Assignment Prompt & Instructions
**files (1)**
– ## number6.docx
**## number6.docx**
This assignment builds on the previous assignments (see below for the 2 previous assignment) in the course, where you identified a social problem and selected a local, state, or federal policy that affects it.
In this assignment, you will analyze the local, state, or federal policy you chose to address your social justice issue, including providing background on the development of the policy and evaluating its effectiveness and feasibility.
Remember that the feasibility of a policy relates not only to its economic feasibility but also to its political and social impact. You will also identify the policy constraints that inhibit the policy from most effectively reaching your targeted population.
Continue to consult the United States Congress website, the Government Accountability Office, public policy analysis research and reports, and other peer-reviewed research to support your analysis. Also, use the NASW Code of Ethics web page—
Analyze the development of your chosen policy.
· Analyze the historical background that led to the development of the policy.
· Define the goals of the policy and how these goals are intended to be met, including services and programs intended to achieve the goals.
· Evaluate the effectiveness of the policy with respect to the target population.
· Consider how well the policy has met the needs of your target population and to what extent it improves the social justice problem you initially researched. Does the policy seem to ignore, impede, or strengthen the social functioning of the target population?
· To what extent does the policy meet or improve the social values of the target population?
· To what extent does the policy adhere to best practice ethics and best practice standards?
· If the outcome of your analysis is that best practice ethics and standards are not being adhered to, include that information in your analysis as well.
· Evaluate the feasibility of the policy.
· Is the policy politically, economically, and administratively feasible? Provide details and rationale.
· Identify the policy constraints that inhibit the policy from fully addressing the problem for the chosen population.
· Have other constraints arisen since the passage of the policy that have made conditions worse or better for the chosen population?
**Guidelines**
· Support your claims and recommendation with clear rationale and support from scholarly, peer-reviewed literature.
**Additional Requirements**
The assignment you submit is expected to meet the following requirements:
·
**Written communication:** Written communication is free of errors that detract from the overall message.
·
**APA formatting:** Resources and citations are formatted according to current APA style and formatting standards.
·
**Cited resources:** A minimum of six scholarly sources. Most literature cited should be current, with publication dates within the past five years.
·
**Length of paper:** 5 typed, double-spaced pages.
·
Assignment 1
**Oppression and Discrimination in Veterans' Mental Health.**
Veterans are highly vulnerable to mental health disparity. They also go through discrimination, inequity, and lack access to care at the same time. This especially happens to individuals from minorities. Studies have also continuously revealed that Black, Hispanic, and Latinx veterans are more likely to experience the most severe forms of posttraumatic stress disorder (PTSD), depression, and anxiety symptoms than their White counterparts (Nillni et al., 2023).
Racial discrimination is not the only means of oppression that veterans face. Sexual orientation is a compounding stressor faced by LGBQ+ veterans, such as discrimination in military culture and healthcare environments (Harper et al., 2023). Bisexual veterans in particular report the most psychiatric distress of any group of sexual orientation, and with significantly more acute PTSD, depression, and anxiety than heterosexual veterans (Harper et al., 2023).
**Ethical Considerations and Implications for Social Work Practice**
NASW can help people who work with veterans' mental health navigate the intricate ethical climate. The main principle that guides social workers to doubt structural inequality and to advocate equality in terms of access to the services is social justice (NASW, 2021). This responsibility is particularly applicable to veteran care, in which access will be determined by race, income, geography, gender, and sexual orientation. It is the ethical responsibility of social workers to identify and intervene in how these factors contribute to the barriers to mental health treatment.
Another field of ethical requirement in the NASW Code of Ethics is cultural competence. Social workers should be familiar with the cultures and lives of their veteran clients, with the specifics of military culture that define help-seeking as a sign of weakness (Randles & Finnegan, 2022). The stigma of receiving mental health care, which is based on internalized, envisaged, and externalized stigmatization, is an important ethical obstacle as it makes people unable to obtain the services to which they have the right. Social workers should also undertake the initiative to eliminate the stigma by practicing in a culturally aware manner, engaging in outreach and advocacy (NASW, 2021). Moreover, there is the moral concept of self-determination, which states that the veterans are to be helped to define their needs and the preferred paths of care, as well as the informal channels of help, such as peer networks. The ethical issue has a practice implication of being affirmative, inclusive, and culturally responsive care is not the best practice; it is a duty of the profession. This failure to provide such care endangers to perpetuate the exploitation that social work is meant to eradicate.
**Current Enacted Policies Addressing Veterans' Mental Health**
There are also several federal level policies in place to govern mental health care amongst veterans. The VA MISSION Act of 2018 made the veterans more accessible to the community providers of care when inaccessible or unavailable VA facilities (Lafferty et al., 2023). The VA MISSION Act has granted veterans to access outside of the VA Care as long as they meet some of the required eligibility provisions, such that the veterans are not geographically and logistically secluded to access mental health care. The Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics (PACT) Act of 2022 further broadened the VA healthcare eligibility to the individuals who had been exposed to toxic substances (McAndrew et al., 2024).
