VA Butler Healthcare System is aiming to provide comprehensive mental healthcare to meet veterans where they are and with what they need.

The system’s mental and behavioral health services stretch from inpatient to outpatient veterans, as well as offering a wide range of clinical and nonclinical experiences. Its programs are designed to adapt to veterans’ changing needs.

Christopher Noullet, a clinical psychologist and recovery coordinator at the VA, said the system has a dedicated outpatient behavioral health clinic to treat veterans with mental health conditions and substance use disorders.

“We have an interdisciplinary staff that offers a variety of services in that clinic. This includes things like psychotherapy and medication management. We have group therapies that we offer and we have behavioral health nursing,” he said.

He said this work is heavily supported by peer support specialists — veterans with personal mental health experiences and proper training.

“Our peers are kind of embedded in multiple places in our programming across our behavioral health services. They are integral in running some of our groups, so we have support groups and we have treatment groups they assist in facilitating. They run our aftercare groups and one of our peers also runs a PTSD group that’s pretty well attended,” he explained.

While many of the programs are tailored broadly, Noullet said a number are designed to help those with specific needs.

“We have an intimate partner violence coordinator and we also have a military sexual trauma coordinator that provide services that support our behavioral health clinic,” he said.

For rural or otherwise isolated veterans, the VA also offers the Rural Access Network for Growth Enhancement, or RANGE, initiative. According to the VA website, RANGE aims to bring mental health treatment, rehabilitation and support services to veterans’ homes or close community locations rather than only in clinic settings.

Noullett said the VA also embeds mental healthcare into its primary care clinics and its home-based primary care services as a way of offering it to those who may not be specifically seeking it, but are interested.

Jeff Patterson, suicide prevention coordinator at VA Butler, said the suicide prevention team has some level of mental health services, such as the Suicide Prevention 2.0 program, which offers telehealth services for those struggling with suicidal behavior. But the team primarily serves to refer and connect veterans with other services offered throughout the system.

“We get notified of a veteran who might be in a crisis or might have recently been in a crisis or experienced a few additional risk factors, whether it be through staff notifying us or the veterans crisis line. Our goal is to get those veterans connected and to make sure that with whatever they’re going through, they have the services needed to help them,” he explained.

He said the suicide prevention team is also responsible for a lot of internal educating for staff in accordance with national guidance as well as overseeing risk assessment protocols for veterans who may not be seeking mental healthcare.

“Every veteran that comes into our doors, at least one time annually, they’re going to be asked about suicide. We do more as needed beyond that,” he said.

But the VA’s programs are not just accessible in clinical environments, but rather as an integrated part of many other VA programs.

Marne Bilanich, nurse manager for VA Butler’s domiciliary, said recreation therapy is an important process for veterans undergoing treatment for substance use disorder in the 56-bed residential rehabilitation environment.

“We have things where we talk about weekend planning, we have leisure counseling and we have structured outings in the community. They go to things such as Moraine State Park to go fishing and Storm Harbor Equestrian Center to work with the horses,” she said among other planned outings.

MaryAnn Capuzzi, recreation therapist for VA Butler’s community living center, said the staff aims to provide meaningful recreational activities and leisure experiences for the 60-bed community.

“What we’re looking to do is improve a veteran’s physical, cognitive, emotional and social well-being. We do that through leisure and various special events and activities. We base those experiences on each veteran’s interests, abilities and own personal goals,” she said.

Karen Dunn, patient-centered care coordinator and a nurse at VA Butler, said she helps lead the creative arts program. She said that program is tailored toward veterans struggling with social isolation and mental health challenges as a way of restoring a feeling of purpose.

“We currently have 26 community partnerships and several of those are related to the arts or music. Maybe (a veteran) wants to learn how to play the guitar or work on a different type of art, or maybe they did something in the past and hasn’t done it in a very long time,” she said.

She said the program offers a range of arts, from photography classes, music lessons and various visual arts as well as yoga, Tai Chi and more at the system’s wellness center and gym.

“I think a lot of things we’ll say are nonclinical, but it’s an alternative to Western medicine and trying to add them together,” Dunn explained. “So, maybe they are seeing a therapist and taking medication, but this is self management. We’re not with them 24/7, so what can they do on their own?”

She recalled a specific time when a veteran receiving guitar lessons from the VA called in to express his appreciation for the program.

“The veteran he talked to was our volunteer services coordinator who had also taken the program, and he’s like ‘yeah, it’s great, I took it too.’ And the veteran’s like ‘No, you don’t get it. I had night terrors last night and I had my gun and my guitar and I made the right choice,’” she said.

As understanding of mental health and treatment changes, VA Butler professionals said they do their utmost to keep up with the times.

Noullett said in recent years, the VA adopted a recovery-oriented focus for all care and has placed more emphasis on supporting veterans’ autonomy in directing their care.

“We have also shifted heavily toward increasing our staff’s training in evidence-based treatments, and we emphasize evidence-based practices in our care,” he said.

He said another major shift has been toward virtual care between telehealth services such as Suicide Prevention 2.0 and mobile phone apps that are “adjunctive” to treatment.

But one thing Noullett specifically highlighted was the VA’s mission to make mental healthcare as readily accessible as possible.

“We do have same-day access for mental health services. There is staff available to assess and offer treatment that same day when there are urgent concerns,” he said.

He said the VA does not require a veteran to be in crisis before seeking mental healthcare and will meet veterans with the type of care they’re comfortable with under their terms.

“We want to be a support whenever they have any concerns,” he said.