Grant Application to the National

Institutes of Health (NIH) To

Address the Mental Health Needs of
Veterans in San Bernardino County

Melissa Acuna, MPH(c)

Sarah Alkejek, MPH (c)
Anh Nguyen, MPH (c)
Vanessa Rangel, MPH (c)
Julian (Jay) Sacdalan, MBA, MPH (c)

March 15, 2018

Abstract
Mental Health Services Veterans (MHSV), a non-profit organization, seeks to provide
veterans ages 18-65 years old with mental health care, resources, and services in San Bernardino
County. MHSV was established in 2012 and has more than five years experience providing
services to veterans with mental health disorders/substance abuse in the counties of Los Angeles,
Riverside, San Bernardino and San Diego. Many veterans experience mental health disorders,
substance use disorders, post-traumatic stress, and traumatic brain injury at disproportionate rates
compared to their civilian counterparts. However, the majority of veterans dealing with mental
health problems do not adequately utilize needed care. Eighteen to twenty-two percent American
veterans commit suicide daily and young veterans aged 18–44 are most at risk. The MHSV plans
to assist veterans (age 18-65) in San Bernardino County by providing counseling and social
support, therapeutic activities, treatment options, symptoms, and support recovery. Currently,
there are 1,893,539 veterans living in California. Among those, 96,196 live in San Bernardino
County, which accounts for 19.6% of all veterans in California.
Many barriers limit veterans from obtaining the care they need despite the existence of
other mental health organizations and programs. The MHSV plans to assist veterans (age 18-65)
in San Bernardino County by providing counseling and social support, treatment options,
symptoms, and support recovery. The MHSV program plan will also work within the community
by partnering with existing programs and organizations to strengthen community relations and
eliminate mental health disparities that exist among veterans in San Bernardino County.
The main objective of the project is to serve at least 30% of the veterans diagnosed and
newly diagnosed of mental health illness living in San Bernardino County through the person-
centered care approach (goal setting), motivational interview, counseling, adult day care
programs (Nursing, Physical and Occupational Therapy), therapeutic activities, by the end of the
funding year 2022.
In addition, the project presents its general program plan. This plan talks about the
different processes and personnel needed to give quality care to veterans. The program
evaluation plan presents the performance measure of the project. The measurements include the
pre and post surveys. The expected outcome of the project is to serve at least 200 veterans a day.
The organization will need $2,300,000.00 for the first fiscal year (2019-2020) to sustain the
project. With the help of the fresh funds, the MSHV program will incur a yearly income of
$582,585.00.

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 Table of Contents
I. Specific Aims 3
II. Description of the Target Population 6
III. Approaches and Methods 7
IV. Program Evaluation Plan 10
V. Organizational Capacity and Project Management 11
VI. Budget and Budget justification (See Appendix G) 15
References: 16
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Specific Aims
A. Needs Statement

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 Many veterans and families are facing mental health challenges. Veterans with
Posttraumatic Stress Disorder (PTSD) are more likely to endorse suicidal ideation1. Moreover,
male veterans diagnosed with depression, manic depressive disorder, heavy or binge drinking,
and other alcohol related problems were significantly associated with an increased risk of
suicide2. Thus, identifying and treating mental health illness has the greatest potential to mitigate
suicide risk. There is a need for providing easy diagnosis treatment mental illness among the
veterans’ population.
Our program will provide an opportunity for the veterans to access mental health care
services as the Dept. of Veterans Affairs (VA) has struggled with its capacity to handle this
crushing need for these services by itself. According to a study, conducted by the National
Academies of Sciences, one in four veterans experiences mental illness—but many are not
receiving the help they need due to disparities in access to quality mental health services 3. In
addition, the majority of those who could use these services are unaware of the eligibility
requirements or whether they meet them, do not know how to get the services and do not even
know that the VA provides mental health care.
According to a CNN article titled “Veterans Aren’t Always Getting Mental Care They
Urgently Need.”, veterans sought veteran mental health treatment in the private sector rather than
getting help from the VA4. That number has increased along with wait times at many of the VA
mental health facilities around the country. Also, the U.S. Government Accountability Office
estimated at least 2.1 million veterans received mental health treatment from the VA in the five-
year period from 2006 through 2010, wherein only those who qualify for special combat veteran
eligibility are receiving treatment.