The VA operates the Veterans Crisis Line, and funds the National Center on PTSD responsible of conducting research and disseminating evidence-based treatment of PTSD and other associated ailments. The VA has also developed several LGBTQ+ Veteran Care Coordinators within the centers around the country to reduce barriers in care due to identity. The aim of these coordinators is to provide holistic, supportive care to LGBQ+ veterans, who face barriers unique to them, including having faced discrimination in the military and health care facilities (Harper et al., 2023). In addition, there are the collaborative suicide prevention plans by the U.S. Department of Defense and VA, which is a subset of the National Strategy to Prevent Veteran Suicide since mental health crisis among the veterans require a population-specific response.
**Policy Impact, Limitations and Activism.**
Despite such policy efforts, massive loopholes still exist in attempting to address the intersectional mental health disparities of the veterans. Research has indicated that the policies targeting access have been unsuccessful in mitigating the underlying social factors like discrimination and income inequality leading to mental health disparities in racial and ethnic minority veterans (Nillni et al., 2023). The VA MISSION Act has expanded access theoretically, but the reality of access like transportation, long wait lines, and doubts about civilian ability to take care of veterans remain barriers to effectiveness, particularly among veterans in marginalized groups (Randles and Finnegan, 2022). Moreover, the policies have tended to be designed in a way that favors the average male veteran and female veterans and LGBTQ+ veterans have been underserved. Particularly, bisexual veterans are less willing to obtain formal assistance of medical practitioners and more willing to rely on internet-based sources, which implies that the existing healthcare-driven policies are not able to access this population (Harper et al., 2023).
Additional policy constraints include community-based mental health services are not funded, longitudinal research investigations of the long-term effects of discrimination on the well-being of veterans, and the absence of a mandatory cultural competency training among mental health service providers who work with various groups of veterans. Effective advocacy strategies that have demonstrated effectiveness are stigma reduction campaigns that incorporate the personal narratives of veterans who have used mental health services, peer support programs that employ military camaraderie as an agent of help-seeking, and healthcare provider training on veteran-specific and identity-affirming care (Randles & Finnegan, 2022). These strategies comply with NASW ethical standards as they focus on the dignity and value of veterans as individuals.
The main issue with present advocacy activities is that they tend to primarily work at the organizational level without creating systemic policy change that would help to address the structural determinants of the veteran mental health disparities. The answer to these problems is to initiate macro level advocacy that exerts pressure on laws that require a cultural competency training program, increased funding to facilitate the conduct of intersectional research, and a policy that makes equity the foundation of VA service delivery. Outreach efforts through digital platforms may be particularly helpful among disadvantaged subgroups, such as bisexual veterans, who are likely to be able to find information online (Harper et al., 2023). Lastly, effective promotion of mental health among veterans should be committed towards addressing the discrimination and inequality that the existing policies, despite being in place, has failed to address.
**References**
Harper, K. L., Herbitter, C., Livingston, N. A., Vogt, D., Iverson, K., Nillni, Y. I., & Galovski, T. (2023). Experiences of discrimination and mental health treatment seeking among LGBQ+ veterans.
_Psychology of Sexual Orientation and Gender Diversity_.
[https://dx.doi.org/10.1037/sgd0000683](https://dx.doi.org/10.1037/sgd0000683)
Lafferty, M., Govier, D. J., Golden, S. E., Disher, N. G., Hynes, D. M., & Slatore, C. G. (2023). VA-delivered or VA-purchased care: important factors for veterans navigating care decisions.
_Journal of general internal medicine_,
_38_(7), 1647-1654.
[https://doi.org/10.1007/s11606-023-08128-0](https://doi.org/10.1007/s11606-023-08128-0)
McAndrew, L. M., Burgo-Black, L., Hunt, S. C., Kossoudji, A., Mains, K. C., Shuping, E., & Llorente, M. D. (2026). Exposure-informed care: why it’s important and how the veterans affairs does it.
_Medical Care_,
_64_(2S), S103-S110. DOI: 10.1097/MLR.0000000000002238
National Association of Social Workers. (2021). NASW code of ethics. Retrieved From:
[https://www.socialworkers.org/About/Ethics/Code-of-Ethics](https://www.socialworkers.org/About/Ethics/Code-of-Ethics)
Nillni, Y. I., Horenstein, A., McClendon, J., Duke, C. C., Sawdy, M., & Galovski, T. E. (2023). The impact of perceived everyday discrimination and income on racial and ethnic disparities in PTSD, depression, and anxiety among veterans.
_PLOS ONE, 18_(9), e0291965.
[https://doi.org/10.1371/journal.pone.0291965](https://doi.org/10.1371/journal.pone.0291965)
Randles, R., & Finnegan, A. (2022). Veteran help-seeking behaviour for mental health issues: a systematic review.
