Approximately 4 million U.S. service members took part in the wars in Afghanistan and Iraq. Shortly after troops started returning from their deployments, some active-duty service members and veterans began experiencing mental health problems. Given the stressors associated with war, it is not surprising that some service members developed such mental health conditions as posttraumatic stress disorder, depression, and substance use disorder. Subsequent epidemiologic studies conducted on military and veteran populations that served in the operations in Afghanistan and Iraq provided scientific evidence that those who fought were in fact being diagnosed with mental illnesses and experiencing mental health?related outcomes?in particular, suicide?at a higher rate than the general population. This report provides a comprehensive assessment of the quality, capacity, and access to mental health care services for veterans who served in the Armed Forces in Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn. It includes an analysis of not only the quality and capacity of mental health care services within the Department of Veterans Affairs, but also barriers faced by patients in utilizing those services. Table of Contents Front Matter Summary 1 Introduction 2 The Veterans Health Administration 3 The Veterans Health Administration's Mental Health Services 4 Clinical Management of Mental Health Conditions at the Veterans Health Adminstration 5 Methodology 6 Department of Veterans Affairs Mental Health Services: Need, Usage, and Access and Barriers to Care 7 Dimensions of Quality in Mental Health Care 8 Mental Health Workforce and Facilities Infrastructure 9 Timely Access to Mental Health Care 10 Patient-Centered Care and the Veteran Experience 11 Effective Mental Health Care 12 Efficient Mental Health Care 13 Equitable Mental Health Care 14 Health Technology for Mental Health Care 15 Quality Management 16 Findings, Conclusions, and Recommendations Appendix A: Supporting Documentation for the Survey Appendix B: Supporting Documentation for the Site Visits: Questionnaires and NVivo Codes