Video: VA North Texas Mental Health Service: Introduction and Updates

Speaker: Rodney Teague

Hello, and welcome to the 2020 North Texas veteran’s mental health summit. I'm dr. Rodney Teague, I am a clinical psychologist and a local recovery coordinator for the V.A. North Texas healthcare system. Today's presentation is going to be about mental health services at north Texas V.A., an introduction to those services for those of you who aren't familiar, and updates to those services for those of you who do have some familiarity. V.A. North Texas is a very large mental health service. You can see from this slide that our numbers increase each fiscal year, and that fy19, we served over 40,000 unique veterans. By that we mean individual veterans, this doesn't count overlapping or repeat visits, so over 40,000 individual veterans came through our doors and saw our providers in fiscal year '19. That makes us the largest mental health service in the V.A. System of over 140 hospitals in the united states. To show just how large a service we are, there are more than 600 staff members working in mental health across our locations, which we'll go through in just a few moments. But we have, as you can see, a whole variety, the whole gamut of mental health workers, social workers, psychologists, nurses, psychiatrists, peer support specialists who are veterans themselves who are in recovery from mental health and substance use disorders and who work in helping to engage their fellow veterans in care and to promote a recovery model of mental health and wellness, advanced practice nurses, physician's assistants for MD’s, addiction therapists, occupational therapists, rehab techs, administration support, and so on.

The number of staff fluctuates just a little bit, but we hover around 600 and that service is growing all the time. This slide gives an overview of the various services that are available, and it's really a lot of fun to take a look at this. A lot of people express a great deal of surprise at the breadth, the scope, the variety of services that are offered through V.A. North Texas mental health service, and I just want to go through some of them, make you aware of them if you're not aware, and maybe a refresher or just an overview of the scope of our services. So the main hospital is in Dallas on Lancaster, and then we have our CBOCS, which stand for community based outpatient clinics, in fort worth, the bonham facility is quite large as is the fort worth facility, but then also we have another brand new facility in garland, which has just opened and is getting staffed up as we speak. That is operating or was a previously operating hospital and a doctors' building adjacent to the hospital, which the V.A. Has now taken over, and so it's a great expansion of our space. Right now there are some primary care teams and a small mental health presence there, increasingly there will be specialty services, administrative services, and a variety of other things available at that garland facility, so stay tuned for more information about garland, especially if you live in that area of the metroplex. We also have clinics in Denton, Tyler, Plano, Sherman, grand prairie, and so the reach is quite expansive for the Dallas Fort Worth area. We provide telemental health support for the clinics in Decatur, Greenville and Granbury, that telemental health support means that veterans can travel to CBOC locations and have technicians help them with telemental health equipment, computer monitor like a television monitor, and there they can be seen by providers from - could be the Dallas hospital, but it also could be a hospital in California, and so that's one way to make sure that we have appropriate coverage, providers for our rural areas, and so we support those telemental health clinics.

In the Dallas facility and Fort Worth, primary care mental health integration is an important element of bringing together traditional medical services with mental health services, so primary care mental health integration is what it sounds like. Mental health providers embedded within primary care teams so that screenings for mental health problems like depression can happen right there with a primary care doctor and a warm handoff can be made to a mental health professional who can provide services on the spot. The PCMHI clinic is also referred to as our access clinic, because it's the main gateway to all our mental health services. Prior to the COVID pandemic, the PCMHI clinic was an all walk-in clinic, meaning that during regular business hours you could just walk in at any time and be seen by a team of providers for triage and disposition, either for brief therapy or medication therapy or whatever's needed, even if that's referral to one of the other outpatient clinics. So that's an important clinic to be aware of if you're looking for, how do I get started with mental health services? You want to start with the primary care mental health integration clinic. Then at the Dallas hospital, we have a variety of outpatient clinics beginning with the diamond team, which is our general outpatient clinic, and it's the largest of our outpatient teams, the silver team treats older veterans and also those with memory problems, the gold team is focused on substance use disorders, there's a dedicated trauma team that deals with post-traumatic stress with acute stress, acute traumatic stress and other problems caused by traumatic experience, including military sexual trauma. The telemental health team that's listed next there with the VVC next to it is our V.A. Video connect, and really one of the most exciting developments in treatment modalities, especially given the pandemic.