_BMJ mil Health_,
_168_(1), 99-104.
[https://doi.org/10.1136/bmjmilitary-2021-001903](https://doi.org/10.1136/bmjmilitary-2021-001903)
Assignment 2
**Purpose of the Policy**
The VA MISSION Act of 2018, officially signed into law as Public Law No. 115-182, was developed to enhance access, quality, and coordination of healthcare services to U.S. veterans, and specifically to those who face barriers to care (Congress.gov, n.d). It is a major revision of the system of Veterans Affairs (VA) healthcare, which was sponsored by Senator Johnny Isakson and passed with bipartisan support in the 115th Congress. It is about ensuring that veterans receive quality and timely care by a combination of VA healthcare services and community-based healthcare providers. This is done by instituting a more adaptable and responsive model of healthcare delivery that is responsive to systemic inefficiencies, including long wait times, provider shortages, and geographic barriers.
The policy is a direct response to inequities in access to care that disproportionately affect marginalized groups of veterans, including racial and ethnic minorities and LGBTQ+ individuals. These groups are more prone to having severe mental health problems and experiencing barriers to receiving treatment (Nillni et al., 2023). The MISSION Act aims to lessen disparities and achieve more favorable health outcomes by expanding eligibility to non-VA care and improving coordination among providers. Continuity of care and the fact that veterans, because of administrative delays or systems failures, should not experience lapses in their services further enhance their patient-centered care commitment.
**Programs and Services Provided Through the Policy**
The VA MISSION Act had a broad scope of programs and services that were aimed at enhancing healthcare delivery. It has one of the most important components, the Veterans Community Care Program (VCCP), which offers eligible veterans the opportunity to receive hospital care, medical services, and extended care services by non-VA providers when the VA facilities are unable to adequately meet their needs (Congress.gov, n.d). The eligibility conditions involve cases when the VA fails to provide the necessary services, does not have a full-service facility within the state of the veteran, or is unable to deliver timely services. Such a program is also needed to overcome the access disparities, especially in underserved or rural areas, among veterans.
The policy along with the VCCP also introduced Veterans Care Agreements (VCAs), which provide the VA with an opportunity to enter into an agreement with community providers, where traditional contracting would not work (Congress.gov, n.d). These types of arrangements consider various factors including travel burden, nature of medical conditions and urgency of care. The policy also granted the option of walk-in care whereby the veterans are given the opportunity to receive certain services but not prior appointments and this is particularly useful in the event of emergency mental health care.
Telehealth was another area that was extended by the Act through the removal of geographic constraints and allowing VA providers to deliver care across state boundaries. It is an urgent step towards tackling logistical and stigma-related impediments to mental health treatment. Telehealth may allow veterans, especially those who may have some reluctance to seek face-to-face care due to stigma, to access care in a more privative and convenient way (Randles & Finnegan, 2022).
The next important element is the further development of the Family Caregiver Program that now covers pre-9/11 veterans (Congress.gov, n.d). This program provides caregivers with financial support, training and support services in recognition of the crucial role these caregivers play in recovering and the well-being of veterans. The policy also incorporates education and training programs on both the provider and veteran side, so that veterans are aware of their healthcare options, and providers are prepared to provide high-quality, culturally competent care to the veterans.
All the eligible veterans are of concern in such programs but specifically of importance to those with discrepancies associated with mental health and systemic discrimination. The minority veterans and LGBTQ+ veterans can have more access points and more adaptable service delivery models that can help alleviate some of the barriers they must incur in traditional healthcare settings.
**Connection between the Policy and the Social Justice Problem.**
The VA MISSION Act is directly related to the social injustice of oppression and discrimination within mental health of veterans. This is also a systemic issue and historical inequalities existed which had traditionally limited access to care and was one of the factors contributing to poorer mental health outcomes among marginalized populations. As has been shown, the racial and ethnic minority veterans have an increased risk of developing PTSD, depression, and anxiety that are often worsened by other issues, including discrimination and socioeconomic disadvantage (Merians et al., 2023). On the same note, LGBTQ+ veterans encounter special issues of stigma and exclusion both in the military and in health care (Harper et al., 2023).
The policy aims at resolving this social justice issue by focusing on structural obstacles to care, especially those involving access and availability of services. The MISSION Act lowers dependency on a centralized system, which could be unable to provide appropriate care to various groups of people (O’Hare et al., 2022). This is an important feature to veterans who might feel sidelined or misinterpreted in conventional VA care.
Nevertheless, the policy enhances access, but it does not completely address the root causes of discrimination. Such issues as implicit bias, the absence of cultural competence in providers, and the stigmatization of mental health remain. According to Randles and Finnegan (2022), even in the presence of the services, stigma is a major obstacle to help-seeking behavior. Thus, the MISSION Act can be considered a significant yet partial measure in the direction of social justice in the mental health of veterans.
