This report published in Psychiatric Services analyzed spending on mental health and substance use disorder treatment in the Department of Veterans Affairs, finding that from 2000 to 2006 costs decreased each year. However, in 2007, the agency experienced a large increase in spending.

Wagner, T. H., Sinnott, P. and Siroka, A. M.  Mental health and substance use disorder spending in the Department of Veterans Affairs. Psychiatric Services, 62:389-395. doi: 10.1176/appi.ps.62.4.389. http://psychservices.psychiatryonline.org/cgi/content/abstract/62/4/389

Authors: Todd H. Wagner, Patricia Sinnott, and Andrew M. Siroka

The RAND Corporation released a study examining the behavioral health needs of veterans of the wars in Iraq and Afghanistan. Using information gleaned from interviews with veterans living in New York State, the authors found that veterans have a substantially elevated rate of depression and post-traumatic stress disorder (PTSD). The report notes that both the U.S. Department of Veterans Affairs (VA) and non-VA services are critical for addressing veterans’ behavioral health needs. The authors propose that policymakers reduce barriers to treatment, improve the adherence to treatment, and improve the quality of services.

From the study:

Since October 2001, approximately 2 million U.S. troops have deployed as part of Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF). Although not always counted as official casualties by the U.S. Department of Defense (DoD), mental health disorders and other types of impairments resulting from deployment experiences are beginning to emerge.

DoD, the U.S. Department of Veterans Affairs (VA), and Congress have moved to study the issues, quantify the problems, and formulate policy solutions. They are beginning to implement the hundreds of recommendations that have emerged from various task forces, commissions, and research reports. However, despite widespread policy interest and a firm commitment from the military services to address these injuries, fundamental gaps remain in our knowledge about the needs of veterans returning from Iraq and Afghanistan, the adequacy of the care system available to meet those needs, and the experiences of veterans and service members who use these systems.

Full Report: A Needs Assessment of New York State Veterans: Final Report to the New York State Health Foundation (PDF | 704 KB) 

RAND Corporation. (2011). A needs assessment of New York state veterans: final report to the New York State Health Foundation. Schell, T. and Tanielian, T. 

The Congressional Budget Office (CBO) released a report examining the cost of veterans’ health care, projecting that the cost of providing care in 2020 will be significantly higher than Congress’ recent veterans’ health care appropriations. 

From the report:

The Department of Veterans Affairs (VA) provides health care at little or no charge to more than 5 million veterans annually. Medical services are provided through the inpatient and outpatient facilities run by the Veterans Health Administration. Those services include routine health assessments, readjustment counseling, surgery, hospitalization, and nursing home care.

 

Full Report: Potential Costs of Veterans’ Health Care (PDF |110 KB) 

Congressional Budget Office. (2010). Potential costs of veterans’ health care.

At the request of Congress, the Institute of Medicine (IOM) published a preliminary assessment of the needs of U.S. military personnel returning from the wars in Iraq and Afghanistan.  The report notes that long-term costs are difficult to predict because the wars are fundamentally different from previous American wars.  However, the IOM issued preliminary recommendations for the Department of Veterans Affairs (VA) and the Department of Defense (DOD) to assess the scope and magnitude of the problems facing new veterans and their families.  IOM recommends that the federal government estimate the number of mental health professionals needed to meet the new demand and determine where to locate them to best serve the returning service members and their families.  In addition, IOM recommends that the DOD and VA conduct or fund research to develop guidelines for long-term care management and assess the effectiveness of existing and planned services.

From the report:

Nearly 1.9 million U.S. troops have been deployed to Afghanistan and Iraq since October 2001. Most return successfully to their normal lives, but many have encountered serious challenges readjusting after their return home. These wars are unlike past conflicts, and the demographics of the all-volunteer military population have changed drastically since the previous war. Many service members deploy multiple times; reservists and National Guard members are called to active duty at an unprecedented rate; more service members are returning home with severe injuries; and more women and parents of young children serve on active duty. These unique circumstances cause unique problems for service members, veterans, and their families, both during and after deployment to Iraq and Afghanistan.

