Veterans Report Barriers in VA Healthcare Experiences

Ann Cheney is an assistant professor in the department of social medicine and population health in the Center for Healthy Communities in the UC Riverside School of Medicine. Photo credit: Ross French, UC Riverside.

Ann Cheney, an assistant professor of social medicine, population, and public health in the School of Medicine, is the lead author on a paper published in BMC Health Services Research reporting that veterans using healthcare services at the Department of Veterans Affairs (VA) can face multiple potential barriers to the services, particularly mental healthcare.

Cheney, a member of the Center for Healthy Communities, and colleagues used a series of interviews to identify the barriers and asked a subset of the 80 veterans who participated in the study to explain the meaning of these barriers in their own VA healthcare experiences. The veterans in the study screened positive for depression, post-traumatic stress disorder, or alcohol use, and were current VA healthcare services uses.

The veterans:

• Expressed concern over stigmatizing labels such as “crazy” and “mental health patients” as well as military attitudes fostering feelings of weakness and failure.

• Indicated a lack of trust in the clinical encounter, which discouraged them from wanting to remain in care.

• Found their personal life struggles made it difficult for them to meet responsibilities, including healthcare services use.

• Encountered appointment problems, staffing issues, limited follow-up from VA healthcare providers and staff, and prioritization of some veterans over others.

• Were largely unaware of VA benefits prior to leaving military service, having limited knowledge of the processes required to obtain benefits, and struggling to understand the use of these benefits.

• Were fearful that their confidential and sensitive information would be shared and disclosed.

“Overall, we found that historical, socio-cultural, and psychological factors inform veterans’ decisions to engage with VA mental healthcare services,” Cheney said. “In particular, our findings show how distrust of the VA as a government institution influences some veterans’ VA mental healthcare services use.”

Cheney explained that military norms and values can stigmatize veterans seeking mental health treatment and influence their decisions about using healthcare following military service.

“Our veterans need support transitioning from the Department of Defense to VA healthcare system. We need communities of practice to facilitate service member and veteran care coordination to reduce barriers for veterans of all service eras,” she said.

Cheney was joined in the study by researchers at San Francisco State University; VA Boston Healthcare System; Harvard Medical School; San Francisco Veterans Affairs Health Care System; University of Arkansas for Medical Sciences (UAMS); VA Health Care System, North Little Rock, Ark.; VA Puget Sound Health Care System, Seattle, Wash.; and University of Washington, Seattle, Wash.

At the time of the study, Cheney was at UAMS and the Central Arkansas Veterans Healthcare System (CAVHS). She collaborated with Jeffrey Pyne, MD, at the CAVHS; he received support for the study from the Veterans Healthcare Administration.

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