The social problem in question is a long-standing issue that has been developing over the years, but has not been resolved yet. The fact that, even though several policy interventions have been implemented, the disparities are still present goes to show that perhaps, more multifaceted solutions may be necessary that would address the needs of both structural and interpersonal factors.
**History and Policymaking**
The VA MISSION Act has been created as a solution to the existing problems with the VA healthcare system with accessibility and the quality of services. The largest triggering factor of the policy was the 2014 VA scheduling scandal that revealed excessive wait times and systemic inefficiencies that failed to allow veterans to receive timely care (Beaubrun, 2026). This crisis has demonstrated the desperately high need for reform, and it has come along with more public and political pressure to reform the system.
The bill was introduced in 2018 and passed with a large margin of bipartisanship, reflecting a broad spectrum of agreement on the question of the need to meet the healthcare needs of veterans. Before being signed into law on June 6, 2018, it underwent several procedures, including committee hearings and roll call votes (Congress.gov, n.d). The well-established legislative support is indicative of the acknowledgment of the importance of healthcare access to veterans.
In the past, the healthcare policies of veterans have been modified to address the new challenges and changes in society. MISSION Act is founded on the earlier legislation, such as the Veterans Access, Choice, and Accountability Act of 2014, but elaborates and narrows down community care options. This evolution provides a shift in the direction of more integrated and more flexible healthcare systems that are more competent to support diversity.
The historical context also demonstrates that there were long-term inadequacies in addressing the issue of discrimination and inequality. It has been typical that policies have been concerned with improving access, yet without speaking fully to the social determinants of health, like income inequality and systemic bias. Consequently, the marginalized groups still face disparities, although there are improvements in policies.
These historical aspects have impacted on the implementation of the MISSION Act. Despite the benefits of the policy, such as the rise in access, it is faced with several challenges, which limit its effectiveness, including provider shortages, problems with the coordination of services, and the persistence of the stigma. Furthermore, the tendencies historically inclined on formulating policies based on a generalized group of veterans have led to gaps in services offered to women and LGBTQ+ veterans (Harper et al., 2023).
**Conclusion**
In summary, the VA MISSION Act of 2018 is an important policy that can improve access to healthcare and mitigate disparities in mental health of veterans. It continues to be dynamic and continues to dictate how the services are to be provided. However, it has been constrained by historical and structural causes which must be countered and always restructured. Policies that will be implemented to achieve true social justice will have to focus on policies that not only will increase access but also will target the causes of discrimination and inequity in the healthcare system.
**References**
Congress.gov. (n.d). S.2372 – VA MISSION Act of 2018. Retrieved from:
[https://www.congress.gov/bill/115th-congress/senate-bill/2372](https://www.congress.gov/bill/115th-congress/senate-bill/2372)
Merians, A. N., Gross, G., Spoont, M. R., Bellamy, C. D., Harpaz-Rotem, I., & Pietrzak, R. H. (2023). Racial and ethnic mental health disparities in US Military Veterans: Results from the National Health and Resilience in Veterans Study.
_Journal of psychiatric research_,
_161_, 71-76.
[https://doi.org/10.1016/j.jpsychires.2023.03.005](https://doi.org/10.1016/j.jpsychires.2023.03.005)
O’Hare, A. M., Butler, C. R., Laundry, R. J., Showalter, W., Todd-Stenberg, J., Green, P., … & Carey, E. (2022). Implications of cross-system use among US veterans with advanced kidney disease in the era of the MISSION act: A qualitative study of health care records.
_JAMA Internal Medicine_,
_182_(7), 710-719. doi:10.1001/jamainternmed.2022.1379
Beaubrun, F. L. O. (2026).
_Strategies to Reduce Diagnostic Wait Times in VHA Facilities_ (Doctoral dissertation, Walden University).
Harper, K. L., Herbitter, C., Livingston, N. A., Vogt, D., Iverson, K., Nillni, Y. I., & Galovski, T. (2023). Experiences of discrimination and mental health treatment seeking among LGBQ+ veterans.
_Psychology of Sexual Orientation and Gender Diversity_.
[https://dx.doi.org/10.1037/sgd0000683](https://dx.doi.org/10.1037/sgd0000683)
Nillni, Y. I., Horenstein, A., McClendon, J., Duke, C. C., Sawdy, M., & Galovski, T. E. (2023). The impact of perceived everyday discrimination and income on racial and ethnic disparities in PTSD, depression, and anxiety among veterans.
_PLOS ONE, 18_(9), e0291965.
[https://doi.org/10.1371/journal.pone.0291965](https://doi.org/10.1371/journal.pone.0291965)
Randles, R., & Finnegan, A. (2022). Veteran help-seeking behaviour for mental health issues: A systematic review.
_BMJ Military Health, 168_(1), 99–104.
