When Nichole Weakley worked as a behavior analyst helping military families, a glaring problem in getting veterans the help they needed was that some of her professional colleagues didn't understand military culture and how to navigate it.
As a military wife with three children, Weakley could tailor her approach to the stresses and challenges associated with military life. If a parent was about to deploy, she might hold off on starting an intense round of behavioral therapy for a child until the family had settled into a post-deployment routine. A clinician without a military background might not think to make that kind of change.
“Being able to be a part of that group really lets you open the door for true understanding,” she said.
The U.S. is facing a stark shortage of mental health professionals, and the challenge is affecting local communities as well as high-profile populations like veterans and current military servicemembers. While the Department of Veterans Affairs has responded by boosting hiring, some associations are trying to recruit a promising cadre of new workers to the profession: military spouses.
The National Military Family Association in recent months has ramped up its efforts to help military spouses enter the mental health profession with scholarships, mentoring programs and information to support training and licensure.
“There's access to providers, then there's access to providers who have the cultural competency about the military community,” said NMFA's executive director Joyce Wessel Raezer. "Who better than military spouses to provide that cultural competency?”
Although the association only has the funds to help 600 spouses with scholarships and financial support, it's also trying to make the aspiring mental health professionals aware of existing loan forgiveness programs and connect them with providers who can supervise their clinical hour requirements without compensation. And it's working with Give an Hour and United Health Foundation to boost its efforts with the Military Spouse Mental Health Pipeline.
But Raezer says there needs to be federal support for such measures in order for them to truly make a difference.
“There simply are not people to hire in some parts of the country, and I've heard stories about VA hiring basically everybody that's available in the community,” Davies said.
The VA already is trying to expand access through other means. More than 120,000 veterans received telepsychiatry appointments in 2015 with over 380,000 visits logged, according to Dr. David Carroll, executive director of VA's Office of Mental Health Operations. The health system also has a “transformative” initiative to integrate mental health services into primary care clinics, allowing veterans to receive the mental healthcare they need in one location even if there isn't a psychologist or psychiatrist on site.
“Veterans like that,” Carroll said. “They're more likely to follow through on the care when it's right there and they don't have to go to another clinic.”
In addition to the convenience, the VA care can be innovative and high quality as well. According to a study published in Psychiatry Online in April, VA's mental healthcare was superior to the private sector by more than 30%, and veterans suffering from schizophrenia or major depression were more than twice as likely to receive appropriate medication as individuals on private plans.
“In terms of healthcare dynamics, they're unique,” said Dr. John Santopietro, chief clinical officer of behavioral health at Carolinas HealthCare System. “They're a federal funding stream. They're not subject to the same funding stream as the rest of us.”
That steady funding allows the VA to be more dynamic and implement state-of-the-art treatments faster than the private industry, Santopietro said, noting that it can take 17 years for a treatment to go from the research phase to implementation in the private world.
But Santopietro said that bureaucracy makes it harder for the VA to recruit. The system is also trying to rebuild its reputation after long wait times and alleged cover-ups led top officials to resign.
According to the VA, its patient wait times are steadily dropping and mental health patients wait an average of 2.6 days to see a provider in August 2016 compared to high of 3.3 days in January 2015 in the last two years, based on their publicly reported numbers. However, those numbers don't include situations like a veteran calling a suicide hotline; Dr. Mike Davies, executive director of the VA's access and clinic administration program, says their numbers reflect when veterans actually request an appointment.
The U.S. Government Accountability Office has challenged VA's statistics with its own report, alleging the wait time average is 26 days from the first time a veteran contacts the VA system.
“This means that about half of people waited less than 26 days and half more than 26 days,” Davies said. “The GAO did not measure waiting times in these cases in the same way VA measures waiting times.”
Still, as the number of mental health patients has increased, Carroll maintains VA wait times have gone down, thanks in part to the department's hiring initiatives and its commitment to training mental health professionals. “We have a model where we have a recommended staffing level for the number of veterans that are being served in that facility or location,” Carroll said.
But hiring can be harder in some locations, and that's where VA's telehealth programs and contracting can come into play. Some local VA facilities have a long history of contracting out some services to private healthcare professionals and hospitals, and the overall system could benefit from expanding the use of those contracts, said Mark Covall, president and CEO of the National Association for Psychiatric Health Systems.
“Clearly, there are major challenges for the VA with respect to getting timely access in the case of mental health services,” Covall said, adding that contracting could help address some of that backlog.
Weakley has seen how that shortage affects military spouses firsthand; although she has a master's degree in behavioral neuroscience, a doctorate in school psychology and is finishing up a law degree, she's currently not a licensed psychologist because it's so difficult to transfer clinical hours and licensure requirements from state to state. As it stands, it's unfeasible for many military spouses to become licensed mental health clinicians, but she believes their personal experience can enhance their ability to help military and veteran families.
“Unless you face a deployment directly and even if you face a deployment as a child, it's very different than facing a deployment as a spouse,” she said. “I think when you're ingrained in this culture and have that understanding, it opens avenues of communication and creates empathy with the situations our families face.”