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Spotlight: Veterans Mental Health Councils| South Central MIRECC

This is the full interview for the Veterans Mental Health Councils article that appeared in the November 2017 issue of the South Central MIRECC Communique Newsletter.

Putting Veterans Perspectives Front and Center: Veterans Mental Health Councils

November 2017 - This month we are excited to share an interview with Dr. Peggy Henderson, the national VA Point of Contact for Veterans Mental Health Councils (VMHCs), who gives us insight into how the councils help Veterans and other stakeholders provide input in VA mental health care.  

Q. Can you tell us a bit about the purpose and history of VA mental health consumer councils?

In 2003, the President’s New Freedom Commission on Mental Health addressed problems in America’s fragmented mental health service delivery system. In his charge to the Commission, President Bush directed its members to study the problems and gaps in America’s mental health system and make concrete recommendations for immediate improvements that the federal government, state governments, local agencies, and public and private health care providers could implement. One of the goals of the Commission was to transform the mental health system to a recovery orientation, one component of which is to “involve consumers and families fully in orienting the mental health system toward recovery.” 

VA took the New Freedom Commission’s recommendations very seriously and developed the Uniform Mental Health Services Handbook (UMHSH) to implement its goals. In that document, VA medical centers are strongly encouraged to facilitate the Veterans Mental Health Councils. A VMHC is a group of Veteran mental health consumers, Veteran family members, and other relevant stakeholders who provide input into VA Mental Health Services. Each council has a VA staff liaison assigned to help the council partner with the local VA facility.

The council’s purpose is to share the unique perspective of the Veteran (and family members), particularly the input of the Veteran who is or has been the recipient of VA Mental Health programs and services. The goal is for councils to work in partnership with the local facility and to foster open communication between VA Mental Health and Veterans. Councils are an opportunity for VA and Veterans to learn from each other, to collaborate, and to promote greater understanding of VA and use of VA MH services by all Veterans and their families. Although some councils began in the 1990s, there was a huge increase in the creation of VMHCs in 2008, in response to the VA’s Uniform Mental Health Services Handbook (UMHSH). Currently, there are 115 VMHCs affiliated with VA facilities nationwide.
 
Q. How do Veterans feel about participating in these councils? What outcomes do they see from their participation?  

Most Veterans who are long term participants on VMHCs have found their council participation beneficial. Some quotes from Veterans serving on VMHCs are below:

• “It gives me a sense of purpose that I am doing something to advocate and assist my fellow Veteran to assure that he or she receives the best quality of mental health care they both deserve.”
• “I personally think having a voice and being able to help our fellow Veterans is the biggest thing. Personal growth and building working relationships with programs so we can help others is the outcome I try to get.”
• “I personally think participating on the council is important because my opinions as a Veteran are important.”
• “We need to educate the community - at - large - on various mental health issues. That's why participating is important.”
• “Veterans feel empowered to participate in their own recovery process because they feel they have a voice and platform to address their whole health and wellness. By participating on the Council, the members feel they demonstrate how to use and build on the skills learned to improve their health and well-being can be used to facilitate change at the VAMC.

All happy councils are alike; each unhappy council is unhappy in its own way (apologies to Leo Tolstoy’s Anna Karenina). VMHCs vary widely in their ability to partner internally (working well with other council members) and externally (with the local VA mental health service line and with the VA staff liaison). Each VMHC is unique, with unique goals and objectives. Councils that are able to partner well tend to have the best outcomes. Such outcomes can include producing community events focused on suicide prevention, anti-stigma, or mental health awareness, promotion of peer support and recovery within VA, advocating for additional recreational activities on VA inpatient mental health units or for the special needs of women Veterans.

Other councils have partnered with the facility to produce an assessment of recovery within the mental health department, are the “voice” of the Veteran in VA Mental Health Executive Boards, provide input on VA mental health handbooks, and have alerted the local facility to problems that Veterans are experiencing with local VA services.  Perhaps the words of a local VMHC says it best; “The Council members see the appreciation and support for Veterans by Veterans regarding Veterans needs when they have felt confused, wounded, and let down. Veteran participation on the Council shows medical center staff and leadership that focusing on what matters most to Veterans increases their sense of security and allows them to set and accomplish their mental health goals.”
 
