Veterans can call professionals who can thereafter offer a listening ear to their problem. This is not accessible to all veterans due to geographical, economic, and social factors.
Impact of Socioeconomic Background on Access to Healthcare
The socioeconomic background of war veterans is a limiting factor to mental healthcare access. War veterans usually find it difficult to reintegrate into normal social life after they have served their nation. This is due to the difference in the environment they find themselves in after retirement which is not characterized by camps and weapons. This stark difference makes it challenging for veterans to have stable families which would form a solid support base against mental illnesses (VA, 2019). Veterans also find it difficult to secure and maintain jobs upon their integration into normal societal life. They find it difficult to exist in an environment that is not characterized by orders and conflict. Veterans with supportive families are usually the luckiest because their healthcare needs are sufficiently addressed. The supportive families ensure they provide moral support during the transition and help veterans avoid alcohol abuse challenges.
How Healthcare Delivered is Affected by the Gap in Access
The healthcare services delivered to veterans are diminished by the absence of equity in care. The health of most veterans is usually not holistic as the focus of providers is not directed at addressing each concern sufficiently. The healthcare services rendered are usually keen to address other illnesses including the widespread chronic diseases. These include diabetes, cancer, and hypertension which make the lives of veterans difficult. The healthcare providers also focus on addressing the deformities and various physical discrepancies in these veterans. The healthcare services, therefore, address a few aspects of their needs while neglecting the need for mental healthcare (Jacobs et al., 2019). The mental health of veterans, therefore, receives inadequate attention and this is characterized by the drugs and substance abuse witnessed amongst them, especially alcohol. The mental healthcare services offered are not adequately customized to fit the needs of specific veterans but instead generalized as a one size fits all model.
Potential Implications if the Gap is not Addressed
If the inequity in mental healthcare of veterans is not addressed, this population will continue to suffer greatly from mental illnesses. The suffering of veterans implies shortened lives where they will be unable to attain the life expectancy of other Americans. They will die earlier from the stress on their minds and bodies. The early deaths of veterans will also be caused by suicidal tendencies, with veterans taking their own lives. Alcohol abuse is also expected to destroy the lives of veterans who sometimes become heavy drinkers to avoid their PTSD. The quality of life led is also going to depreciate due to the inability of veterans to form solid social bonds and make a living in stable jobs.
Existing Initiative
Initiative in Place to Address the Gap
The Veteran Choice Program (VCP) was an initiative instituted to enable eligible veterans to acquire care from community providers instead of waiting for Veteran Association (VA) facility appointments. The VCP required veterans to be first enrolled in the VA Healthcare. The program had specific requirements for veterans who would get healthcare from the community centers. The initiative demanded that veterans who needed aid be distant from the nearest VA facility, having to travel by air, ferry, or boat. The veterans also had to have tried the local VA and been told they had to wait for more than 30 days before an appointment (Stroupe et al., 2019). The requirements by VA before veterans could access VCP were instituted to ensure only those who suffering inequity benefitted from this program. The VCP did not limit the scope of healthcare services accessed by the veterans, including mental healthcare in the services offered. The VCP ensured healthcare was timely and within the set standards of the American healthcare system.
Specific Goals of Existing Initiative
The VCP was instituted to address the challenge of distance for veterans seeking healthcare services, including mental health services. It sought to address the barriers in transport facing veterans who have to travel long distances to access care, including unbearable terrains. Mountain passes, and roads through limited areas such as military bases were a challenge for veterans pursuing healthcare. The program also sought to enable veterans to evade treacherous weather conditions that threatened their lives in pursuit of healthcare. This program also sought to ensure that quality healthcare was not availed to veterans in well-exposed centers only. Veterans in remote areas were affected by the distance and their total health, including their mental health threatened (Stroupe et al., 2019). The program sought to address the mortality experienced by veterans from curable conditions. It sought to ensure veterans led comfortable lives after sacrificing their best years for their nation. It was a means of ensuring veterans felt appreciated for their efforts and sacrifices.
Circumstances Around Development of the Existing Initiative
The VCP was implemented in November 2014 following the enactment of the Veterans, Access, Choice, and Accountability Act. The VCP was instituted upon the realization that VA facilities were insufficient to address the health challenges faced by veterans, including mental illnesses. The VCP sought to increase the options available for veterans and address the inequality caused by geographical and economic barriers. The program was also geared at ensuring that VA facilities had minimal workloads for the veterans, ensuring that the focus was on quality instead of quantity. The program was initiated at a time when VA families were characterized by long waiting times for appointments. Some veterans had to wait more than 30 days before a healthcare professional could see them and address their needs. This was detrimental and led to worsened outcomes before treatment and the effectiveness of interventions was minimized.
Resources Required to Fund the Existing Initiative
The VCP requires funding from the federal US government as veterans’ affairs transcend states but fit within the confines of national regulations. The funding for this program is used in the VA facilities and community facilities where the veterans acquire care. The community centers receive disbursements based on the number of veterans they provide care with. Records for the funding of VCP are available and one of the most crucial is the 2017 allocation (VA, 2017). The president signed the VA Choice and Equality Employment Act of 2017 where the VCP received $2.1 billion in funds. This indicates the progressive commitment by the US government since 2014 to increase allocations for the VCP program (VA, 2017). The resources have been utilized in the payment of healthcare workers dealing with the care for veterans. the funding has consistently tried to increase the number of veterans accommodated under the VCP program to ensure no falls from curable and treatable conditions.
