VETERAN AccEss To MENTAL HEALTH SERVIcEs
VETERAN accessto MENTAL HEALTHSERVICESCurrent Experiences and Future Design Opportunitiesto Better Serve Veterans and Front-Line Providers
If I’m 15 minuteslate, my appointmentis canceled. If you’retwo hours late,I still have to wait.I felt I wasinconveniencing alot of people.
WHAT THEY DON’TUNDERSTANDIS THAT PEOPLE WORK.YOU WANT ME TO TAKETIME OFF WORK TO SEEA THERAPIST?I KEPT HAVING TO TELLMY STORY OVER ANDOVER AND OVER AGAIN.1
About the VA Center for InnovationThe VA Center for Innovation (VACI) is a team of innovators and doerswithin the VA who are dedicated to driving innovation at the largestcivilian agency in the United States Government. The team at VACI doesnot believe in innovation for its own sake, but rather, in innovationthat provides a tangible value to VA and to Veterans. The work of VACIis driven by a strong commitment to a Veteran-centered approach toservice delivery, a dedication to data-driven decision making, and acommitment to design thinking.Since 2011, VACI has worked to identify, test, and evaluate newapproaches to VA’s most pressing challenges. Balancing the practicalwith the aspirational, VACI enables a steady influx of high valueinnovations into the VA, moving them from concept to operationalimplementation.About the Public Policy LabThe Public Policy Lab is a nonprofit innovation lab for government.We apply human-centered methods from design, behavioral science,and technology development to improve the creation of public policyand the delivery of public services. 2016 by the VA Center for Innovation and the Public Policy Lab.ISBN: 978-0-9886455-4-7This work is licensed under the Creative Commons AttributionNonCommercial-ShareAlike 4.0 International License. To view a copy ofthis license, visit http://creativecommons.org/licenses/by-nc-sa/4.0/
2Executive SummaryHOW WE WORKED81012IntroductionDiscovery MethodsDiscovery FieldworkWHAT WE FOUND1618Shared NeedsFindingsWHAT TO DO NEXT282632Quick WinsPilot ProjectsSystem TransformationsAPPENDIX 1:MAPPING MENTAL HEALTH ACCESS44A Service Map of Current Experiences & Design OpportunitiesAPPENDIX 2:MENTAL HEALTH PERSONAS50Personas for Mental HealthcareAPPENDIX 3:JOURNEYS TO CARE62Samples of Veteran and Veteran Supporter Stories Gathered During Fieldwork78Acknowledgments3
Executive SummaryWe set off across the country to learn more about Veterans’ journeysto mental healthcare, both the barriers and the bright spots. We heardstories exemplifying the dedication of VA employees or praising thepositive experiences with VA and non-VA programs. We also learnedabout unmet needs, so that we — as a community caring for Veterans— might reimagine and improve the pathways to access for mentalhealthcare services. Informed by real experiences of our Veterans andtheir families, this effort aims to illuminate actionable opportunities forimproving Veterans’ access to mental healthcare.4I JUST WISH I HADACCESS THATALLOWS YOU TO BESELF-SUFFICIENT.— VETERAN, NEW YORK
HOW WE WORKEDWe explored Veterans’ experiences seeking care, ultimately doinghuman-centered discovery with dozens of Veterans and theirsupporters across the country.WHAT WE FOUNDShared NeedsWe found four needs that are common to Veterans, their supportersand caregivers, and the mental healthcare system overall:clarity, community, continuity, and confidentiality.FindingsIF YOU’RE SEEING AVETERAN – 9 TIMESOUT OF 10 IT’SBECAUSE THEY HAVETO. WE WANT TO GETTO THEM BEFORECRISIS.— Veteran, new yorkWe identified 32 top findings, including: Without the transfer of a Veterans’ records (health and benefits)between VA service sites, Veterans feel burdened and frustrated withretelling their “story” and question VA care. For many Veterans, private providers and non-profits that offerconfidential, bureaucracy-free access to timely care feel like positiveand desirable alternative to VA processes. Veterans with low VA mental health disability ratings interpret theirrating to mean they should not seek mental healthcare (becauseother Veterans have greater need). Many feel offended and interpretthe low rating as VA’s invalidation of their personal experience.WHAT TO DO NEXTDrawing on our findings, we provide 11 recommendations for how toimprove access to care, across three timeframes.Opportunities include:Quick Wins Redesign intake screening forms to be easy and safe Design plain-language intake guidesPilot Projects PreCheck Veterans for mental healthcare Design and implement local matching toolsSystem Transformations Reimagine safe screening and intake processes Establish VA as a model for best-in-class mental careadditional informationIn our appendices, we provide: a map of mental healthcare access,placing our design recommendations in context; a set of VA designpersonas, refocused on mental healthcare; and the visualized storiesof some of the Veterans and Veteran supporters we spoke withduring fieldwork.5
