National Alliance on Mental Illness
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VA Works to Increase Consumer and Advocate Involvement in Mental Health Programs

by Lucia Freedman, LCSW, VA Mental Health Coordinator of the National Mental Health Consumer Liaison Council

In 1997, the VA embarked on a pilot program to establish mental health consumer/advocate councils at the Veterans Integrated Service Network (VISN) level. The Committee on Care of Veterans with Serious Mental Illness (SMI) made a recommendation in the Second Annual Report (1998) to the Under Secretary of Health for the Department of Veterans Affairs to establish a "pilot project to enhance consumer involvement in VHA [Veterans Health Administration] through the establishment and operation of mental health consumer advisory committees that include consumers and consumer advocates at the VISN level." The National VHA Mental Health Consumer Liaison Council that works with the SMI Committee was in full support of the pilot, which was conducted at five sites. One of the lessons learned from the pilot was that it is beneficial to start mental health consumer councils at the medical center facility level.

The NAMI Veterans Committee was in the forefront of supporting the development of consumer/advocate councils. Today, there are mental health consumer councils in all but four VISNs, and many have councils at all the medical centers within the network. For many years, decisions about mental health policies and services were made without any input from consumers or their families. This has been a missed opportunity, as their voices can be essential in providing information to identify gaps in service and to strengthen programs. While the VA did have stakeholder meetings at the VISN level, it was not a forum where specific issues around mental health were brought up. Since the late 1970s, consumer and family organizations have had a growing influence on mental health services in the private sector. This has led to reducing stigma, preventing discrimination, and promoting recovery from mental illness.

Under Public Law 104-262, Congress charged the VA with providing specialized treatment and rehabilitative services to disabled veterans, including those with mental illness. The SMI Committee was charged with oversight of the VA’s ability to provide reasonable access to care and services for veterans with specialized mental health needs. The Committee is required by law to comment on the VA’s performance as part of the annual Capacity Report established by P.L. 104-262. The mental health consumer/advocate councils serve as a step toward the involvement of consumers, family members, and advocates to ensure that services will be provided for veterans who need mental health treatment.

Each of the VA consumer/advocate councils at the VA Medical Centers is unique and represents the community from which patients are drawn. Many councils have chosen to involve consumers, families, veteran service organizations, state veterans’ representatives, county veteran officers, local mental health organizations, and key VA staff. Such inclusive councils provide a forum in which issues that are important to consumers, such as service availability, medications, service gaps, and plans for mental health program development, can be discussed.

As part of the Guiding Principles from the VA Mental Health Chief Consultant for the VISNs, it was suggested that evidence should be available to demonstrate appropriate consumer and other stakeholder involvement and input. The existence of an active consumer/advocate council is such an indicator. The VISN mental health liaisons and the mental health directors at the VA medical facilities have shown leadership in establishing mental health consumer/advocate councils and have in some instances included the council as part of the "Network Director’s Performance Plan for Building Healthy Communities."

The VA provides care for nearly 800,000 veterans with mental illness, and research has shown that they depend on the VA for their care more than veterans with other medical conditions do. The future depends on building a system of care that incorporates the latest principles of recovery for veterans with mental illness. Providing an avenue for the voices of consumers and advocates to be heard within the VA will strengthen this system and will strengthen the community partnerships that will enhance the continuum of care for veterans in the community.