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American Journal of Medical Quality
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Equity in Veterans' Mental Health Care: Veterans Affairs Medical Center Clinics Versus Community-Based Outpatient Clinics

JoAnn E. Kirchner, MD

Veterans Affairs Health Services Research and Development Center for Mental Healthcare and Outcomes Research at Central Arkansas Veterans Healthcare System, North Little Rock, kirchnerjoanne{at}uams.edu, VA South Central Mental Illness, Research, Education, and Clinical Center, Little Rock

Richard R. Owen, MD

Veterans Affairs Health Services Research and Development Center for Mental Healthcare and Outcomes Research at Central Arkansas Veterans Healthcare System, North Little Rock, Department of Psychiatry and Behavioral Sciences, Centers for Mental Healthcare Research, University of Arkansas for Medical Sciences, Little Rock, Arkansas, VA South Central Mental Illness, Research, Education, and Clinical Center, Little Rock

Nancy Dockter, MPH

Veterans Affairs Health Services Research and Development Center for Mental Healthcare and Outcomes Research at Central Arkansas Veterans Healthcare System, North Little Rock

Teresa L. Kramer, PhD

Department of Psychiatry and Behavioral Sciences, Centers for Mental Healthcare Research, University of Arkansas for Medical Sciences, Little Rock, Arkansas

Kathy Henderson, MD

VA South Central Mental Illness, Research, Education, and Clinical Center, Little Rock

Tracey Armitage, MS

Veterans Affairs Health Services Research and Development Center for Mental Healthcare and Outcomes Research at Central Arkansas Veterans Healthcare System, North Little Rock, Department of Psychiatry and Behavioral Sciences, Centers for Mental Healthcare Research, University of Arkansas for Medical Sciences, Little Rock, Arkansas, VA South Central Mental Illness, Research, Education, and Clinical Center, Little Rock

Elise Allee, MA

Department of Psychiatry and Behavioral Sciences, Centers for Mental Healthcare Research, University of Arkansas for Medical Sciences, Little Rock, Arkansas

This study examined differences in structures and processes of mental health care at Veterans Administration (VA) primary care clinics, comparing VA medical center (VAMC) clinics to community-based outpatient clinics (CBOCs). A survey was conducted of nurse managers at 46 of 49 primary care clinics (23 VAMC clinics and 23 CBOCs) within a VA health care network in the south central United States. Integration of care and services overall was comparable between VAMC clinics and CBOCs. The service mix differed. Integrated CBOCs more often offered group therapy, medication management, and smoking cessation. Integrated VAMC clinics more frequently used written suicide protocols and depression screening. Distance to offsite specialty care and wait times for referrals were shorter for patients at VAMCs than at CBOCs. The provision of mental health care at CBOCs is comparable to that at VAMC clinics, although differences in patient access to offsite care indicate that full equity was not achieved at the time of the survey. Since 2000, the VA has initiated several programs to address this need. (Am J Med Qual 2008;23:128-135)

Key Words: integration • depression • veterans • collaboration • mental health

This version was published on April 1, 2008

American Journal of Medical Quality, Vol. 23, No. 2, 128-135 (2008)
DOI: 10.1177/1062860607313144
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