Veterans with mental health conditions are not satisfied with the quality of care they receive from clinicians outside of the Department of Veterans Affairs.

The new report, published in JAMA, highlights a concerning lack of specialization and effectiveness from community providers in meeting the specific needs of vulnerable veterans. This comes at a time when the federal government is simultaneously suggesting increased funding for veterans’ care.

Funding for VA community care has increased by – 134% –  $10.6 billion, since 2014, but quality has remained relatively the same and is consistently ranked lower than other VA-funded services. 

Among 231,869 veterans involved in the study, those with mental health conditions consistently rated their experience with VA-purchased community care lower across nine categories than their peers without mental health conditions.

Around 30% of the veterans with mental health conditions also had three or more serious health issues in addition to their behavioral health concerns.

Comparatively, ratings did improve somewhat between 2016 and 2021, but veterans with mental health conditions always rated externally provided mental health care about 1.8 points lower on a 0 to 100-point scale than their peers without mental health concerns.

VA-purchased community care was expanded in 2018 to improve access for veterans. Now, around one-third of VA enrollees use it in some manner, but questions around its effectiveness and quality continue to be persistent issues.

Across the U.S., around 41% of veterans have some type of mental health need, but among them, fewer than 50% who need mental health treatment actually receive it.

Suicide rates were found to be about 21% higher for veterans who received VA-purchased community care services than among those who received direct care from the Veterans Health Administration (VHA), according to the 2024 National Veteran Suicide Prevention Report. Suicide rates were actually lower among veterans who did not receive community care or VHA care services.

Recipients of community care tend to be young, male and living in rural areas with less access to direct VHA services. The study also documented “a greater burden of risk factors among those who also received VA-funded community care, compared to those without such care.”

Veterans who used a combination of VHA care and community services were also more likely to receive a mental health or substance use disorder diagnosis, as well as inpatient and outpatient services, than those without VHA care.

Across the population of more than 6 million veterans, 42.1% received VA-funded community care in some form between 2020 and 2022. Despite the expansion of service access to community care options in 2018, the quality of care has remained lower.

Particularly for more vulnerable veterans who have mental health diagnoses, the finding raises concerns over gaps in satisfaction, overall clinician rating, clinician communication, eligibility determination, first appointment access, recent appointment access, nonappointment access, care coordination and billing.

While previous research found that generally veterans without mental health conditions rated community care lower, the latest evidence published in JAMA “raises the question of how to manage [community care] where there is added complexity due to concomitant behavioral health or military cultural competence needs,” researchers wrote. “The VA has a unique approach to integrating physical and behavioral health care and training clinicians in military cultural competency. However, non-VA community clinicians are not required to have this training.”

The lack of training for taking care of veteran populations may be driving this trend among community care clinicians’ preparedness to address the military-specific needs of veterans who have mental health diagnoses.

Although the quality of care provided to veteran patients with mental health issues is consistently ranked low, the VA has gradually increased community care as a budget line item. Since spending $7.9 billion toward it in 2014, as of 2021 the VA set aside upward of $18.5 billion for community care alone.

Even amid the Trump administration’s vast proposal of budget and research cuts targeted at health care for fiscal year 2026, the VA is one of the only care-related areas receiving a boost in proposed funding. If the budget is approved, it could receive an additional $3.3 billion for medical care, which includes supporting veterans’ case management and support services, and nearly $2.2 billion for electronic health record modernization.

“As the VA considers what type of care is reasonably retained in the VA vs. provided through community partners, and what resources are needed to coordinate care across different systems, additional consideration should be given to vulnerable populations, including veterans with [mental health conditions],” the researchers note.