An evaluation of an initiative to improve Veterans Health Administration mental health services: broad impacts of the VHA's Mental Health Strategic Plan.

In federal fiscal year (FY) 2005 the Department of Veterans Affairs (VA) implemented the comprehensive Mental Health Strategic Plan (MHSP). This study used performance measures from six broad domains to examine changes in the overall delivery of mental health services in the VA since the implementation of the MHSP. Performance measures from fiscal year 2004, the year before implementation of the MHSP, were compared with measures from fiscal years 2005, 2006, and 2007, the first 3 years of MHSP implementation. We combined heterogeneous performance measures within domains through the use of standardized scores or "z-scores." An overall improvement of 0.32 standardized units was observed from FY 2004 to FY 2007, representing moderate to large changes by conventional standards. The domains with the greatest improvement (>1.0 standard deviation units) from FY 2004 to FY 2007 were population coverage/access, outpatient care quality, economic performance (primarily efficiency), and global functioning. There was a 0.3 standard deviation decline in inpatient satisfaction and a slight increase in reliance on inpatient care. Overall improvement in VA mental health care was thus substantial and continuing.