This allows veterans to be seen from their homes on their desktop computer, laptop computer, tablet computer, or even the smartphone, by a provider that's located anywhere, that's located either at a hospital or working from home, perhaps during the pandemic. There has been a veritable explosion in the use of this modality since we went away from face to face visits because of COVID-19 back in the spring of this year, and we have found it to be a tremendously successful modality, and one that's going to be around long after the pandemic is over. There's a lot of advantages to being able to use this modality, veterans seem to like it very much, it alleviates transportation concerns, and is a very exciting development in mental health at V.A. We have a behavioral health team, which means mental health professionals are embedded in various medical areas of the hospital doing things like surgical consults, helping with amputations, amputation cases and spinal cord injury cases, things like that. Our intensive community mental health recovery program, or ICMHR, is a community outreach program that brings mental healthcare, nursing, psychiatry, psychotherapy, med management, out into the community to where our veterans live, those who are challenged to travel to the hospital, so that provides a vital service for them. Our PRRC, or psychosocial rehabilitation and recovery center, is also known as the veterans recovery center, and provides classes on a whole variety of psycho-educational and life skills, subject matter, it is a very veteran focused and veteran directed program, veterans choose the classes that they get involved in and can be involved in that program for up to two years. We have a number of programs under the umbrella of the comprehensive homeless center programs, everything from transitional housing, HUD-VASH vouchers for permanent housing, a peer-led program for assisting folks find housing, folks who have been involved in the justice system and otherwise had difficulty finding housing, specific programs for women veterans, and all of that is driven or initiated by a universal screening so that veterans don't have to know what program they want to go into, they just have to call or come in and they can be screened for all of those programs at once, and then matched up with the right program for them at the particular time that they enter.

We have two residential treatment programs, the 40-bed homeless domiciliary, which is part of the larger comprehensive homeless center programs, and the 40-bed substance use residential rehabilitation program at the Dallas facility. Both of those residential facilities are located there, along with a 35 bed acute inpatient unit, that inpatient unit is providing crisis intervention and acute care for - on a time limited basis, average length of stay around five to seven days, or even less sometimes, and those programs in the homeless domiciliary and the substance use rehabilitation often provide transition for folks leaving the inpatient program. We have a dedicated and growing suicide prevention outreach team, which you'll hear just a little bit more about during this presentation. Our VJO, or veteran justice outreach team, helps veterans who are justice involved by helping to divert them into dedicated veteran courts so that they can enter into treatment programs as an alternative to legal punishments, certainly as an alternative to incarceration in many cases. We have extensive psychiatry, psychology, and other disciplines in training programs here, so the Dallas hospital and the whole V.A. North Texas system is a whole training system, so we're very proud of our trainees and we do our best to hire them after they finish with our training programs, so many of the new personnel have come through training programs right here in north Texas.

It's also important that you know we have a dedicated MST coordinator, that is military sexual trauma services coordinator, we take very seriously providing free and easy access to services for veterans, men and women, who have been affected by military sexual trauma, and so there's a dedicated coordinator to help make sure that those services are available appropriately. Similarly, we have the veteran’s clinical coordinator for LGBTQ issues, V.A. Is committed to serving all who served, and we want all the veterans to know that that's regardless of sex and gender and sexual identity, and we want to provide excellent service for all the veterans who serve. So that's really a brief look at a tremendous variety of services, and at services that run the gamut of the levels of care, you know, everything from inpatient and residential to outpatient, intensive outpatient and partial hospitalization and community care as well. If it comes to needing to contact our mental health clinics, I want you to have the appropriate information to do so. You'll see a list here of the clinics that we talked about. Of note, the Dallas number, that 4279 number, is what's known as our one number. Now that's been instituted now for maybe a little less than a year, so it may be possible not everybody knows about that number. That number reaches all of our outpatient clinics, and by that, I mean when you call that number, you'll get a menu of options to dial, two, for instance, for the primary care and mental health integration clinic, dial three for diamond team, and on down the line, so you can teach your clinic that way.

The other bit of contact information I want you to have is my personal - my work contact information, which will be at the end of this presentation. I want to invite you all, if you have questions about V.A. Services, about how to get engaged with V.A. Services, or you're having trouble in any other arena related to V.A. Mental health services, give me a call and let me help with that. Part of the job that I get to do as local recovery coordinator is helping engage veterans with appropriate services, so I’ll be happy to answer your questions, get you hooked up with the right services, if I can't answer your questions then point you in the right direction, get you talking to the right person. So that contact information will be at the end of the presentation. So that gives you an introduction to who we are and what we do, those previous few slides, the size of the organization, the breadth of the organization, how to get in touch with us. Just a few items of updates, some are things that haven't changed, and this is the first one. This should be no surprise to anybody who's had anything to do with V.A. North Texas or V.A. In general, over the last years, our number one priority continues to be, remains suicide awareness and suicide prevention. We are especially cognizant at this time of pandemic, of economic stress, of extraordinary stress in a lot of arenas throughout our society, that there's greater risk, and we are on even more heightened alert for dealing with suicide, suicide prevention, now than at any time in the past. I want you to have this information about the veteran’s crisis line, which is V.A.'s national offering for veterans to call in or text in for confidential support and connection to V.A. Services. As I mentioned, we have a dedicated suicide prevention coordinator and a team of suicide prevention professionals who work with - throughout the facilities, with at risk veterans and who mitigate those risks that you know, another veteran will take her or his life. We want to prevent that to the extent that we're able to, and we're very aware of the difficult time that we are facing right now and that our veterans are facing.

