Who decides what works? Inside VA’s mental health treatment playbook

Key Points:

• The Department of Veterans Affairs (VA) follows a multi-step process to adopt new treatments for PTSD, depression, anxiety, and substance use disorders, involving research, clinical guidelines, medication reviews, safety and ethics assessments, and practical considerations like staffing and equipment.
• FDA approval is only one step; the VA also evaluates how treatments work specifically for veterans, their feasibility within the VA system, and potential risks before expanding access, as illustrated by the adoption of repetitive transcranial magnetic stimulation (rTMS) for depression.
• The VA’s 2023 PTSD clinical practice guideline applies rigorous evidence evaluation and considers patient perspectives, sometimes resulting in changes to treatment recommendations, such as advising against benzodiazepines and cannabis products due to insufficient evidence or known harms.
• Emerging treatments like ketamine and psychedelic-assisted therapies remain under research and are not yet routine VA care, despite some veterans seeking access to them, highlighting the distinction between scientific promise and VA availability.
• After treatments are implemented, the VA continues monitoring safety and effectiveness through reports, quality checks, and research, periodically updating clinical guidelines to ensure care remains evidence-based and appropriate for veterans.