Transcription
Guide toVA MentAl HeAltH SerViceSfor Veterans& Families
{It takes the strength and courageof a warrior to ask for help.}South Central Veterans Integrated Service Network (VISN) 16Mental Illness Research, Education, and Clinical Center (MIRECC)Consumer Guide WorkgroupGreer Sullivan, MD, MSPHDirector, South Central MIRECCKimberly Arlinghaus, MDAssociate Director for Clinical Care, South Central MIRECCCarrie Edlund, MSResearch Associate, South Central MIRECCMichael Kauth, PhDCo-Director and Associate Director for Education, South Central MIRECCWe Wish to express our thanks to the many Veterans, clinicians, andadministrators who gave us valuable guidance and feedback on translation of VApolicy into a simple, direct, and easily understandable document for Veterans andtheir family members. In particular, we thank the South Central Mental IllnessResearch, Education, and Clinical Center (SC MIRECC) Consumer Advocacy Boardwho have collectively kept the SC MIRECC’s researchers, clinicians, and educators“on track” for many years. So many individuals have contributed to this documentthat it is not possible to list them all. However, we want to acknowledge that the helpwe received was truly invaluable.January 2011
Guide toVA MentAl HeAltH SerViceSfor Veterans& FamiliesIn 2008, VA introduced a new mental healthhandbook that provides guidelines for VAhospitals and clinics across the US. The newhandbook specifies exactly what mental healthservices VA hospitals and clinics are required to offerto Veterans and their families. The requirements differdepending on the size and type of VA hospital or clinicbut apply across the entire VA system.This brochure is a shorter, simplified version of the handbook intended for the generalpublic. If you are a Veteran, Veteran family member, member of a Veterans ServiceOrganization, or member of another group interested in VA mental health care you canuse this handbook to learn what mental health services your local or regional VA healthcare facility has pledged to provide to Veterans.In this brochure, we first describe the guiding principles of mental health care. Then, weexplain how to find mental health care and the different treatment settings where VAoffers mental health care, such as hospitals (inpatient care) or clinics (outpatient care)or through telemedicine (where mental health providers in one location can talk with,evaluate, and treat Veterans at another location through a closed-circuit television). Weprovide information about the types of treatments available for the most common mentalhealth problems of Veterans (such as depression, substance abuse, and posttraumaticstress disorder) and describe the special programs offered for particular groups ofVeterans (such as women Veterans, homeless Veterans or older Veterans).Finally, Appendix A shows the mental health services VA hospitals and clinics arerequired to provide, and the glossary defines common VA mental health terms. Usethis information to find out what services your VA hospital or clinic should be able tooffer you.19171513113579Guide to VA MentAlMentAl HeAltH SerViceS for Veterans and FamiliesSome wounds are invisible.
4It takes the strength and courage of a warrior to ask for help.Guide to VA MentAl HeAltH SerViceS for Veterans and FamiliesPrinciPleS tHAt Guide VA MentAl HeAltH cAre for VeterAnSCertain basic principles form the foundation of all VA mental health care. They are: Focus on Recovery – VA is committed to a recovery-oriented approach tomental health care. Recovery empowers the Veteran to take charge of his/hertreatment and live a full and meaningful life. This approach focuses on theindividual’s strengths and gives respect, honor, and hope to our nation’s heroesand their families. Holistic Coordinated Care – VA health care providers coordinate with eachother to provide safe and effective treatment for the “whole” person—headto toe. Many Veterans begin mental health care with their VA primary careprovider. VA believes Veterans can continue to be treated for many mentalillnesses in primary care or referred for more intensive treatment to specialtymental health care. Also, most VAs have chaplains available to help Veteranswith their spiritual or religious wellbeing. Having a healthy body, satisfyingwork, and supportive family and friends, along with getting appropriatenutrition and exercising regularly are just as important to mental health as tophysical health. Mental Health Treatment in Primary Care – Like a quarterback, theprimary care provider directs the Veteran’s overall care by coordinating servicesamong a team of providers. If you are experiencing mental health problems,talking to your primary care provider is a good place to start. Many times yourmental health problem can be evaluated and treated by your primary careprovider, with extra help from a case manager who can stay in close contactwith you. There are also mental health providers on primary care teams to offerguidance to your primary care provider when needed. When more complexor intensive care is needed, your primary care provider will refer you to aspecialized mental health program for further treatment. Principal Mental Health Provider (PMHP) – Every Veteran who sees amental health specialist is getting “specialty mental health care.” The mentalhealth specialist might be a psychiatrist, psychologist, social worker orcounselor. Veterans who receive specialty mental health care have a PrimaryMental Health Provider (PMHP). The PMHP is the Veteran’s main contact forall specialty mental health services. The PMHP’s job is to coordinate a mentalhealth treatment plan for the Veteran. The plan combines Veterans’ (and theirfamilies’) goals with mental health specialists’ recommendations. Around-the-Clock Service – Emergency mental health care is available 24hours per day, 7 days per week at VA medical centers. If your VA does nothave a 24-hour emergency room, it must provide these services through alocal, non-VA hospital. Telephone evaluations at VA medical centers and thenational suicide hotline are also available 24/7. Care That is Sensitive to Gender and Cultural Issues – VA health careproviders receive training about military culture, gender differences, andethnic issues in order to better understand each Veteran. In situations where aVeteran might feel more comfortable with a same-sex provider (or an oppositesex provider), VA will make every effort to arrange gender-specific care.
