MN507 Abstract and Position Paper
ABSTRACT
There are approximately 30 million Americans that are veterans of military service and there are 171 VA hospitals nationwide. Having access to health care is crucial for Veterans with PTSD; a primary complaint is there is not enough clinics or hospitals. While most appointments can be made within 30 days approximately 9% are made greater than 30 days from time of request (U.S. Department of Veterans Affairs, 2017). Mental illness is huge issue in the United States, and even more specifically Veterans with PTSD. With so many veteran experiencing some level of PTSD it is important for them to be able to get the best care that is readily available to them. Veterans should be able to get easy access to mental health care, with out having to make sacrifices. This paper is going to address the need to increase patient accessibility to mental healthcare and a policy that will address these limitations veterans face when getting access to quality mental healthcare. It is important to change current policies so providers can better meet the needs of the veteran population. We are advocating for policy change to increase clinics staffed by Advanced practitioners such as NP’s and PA’s to provide care for veterans and increase availability for services.
Policy issue
Current policies that VA use is over 60 years old, and in order to address the needs of Veterans with PTSD, policies have to be updated to the current research, and trends, old polices have to be revised and new policies have to be built. The VA uses the Strategic Capital Investment Plan (SCIP) to address the infrastructure deficits, which includes facility utilization, conditions, energy and safety. The analysis of the SCIP showed that to close the access gap, 30 billion dollars need to be spent on construction and leasing (Construction Programs, 2011). Without appropriate funding the VA is going to continue to be in search of way to meet the needs of the Veteran population. It is important for nurses to stand up and make changes on how our veterans are being treated. Nurses are in a position where they can make great changes to the health and well being of Veterans with PTSD. With this Policy change we are advocating for Veterans and their families. As a developing role as primary care providers, APN have the opportunity to provide the quality of care that this group of people need, NP can fill in the gaps that are associated with the barriers that Veterans face when seeking mental healthcare. With so many men and women who have fought for our freedom and continue to do so, it is our duty to assist them to have access to care for PTSD and other ailments brought on by the wars they have fought in and the events many Americans will never understand.
Reasons for the Importance of this policy
One out of every three Iraq and Afghanistan Veterans suffers from PTSD, Traumatic Brain Injury (TBI) or a combination of the two due to combat trauma. Upon returning home, our troops are not receiving proper medical and psychological evaluation or counseling. It’s up to them to seek the help they need and often this help is not easy to find or to access (Burge, 2011). A third of all homeless citizens in America are Veterans. Due to many of the factors discussed here, Veterans with distinguished, even heroic, military records are ending up living on the streets. Do to untreated PTSD or TBI and self medication with drugs and alcohol, many Veterans are finding themselves in conflict with the criminal justice system. Special Veterans Courts are the appropriate response to these problems (Burge, 2011). The cost of PTSD to the individual is high, as it often has comorbidities and significant symptoms that can been seen 10 years after onset (Sharpless & Barber, 2011). One of the barriers that Veterans face, when seeking mental health treatment, is getting an appointment in a timely manner, which is a resulted from lack of providers to fill the appointment slots (US Department of Veteran Affairs, 2014). The majority of mental health specialties are found in urban areas, and only few to sometimes even none being found in rural areas, limiting access to mental healthcare for patients in rural areas (VHA Office of Policy and Planning Office of Rural Health (ORH), 2014).
Cost to Stakeholders
The largest single barrier to timely access to care, according to a VA audit, is the lack of provider appointment slots. An acute shortage of doctors in the VA, particularly in primary care, combined with a burgeoning patient population swelled by both aging veterans from the Vietnam war and younger ones who served in Iraq and Afghanistan, has led to long wait times for care. According to the VA, it is trying to fill 400 vacancies to add to its roster of primary care doctors, which numbered 5,100 in 2013. According to the Pentagon’s Task Force on Mental Health, the military’s “current complement of mental health professionals is woefully inadequate.” Only about one in three soldiers and marines who screen positive for PTSD once they come home report having received mental health care in theatre (APHA, 2014). Without a change to increase access to care for veterans, suicide rates will continue to be the highest they have ever been and co-dependence on illicit drugs and alcohol continue to be a problem within this population.
