Building a Veteran Mental Health Outreach Program
In March of 2018, I had the fortunate experience to be part of the Mayors Challenge team. The Mayors Challenge is a great partnership between the Substance Abuse and Mental Health Services Administration (SAMHSA) and the Department of Veterans Affairs (VA).
Eight major cities from around the country were selected as the inaugural group to kick off the “Mayor’s Challenge to Prevent Suicide Among Service Members, Veterans, and their Families.” The City of Los Angeles was selected as one of the cities to participate. The requirement was to form a multi-disciplinary team to increase suicide prevention resources and support for Veterans and their families. SAMHSA and the VA selected Los Angeles County and City team members based on the sizable Veteran population data, suicide prevalence rates and capacity of the involved entities to lead the way in this effort.
The overarching goal of the Mayor’s Challenge is to reduce suicides among service members, Veterans and their families using a public health approach to suicide prevention. The multi-disciplinary team from Los Angeles consisted of members from the City of Los Angeles Mayors Office, Los Angeles County Department of Mental Health, Didi Hirsch, 211 LA, U.S. Army Suicide Prevention Office, Los Angeles County Sheriff’s Department Mental Evaluation Team (MET), Los Angeles Police Department Mental Evaluation Unit (MEU), Greater Los Angeles VA Suicide Prevention Office and I attended to represent VA Police from our region.
This entire program was funded by SAMHSA and the eight city teams met in Washington DC from March 14-16, 2018. This was to develop a comprehensive framework for a strategic action plan that would be a benefit Veterans in the County and City of Los Angeles.
In July of 2016, the VA conducted an analysis of veteran suicide rates. They reviewed 55 million Veteran records from 1979 to 2014, from every state in the United States. This utilized the VA’s previously collected data from 2012 as well, which analyzed three million Veteran records from 20 different states. The 2012 data revealed that Veteran deaths by suicide averaged 22 per day. The more recent review indicates that in 2014, roughly 20 veterans per day committed suicide. We can all agree that one veteran suicide is too many.
While the VA has made great strides in working to reduce the number of veteran suicides through the development of the Veterans Crisis Hotline, expanding capacity for same day mental health appointments and hiring additional clinicians to address these critical issues, one element had been overlooked. This was the proactive outreach to Veterans in crisis similar to how both LAPD and LASD do proactive outreach to non-Veteran citizens in crisis in their respective communities. Both of these phenomenal agencies have “cornered the market” on the concept of paring a police officer with a mental health clinician to respond and provide resources to those in crisis.
After working with the Mayors Challenge team in DC, I realized quickly that we could do more for our Veterans locally. My staff routinely came in contact with Veterans in crisis and in some cases would end up in a situation where the Veteran would be incarcerated, which is never a good option for someone who truly needs mental health, drug abuse or housing services, not jail.
This led to the creation of the VA Police Veteran Mental Health Evaluation Team (VMET) at our VA Long Beach healthcare system facility. Similar to the MET and MEU teams at LASD and LAPD respectively, this new element is the proactive utilization of VA Police Department (VAPD) officers in conjunction with VA mental health clinicians to conduct outreach contacts and follow-up on cases of veterans experiencing mental health issues/crises.
I have been asked quite frequently how I was able to create this program at my medical center, which is why I was compelled to write this article.
Building the Program
Developing this program took untold amounts of internal and external coordination for this to become a reality. Nothing like this had ever been attempted before. To the VA’s credit, they do have a program that pairs a VA Police Officer and Clinician to teach first responders how to interact with Veterans in the field but that’s where it stops. The VMET team is a natural extension of that program and puts boots on the ground to interact directly with Veterans and provide the care and resources at the point of crisis.
How did this all come about?
To start, I had to get buy in from a plethora of people internal to the VA. I knew I had the support of my law enforcement counterparts, so that was the easy part. Connecting with key stakeholders in Mental Health, Social Work Services and Executive Leadership was just the start.
A white paper was developed jointly by myself and the LA County Sheriffs Dept MET Commander, Lt John Gannon. Both LAPD and LASD expressed previous attempts to work with VA resources with little success. Both of these agencies quickly recognized the unique mental health needs of our Veterans and correctly surmised that the VA was the place where a Veterans care needs to take place.
By forming a strong bond and outstanding working relationship with these two very well respected law enforcement agencies, as well as others, our efforts to help Veterans became the epitome of what collaboration should look like. The white paper encapsulated the vision for the current VMET program. The consensus amongst many stakeholders, both internal and external, was this was a viable program with real possibilities at helping Veterans in crisis.
We engaged in numerous meetings, phone calls, working sessions, late night text messages/phone calls to resolve operational issues that arose and collaborating with other community partners to provide resources we couldn’t.