20201912232121 includes:GuamAmerican SamoaPhilippines2112110221917151311579Guide to VA MentAlMentAl HeAltH SerViceS for Veterans and FamiliesSome wounds are invisible.15181617451369788 includes:Puerto RicoU.S. Virgin Islands
6It takes the strength and courage of a warrior to ask for help.Guide to VA Men tAl HeAltH Ser Vic eS for Veterans and FamiliesHow You cAn find tHe MentAl HeAltH cAre You needIf you have a mental health emergency (like wanting to hurt yourself orsomeone else), go to the nearest hospital emergency room or call 911. If it is not a VAhospital, you may be able to move to a VA facility depending on your circumstances.If you are feeling suicidal, you can also call the National Suicide Prevention Lifeline1-800-273-TALK (8255) and press 1 for the Veterans Suicide Prevention Hotline, orvisit http://www.suicidepreventionlifeline.org/ and click on Veterans Chat Live witha Counselor. Mental health professionals are available to talk with you 24 hoursper day.If you have a mental health problem and have never been seen in a VA hospital orclinic, call VA general information hotline at 1-800-827-1000 or visit VA’s websiteat www.va.gov. You will be able to find the address and phone number of a VAhospital or clinic near you. Some Veterans begin the process of finding mentalhealth care through a Veterans Center. Homeless Veterans can get help findingmental health care at a Veterans drop-in center.If you are already using VA medical services, ask your primary care provider to arrangefor you to see a VA mental health provider.How You know if You HAVe A MentAl HeAltH ProbleMSometimes it can be hard to tell. Since the brain and body affect one another, mentalproblems can cause physical problems along with changes in thinking, feeling, andbehavior. In addition to commonly recognized emotional problems, like feelingvery sad or nervous, symptoms and signs of mental health problems can include: changes in sleep, appetite, weight, or sex life headaches or other physical pain muscle tension and weakness decreased energy, motivation, or interests problems with attention, concentration, or memory irritability, anger, or “short temper” feelings of guilt, worthlessness, helplessness, or hopelessness unhealthy behaviors (misusing drugs, alcohol, food, sex, or other behaviorslike gambling or spending too much money to cope with stress or emotions) problems functioning at home, work, or schoolThe most important thing to remember is to talk with your primary care or mentalhealth provider when you notice new symptoms or problems. Your health careteam can help you figure out what’s going on and what to do about it.
