The VA should develop a portfolio approach that invests in various models, some of which have already been put into practice on local stages, investing most heavily in those approaches which have the potential for scalability, replicability and quality care. Over time, the VA should reinforce its successful programs, eliminate unsuccessful efforts and change its infrastructure to reflect the lessons learned through this evaluation. The key to success will be a rigorous monitoring and evaluation regime that assesses each VA program on efficiency, efficacy and programmatic metrics.

Both Veterans and Veteran-serving organizations in the private and nonprofit sector struggle to make smart, timely decisions in the absence of data. The VA should make available data on the utilization of its mental health care resources, including wait time data for specific facilities. This data should be made available in usable form for veterans, such as through geospatial information displays or through application interfaces like the VA’s PTSD application for smartphones. Such data would better enable VA personnel to coordinate and allocate resources, facilitate the allocation of resources within the private sector that also serves veterans, and improve decision-making by veterans based on the availability of mental health care.

As part of its efforts to generate more mental health care capacity, and use a portfolio approach to do so, the VA must also develop a comprehensive information environment that enables VA providers and partners in other sectors to communicate and share information. Such a system will improve care for veterans by providing better continuity across the range of public, private and philanthropic providers and also will give the VA better data regarding the population with which to allocate resources and make decisions about future agency operations.

If the VA is to partner more meaningfully and effectively with the private and philanthropic sectors, it must embrace a broader vision of its partnership, where the VA is an equal partner with these other sectors. The VA strategy should include a multicomponent structure for engagement with non-VA actors, including policies that foster such partnership, and rules within VA’s ethical and acquisition regulations that allow such partnerships to occur. The VA must also develop a governance and coordination structure, possibly by creating additional federal advisory committees, or local advisory committees in its health care regions or near its major medical centers. And the VA should invest in these community partnerships, using VA capital to fund the “best practice” organizations that are serving veterans in the philanthropic and private sectors, and arguably doing so as well as (or better than) the VA.

Current efforts to add clinical staff at the VA have been hindered by a national shortage of qualified, available mental health care personnel. The VA should address this by expanding its partnerships with academic medical programs to include additional programs that develop mental health care personnel. This expansion should build on the VA’s extensive program for clinical internships. The human capital pipeline should also leverage existing relationships between the VA and programs producing clinical social workers and psychologists with specializations in military social work or related disciplines, such as those at the University of Southern California and University of South Carolina. The VA should invest in these programs, expand them, and seek to replicate them, particularly where they can help produce additional clinical personnel to serve underserved populations (such as in rural areas). The VA should also look for opportunities to integrate veterans into its human capital pipeline, ranging from work in Vet Centers and outpatient clinics to service in VA medical centers. In furtherance of this goal, the VA should study the feasibility of a national scholarship, apprenticeship or training program (possibly tied to existing VA educational benefits) that would generate its own pipeline of veterans with the training and desire to provide mental health care services to fellow veterans in VA facilities.

Emerging technologies hold enormous promise for the VA and its efforts to provide mental healthcare services to veterans. Telemedicine holds promise for expanding VA care in underserved communities and for serving the digital natives of the millennial generation. Certain fitness monitoring and communications technologies can also expand the net of mental health care (such as the "FitBit," which monitors physical activity, sleep, weight and other behaviors, and software solutions such as the PTSD Coach, developed by the VA and fielded to more than 100,000 smartphone users.) Virtual reality technology can be used for both the training of clinical personnel and the treatment of veterans.