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How we workedWe spent four weeks in the fieldtalking with over five dozen individuals— veterans, spouses, supporters,and healthcare providers — to geta multidimensional view of theexperiences Veterans and theirfamilies have when attempting toaccess mental healthcare. Herewe articulate our goals and themethods used to conduct the work.7
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how we worke d IntroductionIntroductionMy wife kept trying to get me to get help.I kept saying that I was fine. I am a stubbornjackass. It took her saying that she wasgoing to leave for me to get help.— Veteran , californiaWhen my [buddy] mentioned to me that I shouldthink about talking to somebody, it turned akey: if somebody else is externally identifyingthat I might be struggling, it’s probably a goodidea for me to do that.— Veteran , FloridaThese quotes are familiar refrains in the journey to mental healthcare.They describe a turning point when a person recognizes their need forhelp, sparked by either their own realization or another’s exhortation.It can take years to get to that point. But it only takes one moment, onereason, to not see it through. An unanswered phone, a curt receptionist, or a confusing form can make someone in need give up. The realization of the need for help, after all, is just the first step on the path toactually receiving care.Once people acknowledge they need mental healthcare, they have tofind it. They must figure out who to ask for help and how to ask. Unlike“physical” healthcare, which may require a patient to know very littleabout what is ailing them prior to gaining care (“Doc, my arm feelsfunny”), many mental care access points put the onus on the patientto know what type of provider and treatment to request. And then theymust navigate forms, websites, waiting areas, and referrals that wouldbe difficult to comprehend even without a struggling psyche.On top of that, VA has special requirements that create additional barriers, from questions of eligibility to Compensation & Pension exams.Veterans often laud the VA’s care once it’s delivered, but they recountfar more than one reason to turn away before that point. Many of thesehurdles may be surmountable, but to someone who is struggling theycan become unbearable.The journey to care — from the turning point when Veterans decide toget care to the subsequent path to seeking that care — is the focus ofthis report.9
h ow we worke d Discovery MethodsDiscovery Methodshuman-centered designVA is actively working to provide a seamless, unified Veteran experienceacross the entire organization and throughout the country. A Veteranwalking into a medical facility in Los Angeles, Detroit, or Ft. Harrisonshould have a consistent experience in each, from how warmly they’regreeted to what service is delivered.As part of this effort to fit Veterans’ needs, rather than asking Veteransto navigate the VA’s complicated structure, the VA is using humancentered design methods. Human-centered design is a multidisciplinary approach that draws from the practices of ethnography,cognitive psychology, and the design professions, from industrialdesign to communications design to service design. It is a practiceused widely across the private sector to build a strong understandingof users, generate ideas for new products and services, test conceptscollaboratively with real people, and ultimately deliver easy-to-useproducts and positive customer experiences.Typically, public agencies design and build services that reflectinstitutional requirements and general internal assumptions aboutusers. New services aren’t shared with users for feedback until late inthe development process or even after launch. At that point, it’s verydifficult to make changes; worse, an agency may have spent a greatdeal of time and resources toward solving the wrong problem entirely.In a human-centered design project, the behaviors, experiences,and preferences of an organization’s ‘users’ drive product, service,or technology design processes. (Users may be defined solely asend-users or customers of the organization, but are more typicallyunderstood as all the users of a product or service — meaning not justend-users but also front-line service providers, managers, deateprototypetestdeliverrefinebuildimplement
how we worked Discovery Methodsleaders, and third-party stakeholders such as contracted providersor community organizations.) The design process itself is phased,with specific activities in each phase to continuously understand andintegrate the preferences of users throughout.Discovery: Collecting and Using Thick DataThis report represents findings from discovery, the first phase of ahuman-centered design project. Design discovery builds on practicesfrom applied anthropology. It therefore has different methods andaims than other forms of information gathering with which readersmight be more familiar, such as surveys — a snapshot of peoples’opinions derived from a fixed set of questions — or ‘big data,’ thebehavior trends revealed by the layering of hundred of thousands ofanonymized data points.Rather, human-centered