Veterans Affairs Clinical Resource Hub Improve Access to Mental Health Services for Rural Veterans

Access to high-quality mental health (MH) care in rural communities remains a persistent challenge. In 2019, the Veterans Health Administration (VA) developed 18 regional Clinical Resource Hubs (CRH) to increase Veteran access to clinical services, mainly through telemedicine and telemental health. This study evaluates trends in CRH MH services among Veterans residing in rural areas for the first 5 years of the program.

This retrospective cohort study utilized CRH MH encounter data (i.e., clinical visits or patient contacts) from the VA Corporate Data Warehouse for the first 5 years of the CRH program (Fiscal years [FY] 2020-2024) with a focus on rural and highly rural Veterans. Veteran demographics and clinic characteristics were collected, and measures were aggregated for each FY. Descriptive statistics were calculated using independent t-tests for continuous variables and Fisher's exact or Chi-square tests for categorical variables.

Using primarily telemental health services, CRH MH teams completed 627,436 encounters, with 81.9% delivered via telemedicine among Veterans residing in rural or highly rural areas. Care delivery shifted substantially over 5 years, with video visits to a patient's homes increasing from 9.2% to 64.3% while clinic-based video visits declined from 77.5% to 7.1%. Racial and ethnic diversity increased steadily over time, especially among Black and Hispanic Veterans. Between FY20 and FY24, encounters for depressive disorders decreased slightly while encounters for anxiety disorders, posttraumatic stress disorder, and attention-deficit/hyperactivity disorder diagnoses increased.

Veterans in rural and highly rural communities often struggle to access MH care, and the CRH MH program was designed to utilize primarily telemental health to fill in these gaps to improve Veteran access. During the first 5 years of the CRH MH program, the amount of MH care provided to rural Veterans more than doubled with expanded site participation and an increasingly diverse patient population over time.