[https://doi.org/10.1136/bmjmilitary-2021-001903](https://doi.org/10.1136/bmjmilitary-2021-001903)
**## number6.docx**
This assignment builds on the previous assignments (see below for the 2 previous assignment) in the course, where you identified a social problem and selected a local, state, or federal policy that affects it.
In this assignment, you will analyze the local, state, or federal policy you chose to address your social justice issue, including providing background on the development of the policy and evaluating its effectiveness and feasibility.
Remember that the feasibility of a policy relates not only to its economic feasibility but also to its political and social impact. You will also identify the policy constraints that inhibit the policy from most effectively reaching your targeted population.
Continue to consult the United States Congress website, the Government Accountability Office, public policy analysis research and reports, and other peer-reviewed research to support your analysis. Also, use the NASW Code of Ethics web page—
Analyze the development of your chosen policy.
· Analyze the historical background that led to the development of the policy.
· Define the goals of the policy and how these goals are intended to be met, including services and programs intended to achieve the goals.
· Evaluate the effectiveness of the policy with respect to the target population.
· Consider how well the policy has met the needs of your target population and to what extent it improves the social justice problem you initially researched. Does the policy seem to ignore, impede, or strengthen the social functioning of the target population?
· To what extent does the policy meet or improve the social values of the target population?
· To what extent does the policy adhere to best practice ethics and best practice standards?
· If the outcome of your analysis is that best practice ethics and standards are not being adhered to, include that information in your analysis as well.
· Evaluate the feasibility of the policy.
· Is the policy politically, economically, and administratively feasible? Provide details and rationale.
· Identify the policy constraints that inhibit the policy from fully addressing the problem for the chosen population.
· Have other constraints arisen since the passage of the policy that have made conditions worse or better for the chosen population?
**Guidelines**
· Support your claims and recommendation with clear rationale and support from scholarly, peer-reviewed literature.
**Additional Requirements**
The assignment you submit is expected to meet the following requirements:
·
**Written communication:** Written communication is free of errors that detract from the overall message.
·
**APA formatting:** Resources and citations are formatted according to current APA style and formatting standards.
·
**Cited resources:** A minimum of six scholarly sources. Most literature cited should be current, with publication dates within the past five years.
·
**Length of paper:** 5 typed, double-spaced pages.
·
Assignment 1
**Oppression and Discrimination in Veterans' Mental Health.**
Veterans are highly vulnerable to mental health disparity. They also go through discrimination, inequity, and lack access to care at the same time. This especially happens to individuals from minorities. Studies have also continuously revealed that Black, Hispanic, and Latinx veterans are more likely to experience the most severe forms of posttraumatic stress disorder (PTSD), depression, and anxiety symptoms than their White counterparts (Nillni et al., 2023).
Racial discrimination is not the only means of oppression that veterans face. Sexual orientation is a compounding stressor faced by LGBQ+ veterans, such as discrimination in military culture and healthcare environments (Harper et al., 2023). Bisexual veterans in particular report the most psychiatric distress of any group of sexual orientation, and with significantly more acute PTSD, depression, and anxiety than heterosexual veterans (Harper et al., 2023).
**Ethical Considerations and Implications for Social Work Practice**
NASW can help people who work with veterans' mental health navigate the intricate ethical climate. The main principle that guides social workers to doubt structural inequality and to advocate equality in terms of access to the services is social justice (NASW, 2021). This responsibility is particularly applicable to veteran care, in which access will be determined by race, income, geography, gender, and sexual orientation. It is the ethical responsibility of social workers to identify and intervene in how these factors contribute to the barriers to mental health treatment.
Another field of ethical requirement in the NASW Code of Ethics is cultural competence. Social workers should be familiar with the cultures and lives of their veteran clients, with the specifics of military culture that define help-seeking as a sign of weakness (Randles & Finnegan, 2022). The stigma of receiving mental health care, which is based on internalized, envisaged, and externalized stigmatization, is an important ethical obstacle as it makes people unable to obtain the services to which they have the right. Social workers should also undertake the initiative to eliminate the stigma by practicing in a culturally aware manner, engaging in outreach and advocacy (NASW, 2021). Moreover, there is the moral concept of self-determination, which states that the veterans are to be helped to define their needs and the preferred paths of care, as well as the informal channels of help, such as peer networks. The ethical issue has a practice implication of being affirmative, inclusive, and culturally responsive care is not the best practice; it is a duty of the profession. This failure to provide such care endangers to perpetuate the exploitation that social work is meant to eradicate.
**Current Enacted Policies Addressing Veterans' Mental Health**
There are also several federal level policies in place to govern mental health care amongst veterans. The VA MISSION Act of 2018 made the veterans more accessible to the community providers of care when inaccessible or unavailable VA facilities (Lafferty et al., 2023). The VA MISSION Act has granted veterans to access outside of the VA Care as long as they meet some of the required eligibility provisions, such that the veterans are not geographically and logistically secluded to access mental health care. The Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics (PACT) Act of 2022 further broadened the VA healthcare eligibility to the individuals who had been exposed to toxic substances (McAndrew et al., 2024).
