Reducing Missed Mental Health

Reducing Missed Mental Health Appointments Among Veterans Through Nurse-Led Motivational Interventions

Reducing Missed Mental Health Appointments Among Veterans Through Nurse-Led Motivational Interventions

Veterans are at increased risk for complex mental health disorders such as PTSD, depression, and substance use, yet their continuity of care is frequently disrupted due to missed outpatient appointments. According to the U.S. Department of Veterans Affairs, over 20% of scheduled outpatient mental health appointments are missed annually, contributing to worsening clinical outcomes, increased hospitalizations, and elevated suicide risk (VA Office of Inspector General, 2022). This disruption undermines recovery, delays medication adjustments, and erodes therapeutic alliances. The purpose of this paper is to describe the identified practice problem of high no-show rates in a VA mental health setting, present a problem and AIM statement, and propose a change framework to address the issue through nurse-led motivational engagement strategies.

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Practice Setting

The practice setting is a VA outpatient behavioral health clinic located in an urban area, serving military veterans aged 18 and older. The clinic operates Monday through Friday, providing services such as psychiatric evaluations, medication management, therapy, and case management. Staffing includes psychiatrists, psychiatric mental health nurse practitioners (PMHNPs), social workers, nurses, and peer support specialists. The clinic is part of a larger Veterans Health Administration medical center that serves thousands of veterans annually, many of whom face transportation issues, homelessness, or co-occurring physical health challenges.

Population

The population includes adult veterans diagnosed with a variety of psychiatric disorders, including post-traumatic stress disorder (PTSD), major depressive disorder, generalized anxiety disorder, schizophrenia, and substance use disorders. The majority are male, with an increasing number of female veterans, many of whom are of diverse racial and cultural backgrounds. Common barriers to care include stigma, low motivation, chronic pain, limited support systems, and difficulties navigating the VA system. Many of these veterans have had previous trauma that impacts trust in providers and engagement in treatment.

Description of the Problem

Missed mental health appointments among veterans are a persistent challenge, with data from the local VA clinic revealing a no-show rate of approximately 28% over the past six months. This exceeds the national benchmark and disrupts care continuity, resulting in delayed symptom management and increased crisis interventions. Observations show that many missed appointments are due to avoidable causes such as lack of motivation, poor understanding of treatment goals, and limited therapeutic engagement. Despite automated reminders and follow-up calls, the clinic lacks a systematic, nurse-led approach to address ambivalence and enhance commitment to care. Research supports that motivational interviewing and relational interventions led by nurses can foster engagement and reduce missed visits (Tahan et al., 2021; Adams et al., 2023).

Problem Statement

In adult veterans receiving outpatient mental health services at a Veterans Administration clinic, current efforts to reduce missed appointments have been ineffective due to the absence of nurse-led motivational engagement strategies, resulting in continued high no-show rates and disrupted continuity of care.

Reducing Missed Mental Health

AIM Statement

The aim of this project is to reduce the outpatient mental health no-show rate by 25% within six months by implementing a nurse-led motivational engagement intervention for veterans who have missed two or more appointments in the past 90 days, thereby improving continuity of care and patient outcomes.

Theoretical Framework

Lewin’s Change Theory will guide the development and implementation of this intervention. This theory includes three phases: unfreezing, change, and refreezing. In the unfreezing phase, data on no-show rates will be presented to staff and stakeholders to increase awareness of the problem and establish urgency. During the change phase, nurses will receive training on motivational interviewing techniques and begin implementing structured motivational calls and brief interventions before and after appointments. In the refreezing phase, successful strategies will be embedded into routine nursing workflows and supported through policy updates and continued staff development. Lewin’s framework supports a structured approach to behavior change and is well-suited to addressing clinical inertia and staff resistance (Burnes, 2020). This model aligns with the VA’s commitment to evidence-based, veteran-centered care and highlights the vital role of nurses in behavior-driven interventions.

Reducing Missed Mental Health

Conclusion

High no-show rates for mental health appointments among veterans continue to challenge continuity of care in VA outpatient settings. This paper identified the lack of structured, nurse-led motivational engagement as a key contributor to the problem. Through the application of Lewin’s Change Theory and a clearly defined AIM statement, a targeted intervention can be developed and implemented to improve attendance, strengthen therapeutic alliances, and support recovery. This initiative emphasizes the power of nursing in leading change and the importance of evidence-based solutions tailored to the unique needs of veterans.

References

Adams, J. R., Vega, R. J., & Schnurr, P. P. (2023). Enhancing engagement in PTSD treatment for veterans: A review of motivational interventions. Journal of Psychiatric Services, 74(2), 125–132. https://doi.org/10.1176/appi.ps.202200146

Burnes, B. (2020). The origins of Lewin’s three-step model of change. The Journal of Applied Behavioral Science, 56(1), 32–59. https://doi.org/10.1177/0021886319892685

Tahan, H. A., Watson, A. C., Sminkey, P. V., & Mullahy, C. M. (2021). Case management engagement and strategies to reduce missed appointments in behavioral health settings. Professional Case Management, 26(3), 107–114. https://doi.org/10.1097/NCM.0000000000000490

U.S. Department of Veterans Affairs Office of Inspector General. (2022). Veterans Health Administration: Review of outpatient appointment scheduling and telehealth utilization. https://www.va.gov/oig/pubs/VAOIG-22-00457-174.pdf