In 2009, Congress asked the IOM to conduct a two-phase study to examine the physical, mental, and other needs of military personnel returning from the conflicts in Iraq and Afghanistan, and of veterans and their family members. This preliminary report presents findings on the scope and magnitude of the problems facing these populations, and lays out a plan for the detailed assessment in the second phase. In the interim, this initial report makes several recommendations that the Department of Defense (DoD) and Department of Veterans Affairs (VA) can act on now, including:

• estimating the number of mental health professionals needed and where they should be located to best care for the full population of returning service members and their families;
• conducting or funding research to develop guidelines for long-term management of polytrauma and traumatic brain injury; assessing the potential benefits of third-location decompression; examining how multiple deployments may affect domestic violence; and evaluating the effectiveness of mental health treatments for women and minorities;
• coordinating and evaluating the many existing readjustment and support programs to maximize their reach and effectiveness;
• producing annual long-term forecasts to ensure the VA will have the resources to care for and support this generation of veterans and family members throughout their lifetimes.
  

Full report: http://www.iom.edu/Reports/2010/Returning-Home-from-Iraq-and-Afghanistan-Preliminary-Assessment.aspx

Institute of Medicine. (2010). Preliminary assessment of readjustment needs of veterans, service members, and their families.

A study published in Health Affairs estimated that the VA’s Health IT system, the Veterans Health Information Systems Information Architecture (VISTA), may have saved the VA $3.09 billion between 1997 and 2007.  The researchers suggest that VISTA has made the provision of health care more efficient, with the biggest savings coming from its component electronic records infrastructure.  However, researchers note that the study only examined potential savings and emphasized the need for empirical studies.

Byrne, C.M., Mercincavage, L.M., Pan, E.C., Vincent, A.G., Johnston, D.S., Middleton, B. Health Affairs, 29(4): 629-638. doi: 10.1377/hlthaff.2010.0119
The value from investments in health information technology at the U.S. Department Of Veterans Affairs. http://content.healthaffairs.org/cgi/content/abstract/29/4/629

Authors: Colene M. Byrne, Lauren M. Mercincavage, Eric C. Pan, Adam G. Vincent, Douglas S. Johnston and Blackford Middleton

At the request of Congress, the Institute of Medicine (IOM) published a preliminary assessment of the needs of U.S. military personnel returning from the wars in Iraq and Afghanistan.  The report notes that long-term costs are difficult to predict because the wars are fundamentally different from previous American wars.  However, the IOM issued preliminary recommendations for the Department of Veterans Affairs (VA) and the Department of Defense (DOD) to assess the scope and magnitude of the problems facing new veterans and their families.  IOM recommends that the federal government estimate the number of mental health professionals needed to meet the new demand and determine where to locate them to best serve the returning service members and their families.  In addition, IOM recommends that the DOD and VA conduct or fund research to develop guidelines for long-term care management and assess the effectiveness of existing and planned services. 

From the report: 

Many men and women return from the war zone successfully and adjust to their lives out of theater, but others have difficulty in readjusting or transitioning to family life, to their jobs, and to living in their communities after deployment. Numerous reports and articles in the popular press have drawn attention to those readjustment issues and have suggested that onset or exacerbation of mental disorders - particularly posttraumatic stress disorder (PTSD), anxiety disorders, and depression - might hinder readjustment. In addition, traumatic brain injury (TBI), often called the signature wound of Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF), is associated with a host of long-term adverse health outcomes, such as unprovoked seizures, decline in neurocognitive function, dementia, and adverse social-function outcomes, including unemployment and diminished social relationships, depression, and aggressive behaviors.

Full report: http://www.iom.edu/Reports/2010/Returning-Home-from-Iraq-and-Afghanistan-Preliminary-Assessment.aspx 

Institute of Medicine. (2010). Preliminary assessment of readjustment needs of veterans, service members, and their families. Board on the Health of Select Populations.