Bridging Gaps in Mental Health Care Access: Evidence From a Nonprofit Telehealth Service for Military Veterans

Prior research has demonstrated the effectiveness of free, nonprofit mental health treatment programs for U.S. military veterans, but little is known about the characteristics and needs of veterans who use these services. This study aimed to examine demographic and clinical profiles of veterans receiving free tele-mental health care, with a focus on veterans' self-reported access to other treatment options.

Veterans (N=148) who completed evidence-based mental health treatment were assessed for demographic factors, pre- and posttreatment psychological symptoms, and self-reported access to other mental health services. Psychological distress (six-item Kessler Psychological Distress Scale [K6]), depressive symptoms (Patient Health Questionnaire-9 [PHQ-9]), posttraumatic stress (Posttraumatic Stress Disorder Checklist for DSM-5 [PCL-5]), and lifetime suicidality (Suicide Behaviors Questionnaire-Revised) were measured before treatment. The K6, PHQ-9, and PCL-5 were assessed after treatment. Veterans self-reported "likely," "unsure," or "unlikely" access to other mental health services.

Nearly half (49%) of participants reported unlikely or unsure access to other mental health services. Compared with veterans reporting likely access, those reporting unlikely access had higher pretreatment psychological distress (p=0.02), depressive symptoms (p=0.02), and posttraumatic stress (p=0.02) and a greater likelihood of meeting criteria for severe psychological distress (K6 score ≥13, p=0.003) and for probable major depressive disorder (PHQ-9 score ≥10, p=0.02). Clinically meaningful treatment responses, measured by remission rates and symptom reduction, were consistent across care access levels, indicating equitable delivery and efficacy.

Free, nonprofit tele-mental health services can reach many veterans who otherwise might remain untreated, bridging gaps in care access and promoting equitable outcomes.