Skip to main content

Mental Health Service Preferences and Utilization Among Women Veterans in Crisis: Perspectives of Veterans Crisis Line Responders

The Journal of Behavioral Health Services & Research volume 46, pages 29–42 (2019)Cite this article

Abstract

Women military veterans are at increased risk of suicide compared to non-veterans, but little is known about the mental health service preferences and needs of women veterans in crisis. This study used qualitative, secondary source key informant interviews to ascertain the experiences of women veterans in crisis from 54 responders working at the Veterans Crisis Line. Responders indicated that women veterans reported different experiences with Veterans Administration (VA) and non-VA care, though drivers of satisfaction or dissatisfaction were similar. Availability of specialty care, sensitivity to veterans’ issues or Military Sexual Trauma, strong provider relationships, and continuity of care contributed to satisfaction; lengthy appointment wait times, limited service options, and insensitivity to veterans’ issues contributed to dissatisfaction. Responders suggested that barriers limiting VA access for women veterans are perceived as similar to non-VA care. Findings suggest that caller experiences with providers drive satisfaction with VA and non-VA mental health services.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

References

  1. Hoffmire CA, Kemp JE, Bossarte RM. Changes in Suicide Mortality for Veterans and Nonveterans by Gender and History of VHA Service Use, 2000-2010. Psychiatric Services. 2015;66(9):959–965.

    Article  PubMed  Google Scholar 

  2. U.S. Department of Veterans Affairs. Suicide Among Veterans and Other Americans 2001-2014 Washington, D.C.:Office of Suicide Prevention 2016.

    Google Scholar 

  3. Centers for Disease Control and Prevention. Fatal Injury Reports, National, Regional, and State, 1981-2015. Atlanta, GA: 2015

  4. Female Veteran Suicide Prevention Act, H.R. 2915 (2015).

  5. U.S. Department of Veterans Affairs. Healthcare Inspection: Implementing VHA’s Mental Health Strategic Plan Initiatives for Suicide Prevention.06–03706-126 Washington, D.C.:Office of the Inspector General 2007.

  6. Brown GK, Ten Have T, Henriques GR, et al. Cognitive therapy for the prevention of suicide attempts: a randomized controlled trial. Journal of the American Medical Association. 2005;294(5):563–570.

    Article  CAS  PubMed  Google Scholar 

  7. Brown LM, Framingham JL, Frahm KA, et al. Crisis Counselors’ Perceptions and Assessment of Suicidal Behavior Among Hurricane Survivors Receiving Crisis Counseling Services. Disaster Medicine and Public Health Preparedness. 2015;9(3):291–300.

    Article  PubMed  Google Scholar 

  8. Linehan MM, Korslund KE, Harned MS, et al. Dialectical behavior therapy for high suicide risk in individuals with borderline personality disorder: a randomized clinical trial and component analysis. Journal of the American Medical Association Psychiatry. 2015;72(5):475–482.

    PubMed  Google Scholar 

  9. Rudd MD, Bryan CJ, Wertenberger EG, et al. Brief cognitive-behavioral therapy effects on post-treatment suicide attempts in a military sample: results of a randomized clinical trial with 2-year follow-up. The American Journal of Psychiatry. 2015;172(5):441–449.

    Article  PubMed  Google Scholar 

  10. Acosta JD, Ramchand R, Jaycox LH, et al. Interventions to Prevent Suicide: A Literature Review to Guide Evaluation of California’s Mental Health Prevention and Early Intervention Initiative. Santa Monica, CA: RAND Corporation;2012.

    Book  Google Scholar 

  11. Ramchand R, Acosta J, Burns RM, et al. The War Within: Preventing Suicide in the U.S. Military. 2011(2162–8254).

  12. U.S. Department of Veterans Affairs. VA Releases Report on Nation’s Largest Analysis of Veteran Suicide [press release]. Washington, D.C.: Office of Public and Intergovernmental Affairs, 2016. pp.1

  13. O’Hanlon C, Huang C, Sloss E, et al. Comparing VA and Non-VA Quality of Care: A Systematic Review. Journal of General Internal Medicine. 2017(1525–1497).

