Observations From the National Implementation of Measurement Based Care in Mental Health in the Department of Veterans Affairs

In 2016, the Department of Veterans Affairs (VA) began the Measurement-Based Care in Mental Health Initiative to implement measurement-based care (MBC) across all mental health programs with the goal of making MBC the national standard of care. Phase 1 of this initiative, beginning in fall 2016 through fall 2017. was carefully designed to meet the ambitious goals of the organization while minimizing implementation barriers. Phase 1 participants reported an increase in MBC implementation across mental health programs with a simultaneous increase in the proportion of patient-reported outcome measures among veterans new to mental health care. The initiative adopted a broad range of strategies informed by implementation science to facilitate implementation at the organizational, provider, and patient level which are described here. The initiative was successful, but use of patient-reported outcome measures across VA mental health remains proportionally low. Technology, VA's hierarchical structure, and competition from other VA mental health initiatives may have slowed national implementation efforts.