Perceived barriers to VA mental health care among Upper Midwest American Indian veterans: description and associations.

ABSTRACT

OBJECTIVES: This community-based study was undertaken to understand why Native-American veterans in the Upper Midwest choose not to use VA mental health services despite high rates of certain psychiatric disorders. RESEARCH DESIGN: A sample consisting of 543 Native-American veterans was obtained using a focused-intensive nonprobability sampling method, structured to over-sample urban and female veterans. Data sources included (1) interview (ie, an open-ended query regarding barriers to VA mental health care), (2) questionnaire (demography, psychiatric rating scales), and (3) computer-based diagnostic questionnaire, the Quick Diagnostic Interview Schedule, and a treatment questionnaire. RESULTS: These data confirmed that Native-American veterans were less apt to employ VA mental health services as compared with other professional and nonprofessional mental health services. Perceived barriers to VA mental health care were coded using a schema developed among Native American and Hispanic VA workers. Types of perceived barriers were qualitatively similar to those obtained from the VA workers, ie, barriers in the VA system, among Native-American veterans themselves, in VA staff members, and among Native American families and communities. Demographic and clinical characteristics among these 543 veterans were not associated with presence-versus-absence of barrier reporting. Among those who did report any barriers, veterans who used more traditional-alternative-complementary (TAC) care reported more barriers than did other veterans. Secondary analysis of those who reported barriers and used TAC revealed that this group had high current rates of Mood Disorder and PTSD symptoms, and high lifetime rates of PTSD and Mood Disorder. Although this latter group had tended to use VA mental health services in the past, they had generally not used them in the last year.