Improvements Recommended in Visit Frequency and Contingency Planning for Emergencies in ICMHR Programs

The VA Office of Inspector General (OIG) conducted a national review to assess elements of the Veterans Health Administration’s (VHA’s) Intensive Community Mental Health Recovery programs (ICMHR). ICMHR provides highly intensive community-based care to veterans with serious mental illness. Visit frequency is a measure of ICMHR service intensity. This review examined the visit frequency for ICMHR-enrolled veterans from April 1, 2019, through March 31, 2021. The time frame represents approximately one year prior to and one year after the onset of the COVID-19 pandemic. Additionally, the OIG evaluated VHA healthcare systems’ contingency planning for veteran medication access during emergencies. The OIG found ICMHR did not meet VHA’s required visit frequency for high-intensity services. ICMHR staff are expected to have, on average, two to three weekly visits with ICMHR-enrolled veterans, typically in the veterans’ communities or homes, to provide high-intensity services. The OIG reviewed ICMHR-related data from VHA, calculated the weekly average number of visits in a veteran’s treatment period, and found that ICMHR did not meet VHA’s required visit frequency for high-intensity services. The OIG also evaluated VHA’s contingency planning for veteran medication access during emergencies. Community-based programs, such as ICMHR, should have program-specific contingency plans for veterans’ medication access, including to long-acting injectable antipsychotic medications, during emergencies. A disruption in medication access could be destabilizing for veterans with serious mental illness. The OIG found the majority of VHA healthcare systems did not have ICMHR-specific contingency plans for veteran medication access. The OIG made three recommendations to the Under Secretary for Health. The recommendations address ICMHR visit frequency and intensity of care provided; the ongoing role of virtual care in the delivery of ICMHR; and ICMHR-specific contingency planning related to medication access during emergencies, with a focus on long-acting injectable antipsychotic medications.