The VA operates the Veterans Crisis Line, and funds the National Center on PTSD responsible of conducting research and disseminating evidence-based treatment of PTSD and other associated ailments. The VA has also developed several LGBTQ+ Veteran Care Coordinators within the centers around the country to reduce barriers in care due to identity. The aim of these coordinators is to provide holistic, supportive care to LGBQ+ veterans, who face barriers unique to them, including having faced discrimination in the military and health care facilities (Harper et al., 2023). In addition, there are the collaborative suicide prevention plans by the U.S. Department of Defense and VA, which is a subset of the National Strategy to Prevent Veteran Suicide since mental health crisis among the veterans require a population-specific response.
**Policy Impact, Limitations and Activism.**
Despite such policy efforts, massive loopholes still exist in attempting to address the intersectional mental health disparities of the veterans. Research has indicated that the policies targeting access have been unsuccessful in mitigating the underlying social factors like discrimination and income inequality leading to mental health disparities in racial and ethnic minority veterans (Nillni et al., 2023). The VA MISSION Act has expanded access theoretically, but the reality of access like transportation, long wait lines, and doubts about civilian ability to take care of veterans remain barriers to effectiveness, particularly among veterans in marginalized groups (Randles and Finnegan, 2022). Moreover, the policies have tended to be designed in a way that favors the average male veteran and female veterans and LGBTQ+ veterans have been underserved. Particularly, bisexual veterans are less willing to obtain formal assistance of medical practitioners and more willing to rely on internet-based sources, which implies that the existing healthcare-driven policies are not able to access this population (Harper et al., 2023).
Additional policy constraints include community-based mental health services are not funded, longitudinal research investigations of the long-term effects of discrimination on the well-being of veterans, and the absence of a mandatory cultural competency training among mental health service providers who work with various groups of veterans. Effective advocacy strategies that have demonstrated effectiveness are stigma reduction campaigns that incorporate the personal narratives of veterans who have used mental health services, peer support programs that employ military camaraderie as an agent of help-seeking, and healthcare provider training on veteran-specific and identity-affirming care (Randles & Finnegan, 2022). These strategies comply with NASW ethical standards as they focus on the dignity and value of veterans as individuals.
The main issue with present advocacy activities is that they tend to primarily work at the organizational level without creating systemic policy change that would help to address the structural determinants of the veteran mental health disparities. The answer to these problems is to initiate macro level advocacy that exerts pressure on laws that require a cultural competency training program, increased funding to facilitate the conduct of intersectional research, and a policy that makes equity the foundation of VA service delivery. Outreach efforts through digital platforms may be particularly helpful among disadvantaged subgroups, such as bisexual veterans, who are likely to be able to find information online (Harper et al., 2023). Lastly, effective promotion of mental health among veterans should be committed towards addressing the discrimination and inequality that the existing policies, despite being in place, has failed to address.
**References**
Harper, K. L., Herbitter, C., Livingston, N. A., Vogt, D., Iverson, K., Nillni, Y. I., & Galovski, T. (2023). Experiences of discrimination and mental health treatment seeking among LGBQ+ veterans.
_Psychology of Sexual Orientation and Gender Diversity_.
[https://dx.doi.org/10.1037/sgd0000683](https://dx.doi.org/10.1037/sgd0000683)
Lafferty, M., Govier, D. J., Golden, S. E., Disher, N. G., Hynes, D. M., & Slatore, C. G. (2023). VA-delivered or VA-purchased care: important factors for veterans navigating care decisions.
_Journal of general internal medicine_,
_38_(7), 1647-1654.
[https://doi.org/10.1007/s11606-023-08128-0](https://doi.org/10.1007/s11606-023-08128-0)
McAndrew, L. M., Burgo-Black, L., Hunt, S. C., Kossoudji, A., Mains, K. C., Shuping, E., & Llorente, M. D. (2026). Exposure-informed care: why it’s important and how the veterans affairs does it.
_Medical Care_,
_64_(2S), S103-S110. DOI: 10.1097/MLR.0000000000002238
National Association of Social Workers. (2021). NASW code of ethics. Retrieved From:
[https://www.socialworkers.org/About/Ethics/Code-of-Ethics](https://www.socialworkers.org/About/Ethics/Code-of-Ethics)
Nillni, Y. I., Horenstein, A., McClendon, J., Duke, C. C., Sawdy, M., & Galovski, T. E. (2023). The impact of perceived everyday discrimination and income on racial and ethnic disparities in PTSD, depression, and anxiety among veterans.
_PLOS ONE, 18_(9), e0291965.
[https://doi.org/10.1371/journal.pone.0291965](https://doi.org/10.1371/journal.pone.0291965)
Randles, R., & Finnegan, A. (2022). Veteran help-seeking behaviour for mental health issues: a systematic review.
