Concerns with Access to Care in the Outpatient Mental Health Clinic at the Charles George VA Medical Center in Asheville, North Carolina

The VA Office of Inspector General (OIG) conducted an inspection to assess concerns with access to mental health care at the Charles George VA Medical Center’s (facility) outpatient Mental Health clinic in Asheville, North Carolina. Complainants alleged concerns regarding delays in Behavioral Health Interdisciplinary Program (BHIP) assessment and psychotherapy consults; prescriber turnover; prescribers’ scope of practice; community care consults; and the role of the suicide prevention team. The OIG substantiated BHIP and psychotherapy consults were not completed within the Veterans Health Administration’s required time frame. Leaders attributed delays to staff vacancies and inefficient BHIP teams. Prescribers incorrectly believed that “permission” from the BHIP team was required before placing psychotherapy consults. Leaders did not clearly communicate with each other or fully address misperceptions about the psychotherapy consult process. The facility did not have processes to ascertain why staff leave so as to inform retention strategies that are necessary to maintain staffing levels. The OIG did not substantiate prescribers were providing care outside of their scope of practice or privileges, as applicable. Facility leaders discouraged, but did not prohibit, clinic providers from entering community care consults. Nearly all the prescribers, as well as additional non-prescribing clinic providers, submitted consults during the period of review. The OIG did not substantiate that the suicide prevention team failed to support prescribers with clinical duties, including patients with a high risk for suicide patient record flag; however, there was a general misunderstanding by some prescribers about the role of the suicide prevention team. Leaders failed to communicate to staff about the suicide prevention team’s role. The OIG made seven recommendations regarding mental health consult scheduling, community care referrals, BHIP implementation, staff retention, leaders’ communication, the role of the suicide prevention team, and follow-up care for patients with high risk for suicide patient record flags.