Area VA Leads National Mental Health Efforts

Valley News Staff Writer
Published: 9/14/2016 11:49:27 PM

White River Junction — A pioneering effort at the Veterans Affairs Medical Center here to provide same-day care to veterans who come in with mental health issues has spread through the sprawling health system run by the U.S. Veterans Health Administration.

“Things that have happened here in White River (Junction) have profoundly affected the entire VA system,” said Andrew Pomerantz, the national mental health director for integrated care in the VA’s Office of Patient Care Services.

Pomerantz, who was chief of mental health services in White River Junction from 1992 until 2010 and is still an associate professor of psychiatry at Dartmouth College’s Geisel School of Medicine, spoke on Wednesday to about 60 attendees at a community mental health summit sponsored by the VA.

The local VA’s walk-in Primary Mental Health Clinic was established in 2004 in the wake of cuts to funding and staffing in mental health services, according to Pomerantz. It was launched with the recognition that many patients seeking mental health care never return for a second appointment, he said.

For 44 hours a week — from 8 a.m. until 4 p.m. on weekdays and until noon on Saturdays — the clinic is available for same-day appointments by patients who walk in on their own or are sent from the nearby primary care clinic, said Mark Detzer, a psychologist at White River Junction.

Nationwide, about 1 in 4 primary care patients at the VA have at least one mental illness, according to a 2015 paper that Pomerantz co-authored.

In the primary mental health clinic, most visits begin with screening questionnaires for depression, anxiety, post-traumatic stress disorder and quality of life, Detzer said. A patient typically spends 20 to 40 minutes with a psychologist and 20 to 30 minutes with a doctor or nurse practitioner who can prescribe medication, he said.

Most patients leave with a treatment plan that may include such follow-up measures as testing, care management, participation in an open therapy group or a second appointment, according to Detzer.

Rather than requiring patients to pass through layers of preliminary interactions to obtain high-level care, the White River Junction approach “front loads the most skilled people,” he said.

Detzer noted the local VA’s role as a small, teaching hospital — it has 50 medical and surgical beds and 24 beds for behavioral health and has affiliation agreements with both Geisel and the University of Vermont College of Medicine.

“This is a pretty special place,” he said.

But the primary mental health clinic model has been rolling out nationwide, and has so far been adopted in about one-third of the VA system, Pomerantz said. His role in developing the new approach was a factor in his selection for his current job, he added.

It isn’t the only effort underway to expand veterans’ access to mental health care.

In New Hampshire, where 30,000 of 115,000 resident veterans receive care from the VA, military liaisons have been embedded in each of the state’s 10 community mental health centers, according to Jo Moncher of the state Health and Human Services Department. Emphasis is placed on identifying veterans and family members which, she said, can “start a conversation that can lead to better care.”

Increasing access to mental health care could help curb the high suicide rate among veterans, which currently exceeds 20 a day, Pomerantz said. On average, only six of those 20 are in the care of the VA, he added.

Wednesday’s event concluded with a slide presentation by Kelly Posner, who led a team at Columbia University that developed a Suicide Severity Rating Scale, a widely used screening procedure that employees and volunteers at all levels of an organization can be trained to use to detect suicide risk.

“Everyone everywhere can ask and should ask,” Posner said. “Prevention absolutely depends on identification.”

Rick Jurgens can be reached at or 603-727-3229.

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