I would like to pause here and dive into another short topic of discussion. At the same time I was developing the VMET program, I was concurrently developing another program to keep the medical center safe. This was our “TMU” or Threat Management Unit. This unit was stood up to focus solely on the investigation and management of threats to the medical center and its employees. I bring this up because there was an immediate recognition that VMET and TMU cases might cross paths.
Because I don’t always have all of the answers, I enlisted the aid of a law enforcement consulting firm to assist me in integrating the TMU and VMET programs to create a more holistic, and overall streamlined program. That consulting firm, Sentinel Resource Group, LLC and its CEO Wesley Bull, did a fantastic job helping us integrate and operationalize both programs to ensure crossover and in some cases de-confliction was seamless.
The VMET pilot program went live on August 20th, 2018. In just 6 months, the VMET went from an abstract idea to full blown implementation. To date the team has responded to roughly 375 Veteran crisis calls. This number includes follow ups on initial calls for service. This team performs a version of “case management” to ensure when they get a Veteran back to the medical center for care, that they are routing the Veteran to appropriate services. The team does periodic follow up to ensure the Veteran is staying on the right path and moving toward recovery.
This case management component is hugely important because it shows that we care about the outcome and that we are partners in that Veterans success in recovery. The response to this service has been overwhelmingly positive and has garnered some media attention of the team.
I would be remiss in not mentioning the team by name, because what they have done has exceeded everyone’s expectations for this program. The team consists of Long Beach VA Police Officer Tyrone Anderson and VA Clinician Shannon Teague. Both are Marine Corps Veterans themselves. I believe this factor has contributed greatly to their success as well as the fact both are extremely dedicated, caring professionals that truly want to serve our Veterans. I consider myself a very fortunate leader to have many of these type of folks that worked with me at the VA. They are the true reason the program is a success.
The team is a force multiplier in the fight against Veteran suicide. They are able to bring the many resources the VA has to bear on a particular issue a Veteran has. This pro-active outreach co-response model has changed the course in several Veterans lives.
The other thing I will say is that building this program in a government bureaucracy like the VA in most cases would have been extremely challenging and would have taken probably years to get off the ground. That would not have been a viable option in this case given the extreme need for suicide prevention resources/solutions. As previously stated this went from concept to operational in 6 months.
I give a lot of credit to my leadership team for believing in me and the mission to execute this program effectively and within VA guidelines. Guidelines that in some cases had to be developed since nothing like this had ever been attempted. By utilizing existing frameworks we were able to effectively craft policy and work with our community partners to establish criteria for the team’s response as well local guidelines for the team to follow.
In addition, the Executive Leadership Team truly and openly supported out of the box, problem solving critical thinking by medical center employees. Those types of environments are best for testing and learning new ideas and programs. I would have to say in my case with this program, it was the most optimal of conditions, which I am grateful for.
In conclusion, and to really put a finer point on things, it took a monument of effort to get this program operationalized. For those that are wanting to stand up a program like this in their organization or a different program the key take a ways for me were:
- Develop a strong concept based on an existing problem. Do your homework!
- Fully develop out that concept and its benefit in a white paper or other medium.
- Use lots of data to support your concept.
- Define expected outcomes on both implementation and non-implementation.
- Involve every stakeholder this may impact or that you may need resources from to ensure your concept works and is successful. This may evolve over time as some stakeholders may not show up as obvious in the beginning.
- Develop strong relationships with your key stakeholders. They will also likely end up being your strongest advocate and voice for you and what you are trying to achieve.
- Get leadership buy-in as early as possible. This helps pave the way for folks who may want to derail what you are trying to achieve. The conversation changes with those folks when they know that leadership is supporting it, and they will be less likely put up roadblocks.
- Keep leadership in the loop of progress and issues. Never blind side them (Obvious statement)
- Select the right people to execute the mission you are trying to achieve. Selecting the wrong people will ultimately cause the demise of your program and damage your credibility and make it harder to do something similar in the future.
- Ask for help any time you think you need it. Depending on the complexity of a project, collaborating with those trusted advisors will help your program succeed.
- Be engaged and promote your program/project to those you will think benefit most from it. Be your own champion in this area!!
Ultimately, I am beyond grateful that I was in a position to implement and support a very needed program that has provided significant positive impacts to Veterans that were contemplating suicide. I can confidently say VMET’s creation and interventions have truly saved lives and this program has met and certainly exceed what is was intended to do.
Aside from the people in this article that were already mentioned, there are a great many others that supported and helped this program along the way and too many to mention here. Those folks know who they are and I have expressed my gratitude to them on many occasions.
For any questions about this program or anything I might not have covered, I can be reached at the below contact information. I am happy to help where I can!