_BMJ mil Health_,
_168_(1), 99-104.
[https://doi.org/10.1136/bmjmilitary-2021-001903](https://doi.org/10.1136/bmjmilitary-2021-001903)
Assignment 2
**Purpose of the Policy**
The VA MISSION Act of 2018, officially signed into law as Public Law No. 115-182, was developed to enhance access, quality, and coordination of healthcare services to U.S. veterans, and specifically to those who face barriers to care (Congress.gov, n.d). It is a major revision of the system of Veterans Affairs (VA) healthcare, which was sponsored by Senator Johnny Isakson and passed with bipartisan support in the 115th Congress. It is about ensuring that veterans receive quality and timely care by a combination of VA healthcare services and community-based healthcare providers. This is done by instituting a more adaptable and responsive model of healthcare delivery that is responsive to systemic inefficiencies, including long wait times, provider shortages, and geographic barriers.
The policy is a direct response to inequities in access to care that disproportionately affect marginalized groups of veterans, including racial and ethnic minorities and LGBTQ+ individuals. These groups are more prone to having severe mental health problems and experiencing barriers to receiving treatment (Nillni et al., 2023). The MISSION Act aims to lessen disparities and achieve more favorable health outcomes by expanding eligibility to non-VA care and improving coordination among providers. Continuity of care and the fact that veterans, because of administrative delays or systems failures, should not experience lapses in their services further enhance their patient-centered care commitment.
**Programs and Services Provided Through the Policy**
The VA MISSION Act had a broad scope of programs and services that were aimed at enhancing healthcare delivery. It has one of the most important components, the Veterans Community Care Program (VCCP), which offers eligible veterans the opportunity to receive hospital care, medical services, and extended care services by non-VA providers when the VA facilities are unable to adequately meet their needs (Congress.gov, n.d). The eligibility conditions involve cases when the VA fails to provide the necessary services, does not have a full-service facility within the state of the veteran, or is unable to deliver timely services. Such a program is also needed to overcome the access disparities, especially in underserved or rural areas, among veterans.
The policy along with the VCCP also introduced Veterans Care Agreements (VCAs), which provide the VA with an opportunity to enter into an agreement with community providers, where traditional contracting would not work (Congress.gov, n.d). These types of arrangements consider various factors including travel burden, nature of medical conditions and urgency of care. The policy also granted the option of walk-in care whereby the veterans are given the opportunity to receive certain services but not prior appointments and this is particularly useful in the event of emergency mental health care.
Telehealth was another area that was extended by the Act through the removal of geographic constraints and allowing VA providers to deliver care across state boundaries. It is an urgent step towards tackling logistical and stigma-related impediments to mental health treatment. Telehealth may allow veterans, especially those who may have some reluctance to seek face-to-face care due to stigma, to access care in a more privative and convenient way (Randles & Finnegan, 2022).
The next important element is the further development of the Family Caregiver Program that now covers pre-9/11 veterans (Congress.gov, n.d). This program provides caregivers with financial support, training and support services in recognition of the crucial role these caregivers play in recovering and the well-being of veterans. The policy also incorporates education and training programs on both the provider and veteran side, so that veterans are aware of their healthcare options, and providers are prepared to provide high-quality, culturally competent care to the veterans.
All the eligible veterans are of concern in such programs but specifically of importance to those with discrepancies associated with mental health and systemic discrimination. The minority veterans and LGBTQ+ veterans can have more access points and more adaptable service delivery models that can help alleviate some of the barriers they must incur in traditional healthcare settings.
**Connection between the Policy and the Social Justice Problem.**
The VA MISSION Act is directly related to the social injustice of oppression and discrimination within mental health of veterans. This is also a systemic issue and historical inequalities existed which had traditionally limited access to care and was one of the factors contributing to poorer mental health outcomes among marginalized populations. As has been shown, the racial and ethnic minority veterans have an increased risk of developing PTSD, depression, and anxiety that are often worsened by other issues, including discrimination and socioeconomic disadvantage (Merians et al., 2023). On the same note, LGBTQ+ veterans encounter special issues of stigma and exclusion both in the military and in health care (Harper et al., 2023).
The policy aims at resolving this social justice issue by focusing on structural obstacles to care, especially those involving access and availability of services. The MISSION Act lowers dependency on a centralized system, which could be unable to provide appropriate care to various groups of people (O’Hare et al., 2022). This is an important feature to veterans who might feel sidelined or misinterpreted in conventional VA care.
Nevertheless, the policy enhances access, but it does not completely address the root causes of discrimination. Such issues as implicit bias, the absence of cultural competence in providers, and the stigmatization of mental health remain. According to Randles and Finnegan (2022), even in the presence of the services, stigma is a major obstacle to help-seeking behavior. Thus, the MISSION Act can be considered a significant yet partial measure in the direction of social justice in the mental health of veterans.