designers gather ‘thick data’ — informationthat merges insights into human meaning with an understanding ofthe social context in which human lives occur. Design researchers seekto engage with service users in the context of their own lives. Theymeet with people in their homes, workplaces, or communities andcollect life stories, high and low moments, and descriptions of people’sfeelings and desires — and the role the service plays in all of them.This work is personal and time intensive: in a typical design discoveryprocess, designers will speak with no more than 50 to 100 people.Those conversations alone will generate hundreds of pages ofresearch notes.Designers then subject this body of knowledge to synthesis, thedistillation and extraction of findings that represent the livedexperiences of multiple respondents. Those findings allow designersto diagnose a set of common needs and to identify future pathways fordesign — all grounded in the actual preferences of real service users.11
h ow we worke d Discovery FieldworkDiscovery FieldworkTo get a multidimensional view of the experiences that Veterans havewhen accessing mental healthcare, we spoke with a diverse group ofVeterans — both men and women, in urban and rural areas across thecountry, from four branches of service and both active and reservecomponents, representing all service eras from Vietnam to the present,career military and draftees, and enlisted and officer ranks.We also talked with Veterans’ family members, with front-line VA andprivate-sector service providers (in both medical and administrativeroles), with leaders at nonprofit organizations that focus on Veterans’mental health, and with a number of subject-matter experts in otheraspects of mental health treatment and healthcare administration andpolicymaking. Ultimately we spoke with more than five-dozen individuals and gained a rich picture of their frustrations and aspirations.Normally I callmy sis or dadeven though theydon’t understand.I don’t want to bea burden on myfamily. I don’t needanyone at my beckand call but itwould be nice tohave someone totalk with.Inquiry Areas— Veteran, californiaTo focus our inquiry into Veterans’ experiences when accessing mentalhealthcare, we identified four critical phases for exploration, spanningfrom people’s time in military service to the point when they are receiving mental healthcare. Each phase was explored as we attempted tobetter understand the processes and pathways people undergo to gainmentally healthy lives.military serviceHow does militaryservice shape people’sperceptions of mentalhealthcare and theirpathways to seeking it?12tu rn ing p ointWhat causes theturning point wherepeople decide to getmental healthcare?Our primary interests were the‘turning point’ moments whenVeterans decide to get care and theirsubsequent experiences seekingcare to fit their needs.seeking careWhat happens whenpeople seek mentalhealthcare from the VAor other providers?getting careHow does the natureof someone’s turningpoint and pathway tocare influence theirexperience receivingcare?
how we worked Discovery Fieldwork55interview participants8%HOURSveteranfa m ily m e m b er sf ront-lineprovider sof interviews withveterans, veteransupporters, andhealthcare pporters— Totals to more than 100% as some participants fit more than one category( 42 ) veterans( 8 ) healthcareexperts( 24 ) AllParticipants32%(21 ) female(44 ) maleV eteran ington, dcnorth carolinafloridanew yorknew hampshiremaine9.5%(4 )(27 )(4 )(7)air forcearmynavymarines64.3%13
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what we foundHere we lay out our top findings,as well as the four critical needswe believe all mental healthcarestakeholders share.15
w h at we f o u n d Shared NeedsShared NeedsOur discussions with Veterans, their families, frontline VA staff, and other stakeholderssuggested that the many different participants in mental healthcare share criticalcommon needs.safetyMany Veterans seeking mentalhealthcare need to feel safe and secure.easeMany Veterans seeking mentalhealthcare need processes that are readilyavailable, clear, and free of complex andnumerous steps.These shared requirements – for services that are both safe and easy – can serve asstarting points to design more Veteran-centric services and also address system needs.This multi-stakeholder approach to service design is especially important for thosewho need mental healthcare.16ClarityVeterans and other stakeholders need a clearunderstanding of Veterans’ choices for care and tangiblepathways for getting or providing that care.ContinuityWhen working through multiple steps to gain mentalhealthcare, Veterans and stakeholders benefit fromfamiliar and reliable interactions.CommunityMany Veterans and other stakeholders benefit from asupport network – a knowledgeable buddy, groups of peers,or colleagues – to enable successful access to care.ConfidentialityVeterans who seek mental healthcare (and those whoserve them) need to know their personal information willbe protected and secured.