  14. Hussey P, Ringel J, Ahluwalia S, et al. Resources and Capabilities of the Department of Veterans Affairs to Provide Timely and Accessible Care to Veterans. Santa Monica, CA: RAND Corporation;2015.

    Google Scholar 

  15. Watkins KE, Pincus HA Fau - Paddock S, Paddock S Fau - Smith B, et al. Care for veterans with mental and substance use disorders: good performance, but room to improve on many measures. Health Affairs. 2011(1544–5208).

  16. Runnals JJ, Garovoy N, McCutcheon SJ, et al. Systematic review of women veterans’ mental health. Womens Health Issues. 2014;24(5):485–502.

    Article  PubMed  Google Scholar 

  17. Washington DL, Bean-Mayberry B, Riopelle D, et al. Access to care for women veterans: delayed healthcare and unmet need. Journal of General Internal Medicine. 2011;26 Suppl 2:655–661.

    Article  PubMed  PubMed Central  Google Scholar 

  18. MacGregor C, Hamilton AB, Oishi SM, et al. Description, development, and philosophies of mental health service delivery for female veterans in the VA: a qualitative study. Womens Health Issues. 2011;21(4 Suppl):S138–144.

    Article  PubMed  Google Scholar 

  19. Washington DL, Yano EM, Simon B, et al. To use or not to use. What influences why women veterans choose VA health care. Journal of General Internal Medicine. 2006;21 Suppl 3:S11–18.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Bean-Mayberry BA, Chang CC, McNeil MA, et al. Patient satisfaction in women’s clinics versus traditional primary care clinics in the Veterans Administration. Journal of General Internal Medicine. 2003;18(3):175–181.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Bean-Mayberry B, Yano EM, Washington DL, et al. Systematic review of women veterans’ health: update on successes and gaps. Womens Health Issues. 2011;21(4 Suppl):S84–97.

    Article  PubMed  Google Scholar 

  22. Cucciare MA, Lewis ET, Hoggatt KJ, et al. Factors Affecting Women’s Disclosure of Alcohol Misuse in Primary Care: A Qualitative Study with U.S. Military Veterans. Womens Health Issues. 2015.

  23. Dichter ME, Wagner C, Goldberg EB, et al. Intimate Partner Violence Detection and Care in the Veterans Health Administration: Patient and Provider Perspectives. Womens Health Issues. 2015;25(5):555–560.

    Article  PubMed  Google Scholar 

  24. Callegari LS, Borrero S, Reiber GE, et al. Reproductive Life Planning in Primary Care: A Qualitative Study of Women Veterans’ Perceptions. Womens Health Issues. 2015;25(5):548–554.

    Article  PubMed  Google Scholar 

  25. Thomas TL, Kang HK, Dalager NA. Mortality among Women Vietnam Veterans, 1973–1987. American Journal of Epidemiology. 1991;134(9):973–980.

    Article  CAS  PubMed  Google Scholar 

  26. Silverman MM, Berman AL, Sanddal ND, et al. Rebuilding the Tower of Babel: A Revised Nomenclature for the Study of Suicide and Suicidal Behaviors Part 1: Background, Rationale, and Methodology. Suicide and Life-Threatening Behavior. 2007;37(3):248–263.

    Article  PubMed  Google Scholar 

  27. Strauss A, Corbin JM. Basics of Qualitative Research: Techniques and Procedures for Developing Grounded Theory. Vol 2. Washington, D.C.: SAGE Publications; 1998.

    Google Scholar 

  28. Ramchand R, Ayer L, Kotzias V, et al. Suicide Risk among Women Veterans in Distress: Perspectives of Responders on the Veterans Crisis Line. Womens Health Issues. 2016;26(6):667–673.

