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Published on: February 16, 2011
Patient-centered mental health care for female veterans
Rachel Kimerling1, Lori A Bastian, Bevanne A Bean-Mayberry
1Dr. Kimerling is with the National Center for PTSD, Veterans Affairs (VA) Palo Alto Health Care System, Menlo Park, California ( rachel.kimerling@va.gov ). She is also with the Center for Innovation to Implementation at VA Palo Alto Health Care System, where Ms. Bucossi, Ms. Carney, Ms. Pomernacki, and Dr. Frayne are affiliated. Dr. Frayne is also with the Division of General Medical Disciplines, Stanford University School of Medicine, Stanford, California. Dr. Bastian is with the Health Services Research and Development (HSR&D) Pain Research, Informatics, Multi-Morbidities, and Education Center, VA Connecticut Healthcare System, West Haven, and the Division of General Internal Medicine, University of Connecticut Health Center, Farmington. Dr. Bean-Mayberry and Dr. Yano are with the HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Sepulveda, California. Dr. Bean-Mayberry is also with the Department of Medicine, University of California Los Angeles (UCLA) David Geffen School of Medicine, Los Angeles. Dr. Yano is also with the Department of Health Policy and Management, UCLA Fielding School of Public Health. Dr. Goldstein is with the HSR&D Center for Health Services Research in Primary Care, Durham VA Medical Center, and the Department of Medicine, Duke University, Durham, North Carolina. Dr. Phibbs is with the HSR&D Health Economics Resource Center, VA Palo Alto Health Care System, Menlo Park, California, and the Department of Pediatrics, Stanford University School of Medicine, Stanford, California. Dr. Sadler is with the HSR&D Center for Comprehensive Access and Delivery Research and Evaluation, Iowa City VA Health Care System, and the Department of Psychiatry, University of Iowa Hospitals and Clinics, Iowa City. Portions of this article were presented at the annual research meeting of the Academy Health, Baltimore, June 23-25, 2013.
Objective:
Mental health services for women vary widely across the Veterans Health Administration (VHA) system, without consensus on the need for, or organization of, specialized services for women. Understanding women's needs and priorities is essential to guide the implementation of patient-centered behavioral health services.
Methods:
In a cross-sectional, multisite survey of female veterans using primary care, potential stakeholders were identified for VHA mental health services by assessing perceived or observed need for mental health services. These stakeholders (N=484) ranked priorities for mental health care among a wide range of possible services. The investigators then quantified the importance of having designated women's mental health services for each of the mental health services that emerged as key priorities.
Results:
Treatment for depression, pain management, coping with chronic general medical conditions, sleep problems, weight management, and posttraumatic stress disorder (PTSD) emerged as women's key priorities. Having mental health services specialized for women was rated as extremely important to substantial proportions of women for each of the six prioritized services. Preference for primary care colocation was strongly associated with higher importance ratings for designated women's mental health services. For specific types of services, race, ethnicity, sexual orientation, PTSD symptoms, and psychiatric comorbidity were also associated with higher importance ratings for designated women's services.
Conclusions:
Female veterans are a diverse population whose needs and preferences for mental health services vary along demographic and clinical factors. These stakeholder perspectives can help prioritize structural and clinical aspects of designated women's mental health care in the VHA.
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