what we f ound Shared NeedsV eteran sFront-Li ne VA Provi der sOt h er Hea lt h c are Stake h o l der sVeterans need easy-to-understand pathways to accessholistic care from the treatmentecosystem of both VA and nonVA providers; plain language innon-clinical terms is also critical.Front-line VA employees canbenefit from clear protocols, butalso the permission and resourcing to innovate in order to bestserve Veterans consistent withlocal and individual needs.Non-VA organizations stronglydesire clear, collaborative, andpublic pathways for making theirmental health services moreknown and accessible to Veteransand their families.Veterans need to navigate as fewhand-off points as possible onthe path to care; optimally, theyexperience no more than twosteps in the process of seekingthen receiving care, and they areable to form an ongoing relationship with care providers.Front-line VA employees feelmore professionally satisfiedwhen they can establish ongoingrelationships with Veteranswho need and seek mentalhealthcare.VA administrators need theefficiencies inherent in reducingmulti-touchpoint services. NonVA organizations need to beable to access and serve Veteransbefore they reach a crisis point,often the last step of a difficult,multi-step service journey.Many Veterans need and seekout peers during tough timesand often need mulitple ‘nudges’before making the step to accessmental healthcare.Many Front-line VA employeesdesire increased awarenessand pathways for referral tocommunity resources fromwhich Veterans can benefit.VA administrators and non-VAorganizations need productiverelationships with each other tobest enable improved and rapidaccess to helpful services withprotective community support.Veterans need to be able to trusttheir pathways to seeking andsubsequently getting care will bedelivered with utmost privacy andtransparency.Many Front-line VA employeesdesire clear guidelines on howto share Veteran informationwith other parties, to includeVeterans in information sharing,and to protect their own confidentiality.VA administrators need thesystem’s users, staff, and regulators to have confidence in VA’smanagement, and third-partyproviders need explicit pathwaysfor receiving and sharing backVeteran information in ways thatare professional and secure.17
h ow we workewh at we f o u n dd FindingsSection ContentFindingsThis section presents ideas, issues, and bright spots that emerged fromour fieldwork; these findings are the result of the analysis ofthe interviews with Veterans, their families, and other stakeholders.In the design approach to user research, this is known as the‘synthesis’ process.As Veterans told us about their personal experiences in attemptingto access mental healthcare, they describe many of the unmet needsthat form barriers to care. It also became clear that there are manyhelpful people doing yeoman’s work to connect Veterans with germaneservices. And while frustrations with ‘the system’ were common, thereare also bright spots that may warrant system-wide diffusion.18WE THINK THAT SERVICEDELIVERY MEANS‘I ALREADY GAVE YOUACCESS TO THAT.’IN ANY OTHER FIELD DOWE DO THAT?— VA Front-line Provider
what we f ound Findingsphase 1: military serviceMultiple preliminary mental-healthscreenings (e.g., C&P and clinical intake)feel confusing, inane, and invasive andlead to screening fatigue, evasiveanswers, and attrition.continuityIt’s very powerful for service membersto know that their commander orother respected leaders receive mentalhealthcare.communitym i l i tary s erv i c et urn i n g po i nts eek i n g c aregett i n g c arePoor post-military job placement hassignificant mental health impacts: lackof work exacerbates depression andsubstance abuse, creating lifelong harms.communityPerceived lack of confidentiality keepsmilitary service members from gettingmental healthcare from on-base providers– or at all. These perceptions of mentalhealthcare often follow Veterans intocivilian life and serve as a barrier to care.confidentiality19
h ow we workewh at we f o u n dd FindingsSection Contentphase 2: Turning pointVA primary care teams and privateproviders integrate mental healthscreening into primary care treatment.continuityWithout the transfer of a Veterans’records (health and benefits) between VAservice sites, Veterans feel burdened andfrustrated with retelling their “story” andquestion VA care.m i l i tary s erv i c et urn i n g po i nts eek i n g c arePreliminary mental health intakeexperiences (both benefits and health)can turn Veterans off from mentalhealthcare altogether and form a lastingnegative impression of VA services overall.continuity“if they belong to my tribe,then I trust them.”— Veteran, F loridacontinuity20gett i n g c are
