Study Shows Low Rates of VA Vocational Service Use among OEF/OIF Veterans with Mental Health Conditions
BACKGROUND:
Of the nearly 300,000 OEF/OIF Veterans who enrolled in VA healthcare from 2002 through 2008, 37% received mental health diagnoses, including 22% with PTSD, 17% with depression, and 10% with substance use disorder (SUD). Moreover, approximately 20% of OEF/OIF Veterans have sustained a mild traumatic brain injury (TBI). These top four mental health conditions can limit readiness for civilian employment and contribute to impaired job performance. Supported employment, the evidence-based practice for helping people with mental health disorders return to work, is now a mainstay of VA healthcare. Supported employment involves rapid job searching for competitive jobs in an integrated vocational and mental health treatment model, and primarily targets Veterans with severe mental illness (not common among OEF/OIF Veterans) or those who are homeless. This study assessed nationwide patterns of supported employment and vocational service use among OEF/OIF Veterans with the top four mental health conditions. Investigators also examined whether access and engagement in vocational services, as well as competitive work placement, was related to any demographic, financial, or clinical factors. Using VA data, investigators identified 75,607 OEF/OIF Veterans with PTSD, depression, SUD, or TBI who accessed VA care in FY08 or FY09, as well as a subset of these Veterans (n=1,010) whose employment was tracked during their participation in VA vocational services.
FINDINGS:
- Of the 75,607 OEF/OIF Veterans with mental health diagnoses included in this study, only 8% (n=6,345) had a vocational services encounter during the study period, with 2% of these receiving evidence-based supported employment. Moreover, retention was low, with most Veterans attending just one to two appointments.
- Veterans with TBI - and those with more mental health conditions overall - were more likely to access vocational services.
- Among Veterans whose employment was tracked, 51% with at least one supported employment encounter worked competitively, compared to 21% of those who did not receive supported employment. Thus, supported employment was effective when it was provided.
- Results indicate that recovery-oriented, evidence-based, supported employment is the best way to assist unemployed Veterans with mental health conditions to achieve competitive employment. However, resources are limited for Veterans without psychosis and those who are not homeless. Given that OEF/OIF Veterans with TBI are more likely to need vocational services, the authors suggest supported employment could be effectively integrated into VA polytrauma clinics.
LIMITATIONS:
- Because referrals to vocational services are not tracked nationally, investigators could not ascertain how many OEF/OIF Veterans with mental health conditions were referred to VA or non-VA vocational services.
- This study was unable to assess barriers to engagement and retention in vocational services.
AUTHOR/FUNDING INFORMATION:
This study was funded by VA/HSR&D's Mental Health Quality Enhancement Research Initiative (QUERI: RRP 10-052). All authors, except for Dr. Resnick, are part of VA's Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System.
Twamley E, Baker D, Norman S, Pittman J, Lohr J, and Resnick S. VHA Vocational Services for OEF/OIF Veterans with Mental Health Conditions. Journal of Rehabilitation Research & Development 2013;50(5):663-70.
