Veteran-centered barriers to VA mental healthcare services use

BMC Health Serv Res. 2018 Jul 31;18(1):591. doi: 10.1186/s12913-018-3346-9.


Background: Some veterans face multiple barriers to VA mental healthcare service use. However, there is limited understanding of how veterans' experiences and meaning systems shape their perceptions of barriers to VA mental health service use. In 2015, a participatory, mixed-methods project was initiated to elicit veteran-centered barriers to using mental healthcare services among a diverse sample of US rural and urban veterans. We sought to identify veteran-centric barriers to mental healthcare to increase initial engagement and continuation with VA mental healthcare services.

Methods: Cultural Domain Analysis, incorporated in a mixed methods approach, generated a cognitive map of veterans' barriers to care. The method involved: 1) free lists of barriers categorized through participant pile sorting; 2) multi-dimensional scaling and cluster analysis for item clusters in spatial dimensions; and 3) participant review, explanation, and interpretation for dimensions of the cultural domain. Item relations were synthesized within and across domain dimensions to contextualize mental health help-seeking behavior.

Results: Participants determined five dimensions of barriers to VA mental healthcare services: concern about what others think; financial, personal, and physical obstacles; confidence in the VA healthcare system; navigating VA benefits and healthcare services; and privacy, security, and abuse of services.

Conclusions: These findings demonstrate the value of participatory methods in eliciting meaningful cultural insight into barriers of mental health utilization informed by military veteran culture. They also reinforce the importance of collaborations between the VA and Department of Defense to address the role of military institutional norms and stigmatizing attitudes in veterans' mental health-seeking behaviors.

Keywords: Cultural domain analysis; Health care services use; Mental health; Patient-centered care; Qualitative research; Veterans.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adult
  • Aged
  • Cluster Analysis
  • Facilities and Services Utilization
  • Female
  • Financing, Personal
  • Health Behavior
  • Health Services Accessibility / statistics & numerical data*
  • Help-Seeking Behavior
  • Humans
  • Interprofessional Relations
  • Male
  • Mental Health
  • Mental Health Services / statistics & numerical data*
  • Middle Aged
  • Military Personnel / statistics & numerical data
  • Patient Acceptance of Health Care / statistics & numerical data
  • Physical Examination
  • Social Behavior
  • Stereotyping
  • United States
  • United States Department of Veterans Affairs
  • Veterans / statistics & numerical data
  • Young Adult