WhaGuide to VA MentAlMentAl HeAltHHealth SerViceSServices for Veterans and FamiliesSome wounds are invisible.1917151311579
8It takes the strength and courage of a warrior to ask for help.Guide to VA MentAl HeAltH SerViceS for Veterans and Families residential care for Veterans with a wide range of mental health problems and/or rehabilitative care needs (such as homelessness, job training, and education)who would benefit from living in a structured environment for a period of time(see Appendix B). Supported work settings to help Veterans join the work force and live well inthe community (see Appendix C for more details)Different treatment settings are appropriate for different problems atdifferent times. For example, a severely ill or suicidal Veteran mightneed inpatient treatment in a hospital for several days. When theillness becomes less severe, he or she may return home and receivetreatment as an outpatient in a VA clinic.For Veterans who receive inpatient mental health treatment, VA willcheck on the Veteran’s progress within one week after she/he leaves thehospital. This evaluation might be by telephone or, possibly, in person,just to make sure the Veteran is doing well. VA will also ask the Veteranto come back for a follow-up appointment no later than two weeksafter discharge from the hospital.In addition, Veterans who live a long distance from a VA medical center can stillreceive treatment through telemedicine. In many parts of the country, especiallyin rural areas, there may not be very many providers experienced in treatingmental health problems. To remedy this situation VA offers treatment throughtelemedicine. That is, mental health providers located at larger VA medical centerscan talk with, evaluate, and provide treatment for Veterans at smaller communitybased VA clinics through a special closed-circuit television. Telemedicine services,like face-to-face mental health services, are confidential. More and more VA clinicsare using telemedicine technology to connect patients with specialists who are noton-site. For example, if you are a Veteran living in a rural area and need specializedcare for PTSD that is not available at your local VA clinic, you may receive thistreatment from a PTSD specialist at another VA location using telemedicinetechnology.treAtMentS for SPecific MentAl illneSSeSVA offers treatment for a wide range of mental health problems. These problemsinclude, but are not limited to, depression, anxiety, posttraumatic stress disorder(PTSD), substance abuse, bipolar disorder, and schizophrenia. Treatments such asmedications, psychotherapies (talk therapies), and psychosocial rehabilitation andrecovery services help the Veteran along the road to recovery. VA uses treatmentsthat have been proven to be effective for specific mental health disorders. Theseproven treatments are called evidence-based treatments.Examples of common mental health treatments for Veterans include:Treatments for Depression and Anxiety. Depression and Anxiety are commonamong the general public and among Veterans. Treatments include: Antidepressant medications, anti-anxiety medications, and medications toease sleep and other problems
Talk therapies, such as: Cognitive behavioral therapy (CBT) to help individuals understand therelationship between thoughts, emotions, and behaviors, learn new patternsof thinking, and practice new positive behaviors (relaxation techniques,using calming tapes to improve sleep, exercising, or socializing with friends) Acceptance and commitment therapy (ACT) to help people overcometheir struggles with emotional pain and worries. It helps them recognize,commit to, and achieve what’s important to them Interpersonal therapy (IPT) to help people promote positive relationshipsand resolve relationship problemstreAtMentS for SubStAnce AbuSeSubstance abuse problems are common in the general public and among Veterans.When Veterans have trouble readjusting to civilian life, some turn to substancesto help them cope. Persons can abuse or become addicted to alcohol, tobacco, andillegal drugs and misuse prescription medications. Treatments for substance abuseinclude: Medications, such as Acamprosate or Naltrexone, to decrease cravings for alcoholand medications to ease withdrawal (“detox”) from alcohol and drugs. Medicationslike buprenorphine and methadone can also be used as therapeutic substitutesfor illegal drugs (heroin) or addictive prescription pain medications. Talk therapies, such as: Motivational enhancement therapy to help the individual strengthenhis/her commitment to getting clean and sober Cognitive behavioral therapy to help the individual identify the needsthat alcohol/drugs meet and learn new ways of meeting those needs.In this way, the individual develops new coping skills to avoid relapse. Opioid Treatment Programs (OTPs) that include illegal substances, such as heroinand some prescription pain medications. Opioid Treatment Programs offer talktherapies and provide medications like methadone and buprenorphine to helpVeterans stop abusing opioids. These medications work as carefully-monitoredsubstitutes for the drugs of abuse. Methadone can only be obtained in methadonemaintenance programs located at some VA hospitals. But buprenorphine, a newermedication similar to methadone, can be prescribed by any physician who hasreceived training, even a primary care physician. This means that Veterans wholive far from VA OTPs can receive buprenorphine from a primary care provider orpsychiatrist at their local community based outpatient clinic. Residential treatment programs for substance abuse allow Veterans to liveat a treatment facility, usually for 30-90 days, while undergoing intensivetreatment. This treatment environment provides support and structure to helpthe Veteran achieve long-term recovery. See Appendix B for more informationabout residential treatment options. Work therapies are commonly prescribed for Veterans to promote and supportrecovery as Veterans learn to live clean and sober lives (see Appendix C).1917151311579Guide to VA MentAlMentAl HeAltH SerViceS for Veterans and FamiliesSome wounds are invisible.