Why Existing Initiative is Ineffective and Requires Improvement
The VCP has so far not achieved the desired results in ensuring that the care of all veterans is addressed effectively. The program focuses on all aspects of healthcare to ensure veterans live holistic lives, but its terms are unfriendly. The distance minimum is for veterans living more than 40 miles from the VA facilities (Stroupe et al., 2019). This distance should be reduced to smaller numbers to ensure easy access for veterans to healthcare facilities of their choice. The intervention also failed to address the challenge of insufficient VA facilities across the US when this is the biggest challenge to equity in health access, including mental health. The waiting time for veterans seeking healthcare from community facilities is also set at 30 days. This is a great number and within such a period, patients are likely to experience deteriorating conditions, making treatment difficult when the period elapses. This period should be reduced to a more favorable number so that veterans can access care promptly.
Regulation
Current Regulation on Existing Initiative
The Veterans Access, Choice, and Accountability Act of 2014 was signed into law in 2014 and regulates the actions of the Veterans Association. It also regulates the implementation of the VCP across the nation and ensures the necessary bodies are held accountable for their actions. The development of this act considered the need for regulation of veteran healthcare, given the population’s importance to the nation. The act considered the prevailing situation where the government intervention in veteran healthcare was minimal and sought to change this scenario. The act also considered the difficulties encountered by veterans when seeking healthcare intervention from the VA (Congress.gov, 2013). The proponents carried out investigations into how well the healthcare needs of veterans, especially their mental health was being met.
The investigations revealed massive inequality discrepancies and sought to address them. The biggest considerations for the act included the socioeconomic status of the veterans and their geographical constraints. The act was grounded on addressing the long waiting times and the distance supposed to be covered by veterans before they accessed care. The proponents of the act wanted to address the challenge of inadequate provision of care to guarantee that the needs of all veterans were met.
The act required the secretary of the VA to provide a comprehensive list of the activities and services offered to the veterans visiting their facilities. The act sought to have the government evaluate the quality of care offered in all aspects, including mental health interventions. A comprehensive list of the members of the VA was also a vital requirement of the act to ensure proper budgetary allocation for the activities of the members. A computerized system detailing the veterans treated at local healthcare centers instead of VA facilities was an additional requirement and ensured transparency in operation.
The needs of veterans from the minority communities in the US were also considered. The act directed the VA secretary to consider the needs of Indian Americans (Congress.gov, 2013). The meticulous records of veterans who accessed all forms of care at the community facilities would ensure efficient remuneration and allocation of payment. The act also required the staffing of VA facilities to be adequate, and for these records to be provided to the government. This would ensure that the workers were not overworked, and most importantly that the veterans received top-notch quality services.
Regulatory Level of Existing Initiative
The regulation of the VCP is mainly at the federal level with the federal government allocating funds directly to the program. The initiative is a product of a bill passed into law by congress, hence this is a crucial level of regulation for the initiative (Congress.gov, 2013). The allocation of the funds for this program is a subject of the budgetary process before allocation. This, therefore, makes the revenue and monetary allocators within the country directly responsible for the designation of money. The biggest watchdog for the VCP program is the US Department of Veteran Affairs which ensures the laws instituted are followed. This institution is directly linked to the federal government and ensures timely updates on the operations of the program. It conducts regular investigations into the activities of this department to ensure they are in tandem with the set legislation. The department also conducts audits into the officials serving within the VA to prevent misappropriation of these crucial funds.
Conclusion
In conclusion, the interventions made by the VCP to address inequality in the provision of care, including mental health, for veterans are underwhelming. The initiative is more demanding of the veterans, instead of easing their process of seeking and accessing healthcare. The distance and time limitations addressed above are the biggest barriers for these citizens and should be addressed for more seamless healthcare. The separation of the different aspects of healthcare is also inadequate as the focus on mental healthcare is inadequate. There is a need for future modifications to regulations and initiatives to consider a more diverse approach for greater success.
References
Congress.gov. (2013). H.R.3230 – 113th Congress (2013-2014): Veterans Access, Choice, and Accountability Act of 2014. Congress.gov.
Jacobs, J. C., Blonigen, D. M., Kimerling, R., Slightam, C., Gregory, A. J., Gurmessa, T., & Zulman, D. M. (2019). Increasing Mental Health Care Access, Continuity, and Efficiency for Veterans Through Telehealth With Video Tablets. Psychiatric Services, 70(11), 976–982.
Stroupe, K. T., Martinez, R., Hogan, T. P., Gordon, E. J., Gonzalez, B., Kale, I., Osteen, C., Tarlov, E., Weaver, F. M., Hynes, D. M., & Smith, B. M. (2019). Experiences with the Veterans’ Choice Program. Journal of General Internal Medicine, 34(10), 2141–2149.
VA. (2017). Extension of Veterans Choice Program Funding (pp. 1–2).
VA. (2019). Overview of VA research on Health Equity. US Department of Foreign Affairs.