how we workedwhat we f Sectionound FindingsContentVeterans with low VA mental healthdisability ratings interpret their ratingto mean they should not seek mentalhealthcare (because other Veterans havegreater need). Many feel offended andinterpret the low rating as VA’s invalidationof their personal experience.communityOpaque, multi-step, and duplicativeVA services (benefits and health) makeVeterans uncertain if they’ll get care anddiscourage them from starting the process.clarity“By chance he ran into someone heserved with . they spent threehours together. He came backfrom that and said, ‘I can’t getover how good I feel after I spokewith my buddy.’”— Veteran spouse, MontanaOn filling out VA PTSD FORM 0781:“She [VA employee] told me to picksomething you could google.What, so some clown in anoffice can validate the experiencefor me?”— Veteran, MontanaConcerns about loss of security clearanceor firearms access create a barrier toseeking mental healthcare.confidentialityKnowledgeable buddies play a critical rolein convincing wavering Veterans to seekmental healthcare and in helping themnavigate VA requirements and programs.community21
hwow we workeh at we f o u n dd FindingsSection Contentphase 3: seeking careA positive first visit to the VA builds trust inthe whole system and can improve uptakeof mental health treatment.continuityGetting transfered to multiple VA servicepoints and mental health providers feelsdisrespectful and exposing for Veterans.continuity22m i l i tary s erv i c et urn i n g po i nts eek i n g c aregett i n g c arePrivate providers and nonprofits can’taccess VA records or push informationback into VA systems, hampering effortsto provide holistic care and a seamlessservice journey.continuityFor many Veterans, private providersand nonprofits that offer confidential,bureaucracy-free access to timely care feellike a positive and desirable alternative toVA processes.clarity
what we f ound FindingsThe Compensation & Pension (C&P) examfeels confusing and unnerving to manyVeterans seeking mental healthcare, as itoften requires them to dredge up painfulexperiences with a stranger (someone theywill likely never see again).clarityEasy quick mental health intakeinteractions help Veterans feel that theyhave necessary control over their care.clarityVA forms and memory-recall requirementscan place medically inappropriatedemands on brain-injured Veterans andtrigger trauma symptoms in Veterans withPTSD.clarityVeterans lack reliable tools to sort, pick,and act on the multitudes of VA, privateproviders, and community servicesoffered. They feel overwhelmed and oftenturn away before they connect to care.clarity“My problem as a female veteranis different. Sometimes yourleadership and best friendsyou can’t trust and are actuallyout to get you.”— VETERAN, NORTH CAROLINAVA service environments can beunwelcoming, poorly signed, and offputting to Veterans (especially female andyounger Veterans), creating logistical andemotional barriers.clarity“First-timers” seeking mental healthcarefeel frustrated with the burden ofknowledge required to navigate a system(VA and non-VA) laden with clinicalterminology and complex processes.clarityVeterans reaching out to the VA forpreventative or pre-crisis mental healthtreatment feel like they are a lesserpriority than those in crisis.community23
hwow we workeh at we f o u n dd FindingsSection Contentphase 4: getting careEfforts to provide coordinated mentalhealthcare, from VA PACT teams ornonprofits that bring together providersfrom different sectors, are helping toidentify gaps in treatment.continuityPrivate providers feel dissatisfied with theVA reimbursement structure and timeline,leaving Veterans with high out-of-pocketcosts for non-VA mental healthcare.continuity24m i l i tary s erv i c et urn i n g po i nts eek i n g c aregett i n g c areMany Veterans feel extremely positivelyabout their alternative or holistic healingexperiences from private providers andcommunity services (e.g., outdoor-basedtherapies, yoga, etc.).clarityMany Veterans are dismayed (and leftfeeling like the VA wants to fob them withdrugs) when they are offered psychotropicmedication before exploring nonmedicated treatments options.clarity