10It takes the strength and courage of a warrior to ask for help.Guide to VA MentAl HeAltH SerViceS for Veterans and FamiliestreAtMentS for PoSttrAuMAtic StreSS diSorder (PtSd)Posttraumatic stress disorder can occur after a person has a veryserious or life threatening traumatic experience. For Veterans, this lifethreatening event often occurs during combat. However, other noncombat related events – such a natural disasters, motor vehicle accidents,or sexual trauma – can also threaten life and can result in PTSD. VA hasbeen a national leader in the development of talk therapies for PTSD.Treatments for PTSD include: Antidepressant medications, anti-anxiety medications, mood stabilizingmedications, and other medications to ease nightmares, irritability,sleeplessness, depression, and anxiety Talk therapies: Cognitive behavioral therapy (CBT) to help individuals understandthe relationship between thoughts, emotions, and behaviors, learn newpatterns of thinking, and practice new positive behaviors Cognitive processing therapy (CPT), a form of CBT that involves writingabout one’s traumatic experience and correcting negative thought patternsso that memories of trauma don’t interfere with daily life Prolonged Exposure Therapy (PE) to help people reduce fear and anxietytriggered by reminders of the trauma. This is done by confronting (or beingexposed to) trauma reminders in a safe treatment environment until theyare less troubling. In this way, individuals can stop avoiding and reacting totrauma reminders and live their lives more fully in the present with greaterfreedom from the past. Residential care for longer-term, intensive treatment within a structuredsetting (see Appendix B)T
Psychosocial Rehabilitation and Recovery Services to optimize functioning(see Appendix D). Work therapies to promote and support recovery (see Appendix C). Residential care for longer-term, intensive treatment within a structuredsetting (see Appendix B). Mental Health Intensive Case Management (MHICM). A team of mentalhealth doctors, nurses, and social workers that treat Veterans in their homesand community. MHICM helps Veterans experiencing severe mental illnesshave less need for hospitalization and live more successfully at home and inthe community.SPeciAl ProGrAMS for VeterAn PoPulAtionS witHSPeciAl needSVA recognizes that some groups of Veterans have special mental health needs.In response to these needs, VA has developed special programs tailored forthese groups. VA special programs include: Services for Women VeteransSeveral women’s inpatient units, residential treatment programs, orspecial treatment tracks for women exist. In addition, mixed genderinpatient units or residential treatment centers must ensure safe andsecure sleeping and bathroom arrangements, including, but not limitedto, door locks and proximity to staff. Each regional VA network (calleda VISN) must have residential care programs able to meet the needs ofwomen Veterans. However, the needs for some types of sub-specialtycare (e.g., women with PTSD) may be limited, and women Veterans whoneed these services may be referred to regional or national resources. Suicide Prevention Services Suicide prevention coordinators work with mental health care teams tomonitor and support Veterans at high risk for suicide National Suicide Prevention Lifeline:1-800-273-TALK (8255) (press 1 for Veterans Suicide Hotline) or go tohttp://www.suicidepreventionlifeline.org/ A personal safety plan that helps the Veteran recognize signs thatoften precede his/her suicidal ideas and lists strategies that help theVeteran manage those thoughts and feelings. The plan also identifiespeople that the Veteran can turn to for help. Safety plans are createdwith the mental health provider and the Veteran (including familymembers, if desired). This way, a plan is designed specifically for theVeteran and his/her problem areas.1917151311579Guide to VA MentAlMentAl HeAltH SerViceS for Veterans and FamiliesSome wounds are invisible.
12It takes the strength and courage of a warrior to ask for help.Guide to VA MentAl HeAltH SerViceS for Veterans and Families Services for Veterans Just Returning From DeploymentVA operates 232 community based counseling Vet Centers. Many providersat Vet Centers are Veterans themselves. Vet Centers provide readjustmentcounseling and outreach services to all Veterans who served in any combatzone. Military Sexual Trauma counseling and bereavement counseling are alsoprovided. Services are available for family members for military related issues,and bereavement counseling is offered for parents, spouses, and children ofArmed Forces, National Guard, and Reserves personnel who died in the serviceof their country. Veterans have earned these benefits through their service, andall are provided at no cost to the Veteran or family. Military Sexual Trauma ServicesVeterans who experienced military sexual trauma (MST) may develop PTSDand/or other mental illnesses. Any Veteran who was sexually traumatizedwhile serving in the military, can receive counseling. This is true for bothmale and female Veterans who served in any era. Special inpatient, outpatient,and residential treatment programs are available to male and female Veteranswho experienced MST, using proven medications, talk therapies, and socialsupports. Veterans receiving MST-related counseling or treatment are notbilled for inpatient, outpatient, or medication copayments. Services for Homeless Veterans 1-877-4AID VET (877-424-3838) sp Outreach to Veterans living on the streets and in shelters who otherwisewould not seek help Drop in centers where homeless Veterans can shower, get a meal, and gethelp with a job or getting back into society Medical treatment for physical and mental disorders, including substanceabuse Emergency shelter referral (temporary housing must be arranged withinthree days of shelter placement) Transitional housing in community-based programs Referral to permanent housing through the use of rental assistancevouchers with case management Long-term assistance, case management, and rehabilitation Employment assistance Residential treatment (see Appendix B).
