Veteran Care Quality Erodes as Training Gaps Widen

Urgent concerns raised over privatized mental health services for former service members

Seven years after Congress championed the *VA MISSION Act* to ensure top-tier healthcare for veterans, critical training deficiencies in the privatized community care program are jeopardizing patient well-being. The legislation emphasized quality, with the word appearing 50 times, mandating comparable training for mental health providers in specialized areas like PTSD and TBI.

Systemic Failures Plague Community Care

Despite the *MISSION Act’s* intent, a significant gap persists. Community providers generally possess fewer graduate training hours than their VA counterparts. Research indicates these private clinicians are far less likely to employ scientifically validated psychotherapies for conditions such as PTSD and depression. A RAND Corporation study concluded that community psychotherapists often lack the necessary skills for effective veteran mental health care.

VA providers are required to conduct annual screenings for suicide, PTSD, substance use, military sexual trauma, and depression. Conversely, these essential protocols are absent in the privatized Veterans Community Care Program (VCCP). A concerning 57 percent of private mental health providers do not routinely screen for issues prevalent among veterans.

The VA developed eight specialized training modules on critical veteran mental health challenges. While VA providers must complete all, VCCP providers are only required to finish the opioid safety module, with the remaining seven deemed “recommended.”

GAO Report Reveals Alarming Training Deficiencies

A recent Government Accountability Office (GAO) report underscores the dire consequences of making these trainings optional. Between 2021 and 2023, over 22,700 veterans were referred to community providers outside the VA for mental health care. Astonishingly, only 380, or approximately 2 percent, completed any training.

The report highlights that more than 8,000 veterans identified as active suicide risks were referred to providers without documented suicide prevention training. Furthermore, despite anxiety and stress-related disorders comprising nearly half of patient diagnoses, few community providers had completed training in PTSD or military sexual trauma.

“Network Adequacy” Prioritized Over Competency

The VA has reportedly prioritized “network adequacy”—ensuring a sufficient number of providers—over the enforcement of training standards. This approach suggests a preference for a larger pool of undertrained clinicians over a smaller group with adequate qualifications. This strategy aligns with a decade-long trend toward privatizing veteran healthcare.

Efforts to expand community care access without strengthening training mandates are gaining momentum. The House Committee on Veterans’ Affairs (HVAC) advanced the *Veterans’ ACCESS Act*, which would allow veterans to seek community mental health care without pre-authorization. Similarly, the recently passed *No Wrong Door for Veterans Act* and the *HOPE for Heroes Act* aim to increase referrals to non-VA providers, also lacking explicit training requirements.

Representative **Sheila Cherfilus-McCormick** proposed an amendment during an HVAC hearing requiring community providers to meet the same rigorous training standards as VA clinicians. However, committee Republicans voted it down. This comes as the VA announced a move to yearlong community care authorizations for 52 mental health services, further increasing reliance on external providers.

A Call for Uniform Standards and Accountability

To rectify this crisis, uniform training standards must be implemented across all veteran care settings. Experts propose several key reforms:

• Enforce Uniform Training: All eight core VA training modules should be mandatory for any provider treating veterans, whether within the VA or in the community.
• Strengthen Accountability: Third-party administrators overseeing the VCCP should be empowered to suspend providers who fail to meet training benchmarks.
• Demand Transparency: The VA’s Provider Profile Management System should prominently display training records and be accessible to veterans and the public.

The nation owes its defenders the highest quality of care. Congress and the VA must act decisively to ensure that the *MISSION Act’s* promise of quality is fulfilled by mandating rigorous, enforceable training for all mental health providers serving veterans.