	Most Veterans in Our Review Received Care within 30 Days of Their Preferred Dates, but VHA’s Method of Calculating Wait Times Does Not Always Reflect Overall Wait Times

The 100 veterans included in our review received a full mental health  evaluation in an average of 4 days of the date they preferred to be seen  (known as the preferred date). The full mental health evaluation is the  primary entry point to mental health care. At the five VAMCs we visited,  the average time in which a veteran received this full evaluation ranged  from 0 to 9 days from the preferred date. However, we identified conflicting VHA policies regarding how long it  should take a new veteran to receive a full mental health evaluation: (1) a  14-day policy established by VHA’s Uniform Handbook for Mental Health  Services, and (2) a 30-day policy set by VHA in response to the Choice  Act. Because VHA uses a veteran’s  preferred date as the basis for its wait-time calculations, rather than the  date that the veteran initially requests or is referred for mental health  care, these calculations only reflect a portion of a veteran’s overall wait  time. On average, our review of 100 new veteran medical records found  that a veteran’s preferred date was 26 days after his or her initial request  or referral for mental health care, though this varied by VAMC. VHA Monitors Access to Mental Health Care, but Current Policies Cannot Ensure Reliable Data, Which Precludes Effective Oversight

VHA monitors access to mental health care, but the lack of clear policies  may contribute to unreliable wait-time data and precludes effective  oversight. Among other reasons contributing to the potential unreliability  of VHA wait-time data, we found VHA’s wait-time data may not be  comparable over time or between VAMCs. Data may not be comparable over time. VHA has not clearly communicated the definitions used or  changes made to these definitions used in its wait-time calculations,  which is contrary to federal internal controls standards that call for  management to communicate reliable and relevant information in a  timely manner. This limits the reliability and usefulness of these data  in determining progress in meeting stated objectives for veterans’  timely access to mental health care. Data may not be comparable between VAMCs. When VAMCs use  open-access appointments, data may not be comparable across  VAMCs. Open-access appointments are typically blocks of time for  veterans to see providers without a scheduled appointment. Without guidance on how appointment  scheduling for open-access clinics is to be managed, VAMCs can  continue to implement these appointments inconsistently, and place  veterans on lists outside of VHA’s scheduling system, potentially  posing serious risks to veterans needing mental health care.
Why GAO Did This Study

This testimony summarizes the information contained in GAO's October 2015 report, entitled VA Mental Health: Clearer Guidance on Access Policies and Wait-Time Data Needed ( GAO-16-24 ).

What GAO Found

The way in which the Department of Veterans Affairs’ (VA) Veterans Health Administration (VHA) calculates veteran mental health wait times may not always reflect the overall amount of time a veteran waits for care. VHA uses a veteran’s preferred date (determined when an appointment is scheduled) to calculate the wait time for that patient’s full mental health evaluation, the primary entry point for mental health care. Of the 100 veterans whose records GAO reviewed, 86 received full mental health evaluations within 30 days of their preferred dates. On average, this was within 4 days. However, GAO also found
veterans’ preferred dates were, on average, 26 days after their initial requests or referrals for mental health care, and ranged from 0 to 279 days. Further, GAO found the average time in which veterans received their first treatment across the five VA medical centers (VAMC) in its review ranged from 1 to 57 days from the full mental health evaluation.
conflicting access policies for allowable wait times for a full mental health evaluation—14 days (according to VHA’s mental health handbook) versus 30 days (set in response to recent legislation) from the veteran’s preferred date—created confusion among VAMC officials about which policy they are expected to follow. These conflicting policies are inconsistent with federal internal control standards and can hinder officials’ ability to ensure veterans are receiving timely access to mental health care.
VHA monitors access to mental health care, but the lack of clear policies on wait-time data precludes effective oversight. GAO found VHA’s wait-time data may not be comparable over time and between VAMCs. Specifically
data may not be comparable over time. VHA has not clearly communicated the definitions used, such as how a new patient is identified, or changes made to these definitions. This limits the reliability and usefulness of the data in determining progress in meeting stated objectives for veterans’ timely access to mental health care.
data may not be comparable between VAMCs. For example, when open-access appointments are used, data are not comparable between VAMCs. Open-access appointments are typically blocks of time for veterans to see providers without a scheduled appointment. GAO found inconsistencies in the implementation of these appointments, including one VAMC that manually maintained a list of veterans seeking mental health care outside of VHA’s scheduling system. Without guidance stating how to manage and track open-access appointments, data comparisons between VAMCs may be misleading. Moreover, VAMCs may lose track of patients referred for mental health care, placing veterans at risk for negative outcomes.