Q. How have these councils changed to best suit members needs and reflect VA priorities? 

VMHCs are independent entities and are not managed by VA, and all the members of the VMHC serve without monetary compensation from the VA. Like similar community boards or committees that rely on the time and energy of volunteers, recruitment and retention of members is frequently an issue. Councils are encouraged to make recruitment and retention of members a priority, and VMHCs are strongly encouraged to work hard to have a diverse membership, including diversity in race, ethnicity, gender, and military service era. 

Many VMHCs have found that personal recruitment tends to be the most successful recruitment tool. Other recruitment methods include having VMHC brochures or fact sheets widely available, creating VMHC outreach events, placing VMHC tables in highly trafficked areas of the local facility, and specific recruitment efforts targeting Mental Health Residential Rehabilitation and Recovery Treatment Programs (MHRRTP), Psychosocial Rehabilitation and Recovery Centers (PRRCs), and similar VA programs.

VMHCs have also outreached to the local VA Public Affairs office, which has led to some VMHCs being featured in newsletters, VA daily announcements, or on the VA website. These efforts raise awareness of the VMHC’s existence within the VA and in the community. Most VMHCs find that recruitment is most effective when building on existing relationships. Community mental health partners or Veteran Service Organizations (VSO) can also be invited to attend council meetings, if the council so desires. 

Q. Can you highlight a few of the most important lessons your office has learned from VMHCs?

1. We have found that VMHCs and the VA have the same mission and purpose—to advocate for Veterans. Leveraging the passion, enthusiasm, and expertise of Veteran perspectives and input is crucial to ongoing improvement of VA mental health services.
2. The time invested in forging open, positive, and respectful relationships with the council members early in the VMHC development is well worth the effort. It takes time for a council to develop, and one can expect ‘fits and starts’ as the council works to understand its role and purpose. Patience is a must!
3. Truly listening to the VMHC and working with them to find solutions to their concerns is vital. Sometimes the VA is not able to act on a VMHC suggestion. If that is the case, VA leadership should have a conversation to explain why and to explore other solutions or partial solutions to the concern. Engaging in a diplomatic conversation with a VMHC can help the Veterans understand the regulations and strictures VA is under. Their increased understanding of VA can help them grow into more effective VA partners who benefit themselves, Veterans, and VA.
4. VA mental health departments that proactively solicit VMHC input with projects often find that VMHCs provide valuable expertise.

Q. Can you highlight a few best practices you recommend for facilities or VA program offices starting or maintaining VMHCs?

1. It is crucial that the VMHC develop strong VMHC bylaws and Standard Operating Procedures (SOP) very early in the process. Almost all VMHCs will experience some ‘growing pains’ and conflict at some point. Strong bylaws and established SOPs will enable the VMHC to better weather these challenges and struggles. Without these crucial documents, a VMHC in conflict may fail.
2. VMHCs should strive to develop a culture of positivity, respect, and civility. VMHCs that work hard to partner with others are the most effective and the most likely to achieve their mission. This will take time and effort on the part of the council members and the staff liaison.
3. Local VA mental health leadership is strongly encouraged to periodically attend VMHC council meetings to get to know the VMHC, its members, and its mission. This promotes a sense of empowerment and relevance to the VMHC and will help ensure that the council is a beneficial partner to the facility.
4. Despite the fact Councils are an independent entity; the staff liaison needs to provide guidance and support. Otherwise, the Council may have difficulty partnering with leadership and accomplishing projects. Staff liaisons are facilitators of the Council’s goals – providing encouragement, helping them stay focused, and defining, articulating, and achieving their goals.
5. Document the Council’s activities, accomplishments, and efforts.

Q. Is there anything you want to tell me about VHMCs that I have not asked?

VA has embarked on a mission to modernize its health care system. This effort is designed to deliver “exceptional, coordinated, and connected” Veteran-driven care that ensures that the Veteran is at the center. Getting the Veterans’ input on the health care provided to them is a key component of the modernization effort. VMHCs are a unique way to partner with Veterans, to listen to Veterans, and to receive firsthand information on how Veterans experience VA mental health programs. This information is a gift to VA mental health leaders that can be used to improve the wonderful mental health programs that VA offers and to modify what we do to best fit the needs of local Veterans.  

Thank you for this opportunity to talk about VMHCs. 

Last updated: May 11, 2021

Last updated: November 8, 2017

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