how we workedwhat we f Sectionound FindingsContentMany Veterans want holistic mentalhealthcare: supportive pathways thataccount for medical treatment, familyinvolvement, counseling, addictiontreatment, and employment services.clarityFor some Veterans, treatment for mentalhealth conditions by or with otherVeterans, particularly from the sameservice era and branch, feels safe and isdeeply comforting.communityCommunity nonprofits provide Veteranswith mental health support by beingin service to others. This communityparticipation model feels helpful to manyveterans and can serve as an entry way formore formal treatment.communityVeterans feel the VA asks for patience andtolerance for system error but doesn’tafford the same courtesy to veterans inreturn, undermining trust in the system.communityNon-veteran mental health providers, atthe VA and in private practice, may beperceived by veterans as untrustworthy ifthey don’t understand military contexts ormindsets.communityThough not widely known, theconfidential, easy, and quick access tomental healthcare at Vet Centers providesthe privacy assurances and familyinvolvement many Veterans seek.confidentiality25
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what to do nextBuilding on our findings, we identifiedsome opportunities for improvingaccess to safe and easy-to-use mentalhealthcare (VA or otherwise).These opportunities fall into threemain categories:quick winsHave a rapid impact and make access easieralmost immediately.Pilot PROJECTSExplore approaches and measure impact beforerolling out on a larger scale.System TransformationsReimagine entire systems via large-scale institutionaland/or legislative change.27
w h at to d o ne x t Design OpportunitiesOMB Approved No. 2900-0659Respondent Burden: 1 hour 10 minutesExpiration Date: 8/31/2017VA DATE STAMPDO NOT WRITE IN THIS SPACESTATEMENT IN SUPPORT OF CLAIM FOR SERVICE CONNECTIONFOR POST-TRAUMATIC STRESS DISORDERSTRESSFUL (PTSD)INCIDENT NO. 26A. DATEINCIDENT(Mo.,day,thatyr.) occurred6B. LOCATIONINCIDENTState, Country,Province,landmarkForor militaryinstallation)INSTRUCTIONS:List thestressfulOCCURREDincident or incidentsin serviceOFthatyou feel (City,contributedto your currentcondition.eachincident, provide a description of what happened, the date, the geographic location, your unit assignment and dates of assignment, and the fullnames and unit assignments of you know of who were killed or injured during the incident. Please provide dates within at least a 60-day rangeand do not use nicknames. It is important that you complete the form in detail and be as specific as possible so that research of military recordscan be thoroughlyIf more spaceis needed,attach(Sucha separatesheet, indicatingthe item number to whichthe answersapply.6D. DATESOF UNITASSIGNMENT (Mo.,day,yr.)6C.conducted.UNIT ASSIGNMENTDURINGINCIDENTas, DIVISION,WING, BATTALION,CAVALRY,1. NAME OF VETERAN(First,SHIP)Middle, Last)2. VA FILE NO. FROMTOSTRESSFUL INCIDENT NO. 13A. DATE INCIDENTOCCURRED (Mo.,day,INCIDENTyr.) 3B. LOCATION OF INCIDENT (City, State, Country, Province, landmark or military installation)6E. DESCRIPTIONOF THEQuick Wins3C. UNIT ASSIGNMENT DURING INCIDENT (Such as, DIVISION, WING, BATTALION,CAVALRY, SHIP)3D. DATES OF UNIT ASSIGNMENT (Mo., day, yr.)FROMTOWhile VA has an opportunity to reimagine access tomental healthcare through a systems lens, it also6F. MEDALSOR CITATIONSRECEIVED BECAUSE OF THEhasmanyYOUopportunitiestoINCIDENTrespond to Veterans’urgent unmet needs now. Our discussions withINFORMATION ABOUT SERVICEPERSONS WHO WERE KILLED OR INJURED DURING INCIDENT NO. 2(ATTACHtheA SEPARATESHEETpointedIF MORE SPACEIS NEEDED)keyVeterans acrosscountryto several7B.RANK7A. NAME opportunitiesOF SERVICEPERSON (First, Middle,Last)7C. DATE OF INJURY/DEATH (Mo. day, yr.)for rapid improvement.3E. DESCRIPTION OF THE INCIDENT7E. UNIT ASSIGNMENT DURING INCIDENT (Such as, DIVISION,The “quick fixes” proposed belowwon’tsolveWING,BATTALION,CAVALRY, SHIP)larger-scale access issues, but they can have fastRANK8A. NAME impactOF SERVICEPERSONMiddle, accessLast)8C. DATEOF INJURY/DEATH (Mo. day, yr.)and(First,makeeasier 8B.forthose whoseekcare.These efforts can launch in8E. 2016.8D. PLEASECHECK ONEUNIT ASSIGNMENT DURING INCIDENT (Such as, DIVISION,7D. PLEASE