The social problem in question is a long-standing issue that has been developing over the years, but has not been resolved yet. The fact that, even though several policy interventions have been implemented, the disparities are still present goes to show that perhaps, more multifaceted solutions may be necessary that would address the needs of both structural and interpersonal factors.
**History and Policymaking**
The VA MISSION Act has been created as a solution to the existing problems with the VA healthcare system with accessibility and the quality of services. The largest triggering factor of the policy was the 2014 VA scheduling scandal that revealed excessive wait times and systemic inefficiencies that failed to allow veterans to receive timely care (Beaubrun, 2026). This crisis has demonstrated the desperately high need for reform, and it has come along with more public and political pressure to reform the system.
The bill was introduced in 2018 and passed with a large margin of bipartisanship, reflecting a broad spectrum of agreement on the question of the need to meet the healthcare needs of veterans. Before being signed into law on June 6, 2018, it underwent several procedures, including committee hearings and roll call votes (Congress.gov, n.d). The well-established legislative support is indicative of the acknowledgment of the importance of healthcare access to veterans.
In the past, the healthcare policies of veterans have been modified to address the new challenges and changes in society. MISSION Act is founded on the earlier legislation, such as the Veterans Access, Choice, and Accountability Act of 2014, but elaborates and narrows down community care options. This evolution provides a shift in the direction of more integrated and more flexible healthcare systems that are more competent to support diversity.
The historical context also demonstrates that there were long-term inadequacies in addressing the issue of discrimination and inequality. It has been typical that policies have been concerned with improving access, yet without speaking fully to the social determinants of health, like income inequality and systemic bias. Consequently, the marginalized groups still face disparities, although there are improvements in policies.
These historical aspects have impacted on the implementation of the MISSION Act. Despite the benefits of the policy, such as the rise in access, it is faced with several challenges, which limit its effectiveness, including provider shortages, problems with the coordination of services, and the persistence of the stigma. Furthermore, the tendencies historically inclined on formulating policies based on a generalized group of veterans have led to gaps in services offered to women and LGBTQ+ veterans (Harper et al., 2023).
**Conclusion**
In summary, the VA MISSION Act of 2018 is an important policy that can improve access to healthcare and mitigate disparities in mental health of veterans. It continues to be dynamic and continues to dictate how the services are to be provided. However, it has been constrained by historical and structural causes which must be countered and always restructured. Policies that will be implemented to achieve true social justice will have to focus on policies that not only will increase access but also will target the causes of discrimination and inequity in the healthcare system.
**References**
Congress.gov. (n.d). S.2372 – VA MISSION Act of 2018. Retrieved from:
[https://www.congress.gov/bill/115th-congress/senate-bill/2372](https://www.congress.gov/bill/115th-congress/senate-bill/2372)
Merians, A. N., Gross, G., Spoont, M. R., Bellamy, C. D., Harpaz-Rotem, I., & Pietrzak, R. H. (2023). Racial and ethnic mental health disparities in US Military Veterans: Results from the National Health and Resilience in Veterans Study.
_Journal of psychiatric research_,
_161_, 71-76.
[https://doi.org/10.1016/j.jpsychires.2023.03.005](https://doi.org/10.1016/j.jpsychires.2023.03.005)
O’Hare, A. M., Butler, C. R., Laundry, R. J., Showalter, W., Todd-Stenberg, J., Green, P., … & Carey, E. (2022). Implications of cross-system use among US veterans with advanced kidney disease in the era of the MISSION act: A qualitative study of health care records.
_JAMA Internal Medicine_,
_182_(7), 710-719. doi:10.1001/jamainternmed.2022.1379
Beaubrun, F. L. O. (2026).
_Strategies to Reduce Diagnostic Wait Times in VHA Facilities_ (Doctoral dissertation, Walden University).
Harper, K. L., Herbitter, C., Livingston, N. A., Vogt, D., Iverson, K., Nillni, Y. I., & Galovski, T. (2023). Experiences of discrimination and mental health treatment seeking among LGBQ+ veterans.
_Psychology of Sexual Orientation and Gender Diversity_.
[https://dx.doi.org/10.1037/sgd0000683](https://dx.doi.org/10.1037/sgd0000683)
Nillni, Y. I., Horenstein, A., McClendon, J., Duke, C. C., Sawdy, M., & Galovski, T. E. (2023). The impact of perceived everyday discrimination and income on racial and ethnic disparities in PTSD, depression, and anxiety among veterans.
_PLOS ONE, 18_(9), e0291965.
[https://doi.org/10.1371/journal.pone.0291965](https://doi.org/10.1371/journal.pone.0291965)
Randles, R., & Finnegan, A. (2022). Veteran help-seeking behaviour for mental health issues: A systematic review.
_BMJ Military Health, 168_(1), 99–104.
[https://doi.org/10.1136/bmjmilitary-2021-001903](https://doi.org/10.1136/bmjmilitary-2021-001903)