Services for Veterans Involved with the Criminal Justice System(Justice-Involved Veterans) Mental health assessments for Veterans charged with offenses (usuallynon-violent crimes) that allow for community-based alternatives tojail or prison Assistance for Veterans to connect them with VA care and serviceswhen they are released from state or federal prisons Services for Older Veterans VA Community Living Centers (CLCs) for Veterans needingtemporary assisted care until they can return home or find placementin a nursing home Home-based Primary Care that includes a mental health professionalas part of the team providing care to Veterans in their homes Screening for dementia like Alzheimer’s disease and/or otherproblems that interfere with memory Assessments that help decide whether the Veteran can safely live athome and make informed medical decisionsVeterAnS MentAl HeAltH councilSThese important groups provide a way for people (Veterans, their families, andcommunity groups) who “consume” VA services to offer input to VA leaders aboutthe structure and operations of mental health services. Each facility is stronglyencouraged to implement and maintain a local Veterans Mental Health Council.Each Council has a VA mental health staff member as a liaison. Councils mayinclude several different kinds of members: Veteran consumers and family members of consumers Veteran consumer advocates, such as: Veteran Service Organizations (VSOs) Representatives from the National Alliance on Mental Illness(NAMI), Depression and Bipolar Support Alliance (DBSA),and other mental health advocacy groups Local community employment and housing representativesIf you’re concerned about getting the care you need,talk to your provider about other treatment options.1917151311579Guide to VA MentAlMentAl HeAltH SerViceS for Veterans and FamiliesSome wounds are invisible.
14It takes the strength and courage of a warrior to ask for help.Guide to VA MentAl HeAltH SerViceS for Veterans and FamiliesAHours of CareMedical CenterVery LargeCBoC(more than10,000 Veteransper year)Large CBoCMid-sized CBoCSmall CBoC(5,000-10,000Veterans per year)(1,500-5,000Veterans per year)(fewer than 1,500Veterans per year)Additionalevening, earlymorning, orweekend hours(check locationfor more info)Must provide asneeded to meetneeds of patientpopulationMust provide asneeded to meetneeds of patientpopulationStronglyencouraged toprovideStronglyencouraged toprovideStronglyencouraged toprovideEmergency careImmediate onsite 24/7 (in largermedical centersa mental healthprovider is availablein the emergencydepartment from7 am to 11 pm)Immediate onsite during hoursof operationand/or localcommunityemergencydepartment 24/7Direct patients tonearby emergencydepartment Direct patients tonearby emergencydepartment Direct patients tonearby emergencydepartment The RANGE program might be available in some rural areas for Veterans with SMI.CBT cognitive behavioral therapyMHICM mental health intensive case management3IPT interpersonal therapyACT acceptance commitment therapyPRRC psychosocial rehabilitation and recovery centers6IOP intensive outpatient program1425
Mental Illness/ProblemMedical CenterVery Large CBoCLarge CBoCMid-sized CBoCSmall CBoC(more than 10,000Veterans per year)(5,000-10,000Veterans per year)(1,500-5,000Veterans per year)(fewer than 1,500Veterans per year)Posttraumatic Stress SpecializedDisorder (PTSD)outpatientprograms;evidence-basedtalk sure nce-based talktherapies (cognitiveprocessing therapy,prolonged exposuretherapy) on-siteEvidence-based talktherapies (cognitiveprocessing therapy,prolonged exposuretherapy) on-siteor throughtelemedicineEvidence-based talktherapies (cognitiveprocessing therapy,prolonged exposuretherapy) on-siteor throughtelemedicineGeneral andspecialty serviceson-site or viatelemedicine ,[referral toresidentialtreatmentprogram, VAmedical center,or communityservices ]Schizophrenia,SchizoaffectiveDisorder, BipolarDisorder, DepressionAnxietyGeneral andspecialty services;family services;skills training; peersupport; evidencebased therapies fordepression/anxiety[MHICM2, PRRC5]on-siteMajority of generaland specialtyservices on-siteor via telemedicine; evidence-basedtherapies fordepression/anxietyon-site or throughtelemedicine ;[referrals to VAmedical centeror