    Article  PubMed  Google Scholar 

  29. Bergman AA, Frankel RM, Hamilton AB, et al. Challenges with delivering gender-specific and comprehensive primary care to women veterans. Womens Health Issues. 2015;25(1):28–34.

    Article  PubMed  Google Scholar 

  30. Iverson KM, Hendricks AM, Kimerling R, et al. Psychiatric diagnoses and neurobehavioral symptom severity among OEF/OIF VA patients with deployment-related traumatic brain injury: a gender comparison. Womens Health Issues. 2011;21(4 Suppl):S210–217.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Andrade LH, Alonso J, Mneimneh Z, et al. Barriers to mental health treatment: results from the WHO World Mental Health surveys. Psychological Medicine. 2014;44(6):1303–1317.

    Article  CAS  PubMed  Google Scholar 

  32. Delcher C, Wang Y, Maldonado-Molina M. Trends in Financial Barriers to Medical Care for Women Veterans, 2003–2004 and 2009–2010. Preventing Chronic Disease. 2013;10.

  33. Garcia HA, Finley EP, Ketchum N, et al. A survey of perceived barriers and attitudes toward mental health care among OEF/OIF veterans at VA outpatient mental health clinics. Military Medicine. 2014;179(3):273–278.

    Article  PubMed  Google Scholar 

  34. Walker ER, Cummings JR, Hockenberry JM, et al. Insurance status, use of mental health services, and unmet need for mental health care in the United States. Psychiatric Services. 2015;66(6):578–584.

    Article  PubMed  Google Scholar 

  35. Burnam MA, Meredith LS, Tanielian T, et al. Mental health care for Iraq and Afghanistan War Veterans. Health Affairs. 2009;28(3):771–782.

    Article  PubMed  Google Scholar 

  36. Pfeiffer PN, Bowersox N, Birgenheir D, et al. Preferences and Barriers to Care Following Psychiatric Hospitalization at Two Veterans Affairs Medical Centers: A Mixed Methods Study. The Journal of Behavioral Health Services & Research. 2016;43(1):88–103.

    Article  Google Scholar 

  37. Fottler MD, Ford RC. Managing patient waits in hospital emergency departments. The Health Care Manager. 2002;21(1):46–61.

    Article  PubMed  Google Scholar 

  38. Blender R, Maxey C. Are your patients patiently waiting? What to do about patient wait times. Journal of Medical Practice Management. 2000;16(2):66–69.

    CAS  PubMed  Google Scholar 

  39. Fau AK, Weiss BJ, Fau WB, et al. Piloting Specialized Mental Health Care for Rural Women Veterans Using STAIR Delivered via Telehealth: Implications for Reducing Health Disparities. Journal of Health Care for the Poor and Underserved. 2016;27(4A):1–7.

    Article  Google Scholar 

  40. Jones MD, Etherage Jr Fau - Harmon SC, Harmon Sc Fau - Okiishi JC, et al. Acceptability and cost-effectiveness of military telehealth mental health screening. Psychological Services. 2012;9(2):132–143.

  41. Moreau JL, Cordasco KM, Young AS, et al. The Use of Telemental Health to Meet the Mental Health Needs of Women Using Department of Veterans Affairs Services. Women’s Health Issues. 2018;28(2):181–187.

    Article  PubMed  Google Scholar 

  42. Price M, Gros DF. Examination of prior experience with telehealth and comfort with telehealth technology as a moderator of treatment response for PTSD and depression in veterans. The International Journal of Psychiatry in Medicine. 2014;48(1):57–67.

    Article  PubMed  Google Scholar 

  43. Corrigan PW, Druss BG, Perlick DA. The Impact of Mental Illness Stigma on Seeking and Participating in Mental Health Care. Psychological Science in the Public Interest. 2014;15(2):37–70.