The second item of update, or second item of business here, is to let you know that the pandemic notwithstanding, we have been open for business and we are open for business. The mental health service at north Texas never stopped operating, in fact, it has been operating at 95% to 100% capacity throughout the pandemic. Several things were shifted, but services have remained available. So for instance, those residential and domiciliary services I mentioned at the Dallas facility, the homeless domiciliary and the substance abuse residential program shifted locations to the bonham facility because of the - just because of the physical configuration of the space, it wasn't safe to have veterans in person. But those Dallas facilities reopened as of the 15th of September, and are now admitting veterans again, and generally the mental health service, outpatient services, services for serious mental illness, acute psychiatry, all those programs, all those clinics have remained open throughout the pandemic. As I mentioned, the modalities shifted largely from face to face visit toward telephone and computer-based video, but that has been a really successful transition. At first, the systems were overwhelmed, there wasn't enough bandwidth, but very quickly V.A. Improved the infrastructure available to us, and those bandwidth problems were resolved, and we've had the vast majority of veterans involved say that they are satisfied or better than satisfied, are really quite happy with the option to use video connect or the telephone.

Again, it keeps them from having to travel to the hospital or to the CBOCs, it's convenient as far as timing, so there are a lot of advantages to the shifting modality. Very important for you to know that the mental health clinics have remained open, and some of them for face to face visits throughout the pandemic. Our mental health clinics have been averaging, as you see, greater than 1,800 visits per week, and that represents a remarkable consistency from before COVID through the beginning of the pandemic into the current time. As I mentioned, the Dallas facilities reopened as of the 15th of September, that was the date that was given for the move to phase three of reopening so that all of V.A. North Texas is considered to be reopened, those parts that were closed to visitors, for instance, as of the 15th of September a lot of visits will still take place by video connect or telephone, but veterans can certainly come in person if they so desire. So now, as always, don't hesitate to reach out for us, don't think that we're unavailable, closed, restricted, those kind of things. We are here, open for business and ready to serve. Just a couple of other things, while I have this opportunity I want to point out to you, these aren't services that are unique to the north Texas V.A., but something that you might be aware of and it's something that you might utilize, there are a whole host of V.A. Developed applications for your smartphone that can be very helpful for a variety of circumstances. The two that are listed here, the one on the left is the virtual hope box, and it provides a lot of strategies for improving mental wellness over time, and especially for providing instances or reasons for hope, as the name implies, when things are difficult.

So, opportunities for relaxation, inspiration, coping, and these are apps that are interactive, so you devise the interventions for yourself. The one on the right is about breathing meditation, so a relaxation aid, something to help alleviate anxiety, you can search for either one of those by the names that are given, but if you just put into the app store or the play store, either on iOS or on android, if you just put in V.A. You'll find 20, 25 different applications that have been developed by V.A. For a variety of circumstances. One that I want to point out that's particularly relevant for us right now is this COVID coach, which was developed by the national center for PTSD, which is a V.A. Program, and it was created to help provide education, manage stress, and help us cope during COVID, during the pandemic, and so especially if you are experiencing distress that's related to pandemic, I would invite you to visit the link that's noted here and check out the COVID coach. Again, it's available in the app stores just by searching for V.A. Apps. Coaching into care, again, is a national V.A. Program that's aimed at helping family members and loved ones. V.A. Gets so many questions from family members and loved ones that say you know, my veteran, my father or my brother or my wife is in trouble, is distraught, is having a hard time, I don't know what to do for him or her, I don't know how to help, and coaching into care is devised, is designed exactly for that set of problems. It's a door into V.A. Care that's particularly for family members and loved ones. Please take advantage of the contact information here, let those folks do exactly what the name says, coach you on how you can talk to your veteran about getting help, about how you can partner with your veteran on getting help, join with them in that process, so there's another resource that's important for you, and just a little bit of advice for those of you who are loved ones and family members for veterans, and this is good advice for veterans or anybody as well.

Take care of yourself, especially during this time. We can only help others when we are healthy ourselves. Be hopeful, change takes time, but change is inevitable, and since change is inevitable, then we know that things can change for the positive and get support for yourself when it's appropriate to do so. Monitor yourself, and be careful in that regard, that you get the kind of support that you need. Well that's about all for me. As I mentioned, here's my contact information, I’d invite you to call, that's my V.A. Cell number, and leave a message for me if you don't catch me on the first try, I’ll get back to you for any reason. Feel free to email me as well, just don't put any private information in that email, because we know it's not secure. If you have questions related to V.A. North Texas services that could be answered in a panel discussion that we're gonna have on the 30th, I’d invite you to submit those questions or comments on the same page that you clicked on to get to this presentation, there's a spot there for you to submit your questions. Thanks very much for joining me today, and look forward to seeing you at V.A.