communityservices ]General andspecialty serviceson-site or viatelemedicine ,referral to residentialtreatment program,VA medical center,or communityservices evidencebased therapies fordepression/anxietyon-site or throughtelemedicineGeneral andspecialty serviceson-site or viatelemedicine ,referral toresidentialtreatmentprogram, VAmedical center,or communityservices General andspecialty services;MHICM2; PRRC5;family services;skills training;peer support;evidence-basedtherapies (CBT1,ACT4, IPT3)for depression/anxiety on-site Substance UseDisorders(alcohol, drugs,prescriptionmedications,tobacco)Homelessness General andevidence-basedspecialty services;inpatient oroutpatientdetoxification;opioid treatmentprogramsprovidingmethadone atsome medicalcenters[IOP6]; specializedoutpatienttreatment programswith evidencebased therapiesand medicationmanagementon-siteSpecializedoutpatient programs;evidence-basedtherapies on-siteor throughtelemedicineSpecializedoutpatient programs;evidence-basedtherapies on-siteor throughtelemedicineGeneral andspecialty serviceson-site or viatelemedicine ,referral toresidentialtreatmentprogram, VAmedical center,or communityservices Shelter andemergency services,homelessnessoutreach specialistand communitylinksShelter andemergency services,homelessnessoutreach specialistand communitylinksReferrals tocommunityproviders for shelter,temporary housing,or basic emergencyservices Referrals tocommunityproviders for shelter,temporary housing,or basic emergencyservices Referrals tocommunityproviders forshelter, temporaryhousing, orbasic emergencyservices On-site Telemedicine Referral to VA facilities or community providers Guide to VA MentAlMentAl HeAltH SerViceS for Veterans and Families1917151311579Some wounds are invisible.
16It takes the strength and courage of a warrior to ask for help.Guide to VA MentAl HeAltH SerViceS for Veterans and FamiliesADomiciliary Residential Rehabilitation Treatment Programs (DRRTP) - A DRRTP provides residentialcare for Veterans, treating medical and psychiatric problems, substance use disorders, PTSD, and homelessness.DRRTPs provide a 24 hours per day, 7 days per week, structured and supportive residential environment as apart of rehabilitative treatment. DRRTPs are larger residential programs with multiple units serving variouspatient populations.Domiciliary Care for Homeless Veterans (DCHV) - DCHVs provide a 24/7 structured and supportiveresidential environment as a part of the rehabilitative treatment.Health Maintenance Domiciliary - Health Maintenance Domiciliary beds provide residential care for Veterans,treating medical and psychiatric problems, substance use disorders, PTSD, and homelessness. Health MaintenanceDomiciliary beds provide a structured and supportive residential environment 24/7 as a part of rehabilitativetreatment. Health Maintenance Domiciliary beds focus on symptom reduction and stabilization as part of therehabilitative approach to facilitating community integration.General Domiciliary (General Dom) or Psychosocial Residential Rehabilitation Treatment Programs(PRRTP) - These programs provide residential care for the general Veteran population, treating medical andpsychiatric problems, substance use disorders, PTSD, and homelessness. General Doms and PRRTPs provide a 24/7structured and supportive residential environment as a part of rehabilitative treatment.Domiciliary PTSD (Dom PTSD) or Posttraumatic Stress Disorder Residential RehabilitationTreatment Program (PTSD-RRTP) - These programs provide residential care for Veterans with PTSD includingMilitary Sexual Trauma (MST). Both Dom PTSD and PTSD-RRTPs provide a 24/7 structured and supportiveresidential environment as a part of PTSD rehabilitative treatment.Domiciliary SA (Dom SA) or Substance Abuse Residential Rehabilitation Treatment Program(SARRTP) - These programs provide residential care to Veterans with substance use disorders. Dom SA andSARRTP provide a 24/
PrinciPleS tHAt Guide VA MentAl HeAltH cAre for VeterAnS. Certain basic principles form the foundation of all VA mental health care. They are: Focus on Recovery - VA is committed to a recovery-oriented approach to mental health care. Recovery empowers the Veteran to take charge of his/her treatment and live a full and meaningful life.
