On April 7th, NAMI Montana was honored to be able to meet with the new Secretary of the Veterans Administration Denis McDonough, Senator Jon Tester, Senator Steve Daines, Congressman Matt Rosendale, and a variety of veterans advocates in Helena, Montana.

It was a really powerful meeting and show of bipartisan solidarity for caring for our nation’s veterans. It really meant a lot to us to hear about the progress and focus going into the Commander John Scott Hannon Act.

Here is the the text of the document we left behind with Secretary McDonough. It highlights some of the issues NAMI Montana is asking the Secretary and his team to work on. You’ll notice the writing was a little bit clipped. I was trying to fit it onto a single-two sided page with readable font.


April 7, 2021

Secretary McDonough,

Thank you for your service to our nation’s veterans and for coming to Montana. NAMI Montana supports, educates and advocates for Montanans with mental illness and their families. We also have a track record of national-level veterans mental health advocacy having played leadership roles on Congressional initiatives to improve mental health screenings in the Department of Defense (October 2009) and veterans’ mental health (Commander John Scott Hannon Act, October 2020). We currently serve on your National Research Advisory Council and previously served on the Creating Options for Veterans Expedited Recovery (COVER) Commission. NAMI Montana would like to highlight a few issues that we think are worthy of consideration by you and your team:

Suicide Prevention in the Emergency Room — A report on this program is one of the sections that we personally advocated for in the Hannon Act. In our opinion, this program is the low-hanging fruit for veterans’ suicide prevention. The program has really blossomed under the leadership of Dr. Matt Miller Ph.D., MPH. That expansion brings with it the need to ensure the follow-up conversations required by the program after an emergency department visit are consistently happening. By 2022, we believe it will be time to discuss how to roll this program out virtually to veterans being seen in non-VA emergency departments.

Lack of Crisis Services — The Montana VA shut down its acute crisis services in 2015. Since that date, the Montana VA has relied primarily on hospitals to provide those acute crisis services before transitioning the veteran to long-term care in the VA system. It is likely that there are significant gaps are in that care system, especially since so few Montana hospitals have mental health beds.

Precision Medicine (Section 305 of Hannon) — The Office of Research and Development (ORD) has hit the ground running in incorporating this program into the Million Veterans Program. This program is long overdue to improve the process of effectively diagnosing and treating brain health conditions. The VA needs to let Congress know it need help it when barriers arise — not years later.

  • Need to ensure that the bureaucratic morass that prevent the VA’s research program from buying Information Technology resources does not derail this program.
  • Outsourcing data analysis when necessary. Using Section 306 of Hannon to implement Section 305.

Treatment Resistance Depression — In 2009, the VA estimated that between 10% to 12.5% of veterans require treatment for major depression. If the VA’s veterans population is estimated at 9,00,000 veterans, that breaks down to between 900,000 and 1,125,000 veterans needing care for major depression. Roughly 30% of veterans who receive care for depression may have treatment-resistant depression. (COVER, page 92). This means that between 300,000 and 337,500 veterans may qualify as having treatment resistant depression. Yet, almost none of them received the care required for treatment-resistant depression as recommended by the VA’s own major depression clinical practice guidelines.

  • “According to data collected by the COVER Commission, only approximately 1166 patients VA-wide were referred for electroconvulsive therapy (ECT) in 2018 and about 772 were referred for repetitive transcranial magnetic stimulation (rTMS).” (COVER, Page 92)
  • “Require VHA leaders to include treatment-resistant depression care in VA’s overall care updates to make it clear which areas and regions are not delivering care to these veterans that need it.” (COVER, page 93)

Veterans Equitable Resource Allocation (VERA) System — This healthcare accounting system was implemented in 1997. While it has undergone changes over the years, it needs a broader overhaul to move away from a Fee-for-Service accounting system.

  • Long-term Solution — “Transition VA’s Veterans Equitable Resource Allocation (VERA) system from a fee-for service funding model to a per-patient model of funding with financial incentives for improving population health and person-centered metrics.” (COVER, page 71, 78)
  • Short-term Improvement — “Recognize and incentivize the roles of peer support specialists, behavioral health specialists, health coaches, and chaplains in mental health care in the Veterans Equitable Resource Allocation system.” (COVER, page 100)

Exercise Programming — The VA needs a strong wellness program with a plan for exercising does not solely rely on veterans driving to VA facilities to participate in VA wellness programs.

  • “Despite the widely acknowledged health benefits of exercise, VA sports and exercise programs serve a total of about 15,000 individuals — a small fraction of the total veteran population receiving VA health care.” (COVER, page 26)
  • “Amend 38 CFR 17.38 to remove the restriction on providing gym memberships and create a program for providing mental health patients with vouchers to be used for gym memberships or memberships at facilities such as yoga, pilates, or tai chi studios.” (COVER, page 41)

VA’s Broadband Expansion Effort — We are excited about the broadband expansion efforts offered through American Recovery Plan Act to improve veterans access to care. We recommend significant coordination between the VA and state officials to ensure that the diverse funding efforts work to expand access to care.

Thank you,

Matt Kuntz, JD

Executive Director

NAMI Montana

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