CHECK ONEKILLED IN ACTIONWOUNDED IN ACTIONKILLED NON-BATTLEINJURED NON-BATTLEKILLED IN ACTIONWOUNDED IN ACTIONWING, BATTALION, CAVALRY, SHIP)3F. MEDALS OR CITATIONSYOU RECEIVED BECAUSEOF THE INCIDENTKILLED NON-BATTLEINJURED NON-BATTLE9. REMARKSINFORMATION ABOUT SERVICEPERSONS WHO WERE KILLED OR INJURED DURING INCIDENT NO. 1(ATTACH A SEPARATE SHEET IF MORE SPACE IS NEEDED)4A. NAME OF SERVICEPERSONLast)See the(First,nextMiddle,sectionfor4B. RANK4C. DATE OFINJURY/DEATH (Mo., day, yr.)more systemic opportunitiesfor wider-scalepiloting.I certify that the foregoing statement(s) are true and correct to the best of my knowledge and belief.4D. PLEASE CHECK ONE10. SIGNATUREKILLED IN ACTIONWOUNDED IN ACTIONKILLED NON-BATTLEINJURED NON-BATTLE4E. UNIT ASSIGNMENT DURING INCIDENT (Such as, DIVISION, WING, BATTALION,12. TELEPHONE NUMBERS (Include Area Code)CAVALRY, SHIP) 11. DATEDAYTIMEEVENINGPENALTY - The law(First,providessevereLast)penalties which include fine or imprisonmenttheDATEwillfulOFsubmissionof any statementor evidenceof a material5B. RANK or both, for5A. NAME OF SERVICEPERSONMiddle,5C.INJURY/DEATH(Mo., day,yr.)fact, knowing it is false, or fraudulent acceptance of any payment to which you are not entitled.PRIVACYinformationcollected DURINGon this formto any sourceotherthan what hasbeenBATTALION,authorized under the Privacy Act of5D. PLEASE CHECKONEACT NOTICE: The VA will not disclose5E. UNITASSIGNMENTINCIDENT(Suchas, DIVISION,WING,197
placing our design recommendations in context; a set of VA design personas, refocused on mental healthcare; and the visualized stories of some of the Veterans and Veteran supporters we spoke with during fieldwork. IF you’RE sEEINg A VETERAN – 9 TIMEs ouT oF 10 IT’s BE
Nov 01, 2017 · 34 Dorney, Thomas L Civilian/Non-Veteran: Chelsea MA: 36 Correia, Matthew J Civilian/Non-Veteran: New Bedford MA: 36 Gray, Matthew G Civilian/Non-Veteran: Worcester MA: 36 Paine, Lucas V Civilian/Non-Veteran: Gardner MA: 36 Pham, Cynthia Civilian/Non-Veteran: Quincy MA: 40 Sullivan, Michael T Veteran: Marshfield MA: 41 Reney, Dylan J Civilian .
Mental Health, Mental Health Europe NGO and the UK Royal College of Psychiatrists7. "No health without mental health" has also been adopted by the Irish organisation Mental Health Ireland, Supporting Positive Mental Health. Burden of Mental Disorders Mental disorders have been found to be common, with over a third of people worldwide
3.2 european Policy 12 3.4 Happiness and wellbeing debates 14 4.0 Concepts and definitions: what is mental health? 15 4.1 Dual continuum model of mental health 16 4.2 Measuring mental health 17 5.0 Benefits of mental health promotion 19 5.1 Benefits of preventing mental illness 19 5.2 Benefits of promoting positive mental health 22
3.1 Prevalence of mental ill health 9 3.2 Mental health service need 9 3.3 Mental health service provision gap 10 3.4 Housing system and homelessness 10 3.5 Entries into homelessness 11 3.6 Mental health and housing system capacity 12. 4 Links between housing and mental health 13 5 Housing for people with lived experience of mental ill health 16
A mental health policy (1996) and plan (2007-2011) existed. Emergency and disaster plans for mental health did not exist. Legislation A new Mental Health Act 846 2012 was passed in 2012 and was awaiting Government to establish the Mental Health Board. Financing of mental health services Mental health had a ring-fenced budget of 1.4% of
the veteran is called to Active Duty, a 22-1999b Notice of Change in Student Status should be completed. If the veteran is called to Active Duty, the veteran should give the employer a copy of the orders to put in the veteran’s file. When the veteran resumes training, a VA form 22-1999 is to be comple
mental health is about much more than mental illness, and that there are significant benefits to be gained by approaching mental health from a public health perspective. Positive mental health, mental wellness and mental health promotion have emerged as the missing pieces in a system that has traditionally been
GP Mental Health Treatment Better Access to Mental Health initiative Patients with a mental health condition, including those with chronic or non-chronic diagnosis, benefit from structured management of their treatment needs and referral to appropriate services. Medicare items for GP Mental Health Treatme nt Plans (GPMHTP), Reviews and c