    Article  PubMed  Google Scholar 

  44. Pietrzak RH, Johnson DC, Goldstein MB, et al. Psychological resilience and postdeployment social support protect against traumatic stress and depressive symptoms in soldiers returning from Operations Enduring Freedom and Iraqi Freedom. Depression and Anxiety. 2009;26(8):745–751.

    Article  PubMed  Google Scholar 

  45. Sharp M-L, Fear NT, Rona RJ, et al. Stigma as a Barrier to Seeking Health Care Among Military Personnel With Mental Health Problems. Epidemiologic Reviews. 2015.

  46. Michaels PJ, Corrigan PW, Buchholz B, et al. Changing Stigma Through a Consumer-Based Stigma Reduction Program. Community Mental Health Journal. 2013;50(4):395–401.

    Article  PubMed  Google Scholar 

  47. Coll JE, Weiss EL, Yarvis JS. No One Leaves Unchanged: Insights for Civilian Mental Health Care Professionals Into the Military Experience and Culture. Social Work in Health Care. 2011;50(7):487–500.

    Article  PubMed  Google Scholar 

  48. Mattocks KM, Haskell SG, Krebs EE, et al. Women at war: Understanding how women veterans cope with combat and military sexual trauma. Social Science & Medicine. 2012;74(4):537–545.

    Article  Google Scholar 

  49. Vogt D, Bergeron A, Salgado D, et al. Barriers to Veterans Health Administration care in a nationally representative sample of women veterans. Journal of General Internal Medicine. 2006;21 Suppl 3:S19–25.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Wagner C, Dichter ME, Mattocks K. Women Veterans’ Pathways to and Perspectives on Veterans Affairs Health Care. Womens Health Issues. 2015.

  51. Sneeuw KC, Sprangers Ma Fau - Aaronson NK, Aaronson NK. The role of health care providers and significant others in evaluating the quality of life of patients with chronic disease. Journal of Clinical Epidemiology. 2002;55(11):1130–1140.

Download references

Acknowledgements

The authors wish to acknowledge Kendra Wilsher for her administrative contributions to this project.

Author information

Affiliations

  1. RAND Corporation, 1200 S. Hayes St., Arlington, VA, 22202, USA

    Virginia Kotzias BS, BA, MPP, Rajeev Ramchand BA, PhD, Lynsay Ayer BA, PhD & Zachary Predmore BA

  2. RAND Corporation, 20 Park Plaza, 9th Floor, Suite 920, Boston, MA, 02116, USA

    Charles C. Engel BS, MD, MPH

  3. RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401-3208, USA

    Patricia Ebener BA

  4. VISN 4 MIRECC, Department of Veterans Affairs, 323 North Shore Drive, Suite 400, Pittsburgh, PA, 15212, USA

    Gretchen L. Haas PhD

  5. VISN 2 Center of Excellence for Suicide Prevention, Department of Veterans Affairs, 400 Fort Hill Ave, Canandaigua, NY, 14424, USA

    Janet E. Kemp RN, PhD & Elizabeth Karras PhD

Authors
  1. Virginia Kotzias BS, BA, MPP
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Charles C. Engel BS, MD, MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Rajeev Ramchand BA, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Lynsay Ayer BA, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Zachary Predmore BA
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Patricia Ebener BA
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Gretchen L. Haas PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Janet E. Kemp RN, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Elizabeth Karras PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Virginia Kotzias BS, BA, MPP.

Ethics declarations

All procedures were approved by RAND’s Institutional Review Board.

Conflict of Interest

The authors declare that they have no conflict of interest.

Credits

None.

Disclaimers

None.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Kotzias, V., Engel, C.C., Ramchand, R. et al. Mental Health Service Preferences and Utilization Among Women Veterans in Crisis: Perspectives of Veterans Crisis Line Responders. J Behav Health Serv Res 46, 29–42 (2019). https://doi.org/10.1007/s11414-018-9635-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11414-018-9635-6