Improve Veterans’ Access to Mental Health Services


Congress should direct the Department of Veterans’ Affairs (VA) to improve access to mental health services provided by licensed Marriage and Family Therapists (MFTs) at VA facilities by eliminating specific bureaucratic obstacles.


An average of 22 Veterans commit suicide daily, and an increasing number of Veterans have mental-health needs consequent to extended active-duty deployments. These needs often also affect Veterans’ family members. In 2006, Congress enacted Public Law 109-461 establishing 38 USC § 7401(3) to permit VA to hire MFTs to help serve the increasing number of veterans with mental-health needs. On September 28 2010, VA finally issued MFT Job Specifications (VA Handbook 5005/41), required in order for VA to hire MFTs. The VA amended the MFT Job Specifications in 2018. 

VA employs 24,000 mental-health professionals, of which approximately 100 (0.5%) are now MFTs. Yet MFTs comprise about 13% of all U.S. mental-health professionals. (Similarly, only about 0.05% of VA mental-health professionals are Licensed Professional Counselors, who comprise about 26% of all U.S. mental-health professionals). While MFTs’ underrepresentation in VA mental-health staff is partly due to MFTs’ relative newness within VA, the American Association for Marriage and Family Therapy (AAMFT) believes it also is due to unnecessarily bureaucratic VA obstacles:

-All advanced MFT students are barred from VA internship stipends, despite Psychology and Social Work students being eligible. After mental-health students complete their academic training, in order to be licensed they must successfully complete clinical internships of at least one year. Many of these students depend on financial stipends in order to live during their internships. But VA bars MFT students – even those in COAMFTE degree programs – from receiving stipends, while Psychology and Social Work students in corresponding APA and CSWE degree programs are stipend-eligible. Because many VA healthcare professionals start their careers through VA clinical internships, barring all MFT interns from stipends reduces the number of newly-licensed MFTs working at VA.

-VA’s MFT jobs to date are concentrated in Vet Centers, despite major mental-health needs in VA Medical Centers and Clinics. VA operates about 150 Readjustment Counseling Centers (“Vet Centers”) for recently-returned veterans, the sites of most MFT jobs to date. Vet Centers generally are reported to be working well. In contrast, most of the widespread reports of VA mental-health service problems are at Medical Centers (VAMCs, i.e. hospitals) and clinics. Unfortunately, some VA Medical Centers falsely believe MFTs are ineligible for jobs in those facilities. Although AAMFT is pleased that VA recognizes MFTs’ familial and other relationship-based clinical skills in its Vet Centers, we believe MFTs can be part of the solution in VAMCs and clinics. Like other mental-health professionals, MFTs are licensed in all states to diagnose and treat behavioral disorders.


Improve access to VA mental health services by urging VA to hire more LMFTs to fill open positions at VA Medical Centers, Clinics, and Vet Centers, to create more internship sites for MFT interns, and to create an Occupational Series for MFTs. 

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