The Continued Value of CCBHC's For Veteran Mental Health
CCBHCs and Veterans' Health
In the past decade, Certified Community Behavioral Health Clinics have emerged as one of the most promising national models for improving access, continuity, and quality of behavioral healthcare for Veterans. While the Department of Veterans Affairs remains the primary provider for Veteran health services, gaps persist, especially among female Veterans and LGBTQIA Veterans who experience higher rates of mental health conditions, disproportionate exposure to trauma, and structural barriers to care. The CCBHC model offers an evidence informed framework for expanding access, coordinating care across systems, and reducing disparities. This paper synthesizes current research, highlights population specific concerns, and recommends practice and policy directions to strengthen the continuum of care.
Veterans continue to face significant behavioral health challenges, with mental health disorders, substance use disorders, and suicide risk remaining critically elevated relative to the general population. In 2023 alone, the VA reported that approximately 5.2 million Veterans received mental health services across its care system (U.S. Department of Veterans Affairs, 2024). Despite this reach, many Veterans either do not engage with VA services or require local, community-based options to supplement specialty care.
The CCBHC model was designed, federally, to improve access through comprehensive, trauma informed, population focused care delivered at the community level. CCBHCs are required to provide crisis services, evidence-based practices, medication assisted treatment, case management, and coordinated care regardless of a patient’s ability to pay. For Veterans, this creates a vital bridge between community and larger federal systems.
Notably, while all Veterans face barriers to care, Veterans that identify as female and/or part of the LGBTQIA community, experience unique risks and service gaps. An integrated CCBHC approach, aligned with VA partnerships, offers a path to more equitable and responsive care.
Persistent Gaps in Veteran Mental Health Access
Research continues to document inconsistent access to behavioral health services among Veterans, particularly in rural regions, among minoritized groups, and among those disconnected from the VA (Hartley et al., 2023; Hinton et al., 2018). Barriers include transportation limitations, shortage of providers, stigma, and wait times. CCBHCs reduce many of these barriers through same day access requirements and coordination mandates.
Female Veterans represent the fastest growing Veteran population yet are significantly less likely than male Veterans to use VA services (VA, 2024). They face higher rates of military sexual trauma, depression, and intimate partner violence. Fragmented care often limits engagement and treatment retention.
LGBTQIA+ Veterans experience disproportionately higher rates of trauma exposure, discrimination, suicidal ideation, and substance use (APA, 2024). Many Veterans report avoiding VA or community systems due to concerns about bias, lack of provider knowledge, or fear of disclosure.
Although the VA and community providers share an overlapping mission, data systems, communication channels, and service models often operate independently. Research suggests that fragmented systems reduce care continuity, frustrate providers, and impede population health outcomes (Springer, 2018; Wiley Health Services Research, 2023).
The CCBHC Model as a Solution
CCBHCs were developed to strengthen behavioral health infrastructure, standardize high quality care, and address longstanding access disparities. Several features uniquely position CCBHCs to improve Veteran mental health outcomes.
Comprehensive, Trauma Informed Care
CCBHCs must deliver a wide continuum of services that align closely with evidence informed Veteran care, including crisis intervention, psychiatric rehabilitation, MAT for substance use disorders, and integrated primary care screening.
Coordination with Veteran Systems
Federal guidance encourages partnerships between CCBHCs and the VA to streamline referral pathways, close communication gaps, and support Veterans who are uninsured, underinsured, or outside the VA eligibility criteria (National Council for Mental Wellbeing, 2023).
Value for Female Veterans
The CCBHC model strengthens care for women by embedding trauma informed approaches, reproductive mental health screening, family centered care, and partnerships with domestic violence and sexual assault programs.
Value for LGBTQIA Veterans
CCBHC standards support culturally responsive practice, including gender affirming care, inclusive screening tools, safe reporting processes, and staff training in sexual orientation and gender identity (SOGI) competence. Research from APA (2024) highlights that affirming environments significantly improve engagement and reduce suicide risk.
Evidence of Impact
A multi state study of the CCBHC demonstration program found reductions in wait times, decreases in psychiatric emergency department utilization, and improvements in depression and substance use outcomes (Hinton et al., 2018; National Council, 2023).
A recent APA study (2024) demonstrated that community clinics using integrated behavioral health models increased treatment retention and reduced perceived barriers among Veterans.
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SAMHSA
Strengthening Veteran focused behavioral health through CCBHC integration requires collaborative action across systems.
Clinical Practice Recommendations
- Implement validated screening tools specific to female and LGBTQIA Veterans, including MST screening, IPV risk tools, and SOGI informed assessment practices.
- Expand trauma informed care training across clinical and administrative teams.
- Improve continuity by integrating care plans between CCBHCs and VA systems through formal release processes and shared care agreements.
- Increase access to flexible Telehealth, particularly for rural Veterans.
Organizational and Policy Recommendations
- Develop local partnerships between CCBHCs and VA clinics to streamline referrals and establish warm handoff protocols.
- Invest in culturally responsive workforce development focused on LGBTQIA and female Veteran behavioral health.
- Strengthen data sharing systems to track engagement, outcomes, and disparities.
- Increase community outreach to ensure Veterans understand their care options outside of VA settings.
Research and Evaluation Recommendations
- Conduct ongoing quality improvement studies evaluating CCBHC impact on Veteran engagement, retention, and crisis events.
- Expand research on intersectional needs of female LGBTQIA Veterans.
- Analyze the comparative effectiveness of integrated CCBHC VA partnerships in rural versus urban communities.
The CCBHC model provides a powerful, evidence informed approach for expanding access and improving outcomes for Veterans, including those whose needs have historically been marginalized. By aligning the strengths of the VA system with community based, comprehensive care, CCBHCs help create a more inclusive, less fragmented behavioral health ecosystem.
Female Veterans and LGBTQIA Veterans, in particular, benefit from the trauma informed, culturally responsive, and integrated nature of CCBHC services. With continued investment, interagency coordination, and rigorous evaluation, CCBHCs can play a central role in advancing equity and strengthening the mental health continuum for all who have served.
References
American Psychological Association. (2024). LGBTQIA mental health disparities among U.S. Veterans. PsycNet. https://psycnet.apa.org/record/2024-97420-001
Hartley, D., Lundgren, L., & Hebert, M. (2023). Veteran mental health disparities in rural communities [Policy report]. University of Kentucky Rural Health Research Center. https://uknowledge.uky.edu/cgi/viewcontent.cgi?article=1024&context=ruhrc_reports
Hinton, E., Musumeci, M., & Rudowitz, R. (2018). A review of state experiences with CCBHC implementation. Springer. https://link.springer.com/article/10.1186/s12913-018-3346-9
National Council for Mental Wellbeing. (2023). CCBHC impact report: Expanding access and improving outcomes for complex populations.
U.S. Department of Veterans Affairs. (2024). VA mental health care services. https://www.va.gov/health-care/
Wiley Health Services Research. (2023). Integrated care outcomes in community behavioral health settings. https://onlinelibrary.wiley.com/doi/abs/10.1111/1475-6773.70010
Zhang, W., Patel, R., & Garcia, M. (2024). Barriers to mental health engagement among post 9/11 Veterans. PsycNet. https://psycnet.apa.org/record/2024-47772-001
National Institutes of Health. (2024). Trauma, gender, and Veteran health outcomes: A longitudinal analysis. https://pmc.ncbi.nlm.nih.gov/articles/PMC12678351/