Conclusion
The APHA Policy Statement 20095 (The Role of Public Health Practitioners, Academics, and Advocates in Relation to Armed Conflict and War) states that “practitioners, educators, and other workers in public health can play powerful roles in mitigating the public health consequences of war.” Expanding access to high-quality mental health services among veterans is consistent with this APHA policy (APHA, 2014). In August 2017, the President signed the VA Choice and Quality Employment Act of 2017, which authorized $2.1 billion in addition funds for the Veterans Choice Program. This reflects the ongoing commitment of VA and Congress to make sure Veterans get the right care, at the right time, from the right provider. This new funding helps to ensure that Veterans continue to have access to care in their communities and that community providers are able to continue to provide care to eligible veterans and to receive payment for the care. VA will continue to work with stakeholders to secure funding for VCP for the remainder of FY2018 and to establish a single, consolidated community care program that is simple to understand, easy to administer, and meets the needs of Veterans and their families, community providers, and VA staff. This includes combining existing accounts for VA community care into one account or ensuring flexibility between accounts (U.S. Department of Veterans Affairs, 2017). As the VA continues to work with congress to address funding for the VA community, they should address policy change that would reflect on funding for VA clinics throughout the United States. These clinics could be staffed with Advanced Practitioners and provide care for any veteran with PTSD or other ailments. Many veterans suffer from alcohol use disorder as well as PTSD a comprehensive coordinated simultaneous treatment of both ailments has shown to have great improvements with frequent follow up (Allen et. al., 2016).
References
Allen, J. P., Crawford, E. F., & Kudler, H. (2016). Nature and Treatment of Comorbid Alcohol Problems and Post-Traumatic Stress Disorder Among American Military Personnel and Veterans. Alcohol Research: Current Reviews, 38(1), 133-140.
American Public Health Association. (2014). Removing Barriers to Mental Health Services for Veterans. Retrieved from https://www.apha.org/policies-and-advocacy/public-health-policy- statements/policy-database/2015/01/28/14/51/removing-barriers-to-mental-health-services-for- veterans
Burge, L (2011). Care2Causes. The Problems Facing American Veterans. Retrieved from http://www.care2.com/causes/the-problems-facing-america-s-veterans.html
Construction Program (2011):Retrieved from URL: http://www.independentbudget.org/2013/06-221- 230-CP-C.pdf
Sharpless, B. A., & Barber, J. P. (2011). A clinician's guide to PTSD treatments for returning veterans. Professional Psychology: Research And Practice, 42(1), 8-15. doi:10.1037/a0022351
U.S. Department of Veterans Affairs. Retrieved from https://www.va.gov/healthbenefits/access/appointments.asp
U.S. Department of Veterans Affairs. Access Audit—System-Wide Review of Access (May 12, 2014– June 3, 2014). Available at:www.va.gov/health/docs/VAAccessAuditFindingsReport.pdf. Accessed August 18, 2016
VHA Office of Policy and Planning Office of Rural Health (ORH). Fiscal Years 2012–2014—ORH Strategic Plan Refresh.Available at:www.ruralhealth.va.gov/docs/ORH_StrategicPlanRefresh_FY2012-2014.pdf. Accessed April 10, 2016
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American Journal of Nursing
Author Guidelines for Policy and Politics
The AJN column Policy and Politics focuses on the politics of health care and important public and health policy issues.
When submitting an article to be considered for the Policy and Politics column, include the following:
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a brief presentation of the policy issue or problem and why it’s pertinent to nurses or nursing (if that’s not obvious)
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background information essential to understanding the issue
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a summary of policy alternatives. Include the pros and cons of each
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a summary of the issue or a policy recommendation
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a resource box with Internet links to reputable sources for readers who would like more information or updates on the topic.
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relevant legislation at the federal, state, and local levels
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regulations that interpret or implement related laws
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who the relevant stakeholders are and their positions
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resources that are or would be necessary to implement the policy
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Citations must be provided for all facts, statistics, and quotations (although they may not be printed by us) for fact-checking. Consider how to organize. The Internet has many resources for writers; check http://webster.commnet.edu/writing/writing.htm for one set of links that may be helpful in determining an outline.
The preferred method of submission is as a Word document via the Internet at http://ajn.edmgr.com. For details on formats that are acceptable for submissions, go to the main page, under “files and resources,” then “system requirements.” To accommodate blinded peer review, do not place authors’ names anywhere in your submission. Authors should enter their information directly into the Web site and it will remain linked with their manuscript. This is a secure site; AJN editors control access to all submissions.
Length of article: 1,200 to 2,000 words; authors should send queries to associate editor Diane Szulecki at [email protected].