B. Working Hypothesis
MHSV will provide veterans with mental health services such as treatment options,
counseling, therapeutic activities, and socialization tailored to veterans’ experiences, lifestyles,
and needs.

C. Literature Review (US Veteran specific health issues)

Many veterans who are fortunate to return home safely after a combat have brought some
invisible scars with them that can affect their life. Mental health issues are commonly associated
with conditions such as mental health disorder, PTSD, depression and suicidal thoughts.
Mental Health Disorder
According to a research in the Journal of Counseling & Development, over two million
American military services members have been deployed to Iraq and Afghanistan since

1
Jakupcak et al., “Posttraumatic Stress Disorder as a Risk Factor for Suicidal Ideation in Iraq and Afghanistan War
Veterans.”
2
LeardMann et al., “Risk Factors Associated with Suicide in Current and Former US Military Personnel.”
3
National Academies of Sciences, Evaluation of the Department of Veterans Affairs Mental Health Services.
4
CNN, “Veterans Aren’t Always Getting Mental Care They Urgently Need.”

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2000, and they are at elevated risk of developing mental health disorder as the result of stress and
trauma factors they experience during their military services5. Medical records of veterans reveal
that one in three patients was diagnosed with at least one mental health disorder--41% were
diagnosed with either a mental health or a behavioral adjustment disorder6. As a result of these
issues, many veterans have developed substance use disorders (SUD) and a considerable number
have ultimately committed suicide.
Post-Traumatic Stress Disorder (PTSD)
According to the American Psychiatric Association7, diagnosis is based upon four symptom
categories: intrusive symptoms (flashbacks), avoidance of reminders (isolation), negative
thoughts and feelings (“no one can be trusted”), and arousal and reactivity symptoms
(exaggerated startle response). PTSD is often associated with “traumatic brain injury” (TBI),
military sexual trauma (MST), sleep problems, substance use, pain, and other psychiatric
disorders and requires comprehensive assessment. According to the article, “Consequences of
PTSD for the work and family quality of life of female and male U.S. Afghanistan and Iraq War
veterans”, research has shown the symptoms of PTSD such as increased vigilance and social
withdrawal can contribute to some problems in former veterans’ lives8. The study has suggested
programs that focus on the negative impact of PTSD may benefit to increase quality of life for
veterans after experience traumatic events during their military services.
Major Depressive Disorder (MDD)
According to an article in Military Medicine9, Major Depressive Disorder (MDD) is one of the
most common mental illnesses that is diagnosed among active or former veterans and noted the
diagnosis rate for veterans’ depression is 14%. MDD symptoms include feeling persistently sad
or irritated, lack of sleep and/or appetite, recurrent thoughts of death or suicide, feelings of
hopelessness, emptiness and loneliness. The National Alliance on Mental Illness (NAMI) found
that individuals with PTSD were less likely to commit suicide versus those with depression

5
Whiteman et al., “The Development and Implications of Peer Emotional Support for Student Service
Members/Veterans and Civilian College Students.”
6
Olenick, Flowers, and Diaz, “US Veterans and Their Unique Issues.”
7
“Post-Traumatic Stress Disorder.”
8
“Consequences of PTSD for the Work and Family Quality of Life of Female and Male U.S. Afghanistan and Iraq
War Veterans. - PubMed - NCBI.”
9
Hundt et al., “A Systematic Review of Cognitive Behavioral Therapy for Depression in Veterans.”

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probably due to the increased awareness and acceptance of PTSD10. Despite its devastating
effects, major depression is a treatable illness with 80% - 90% success rate using medication,
psychotherapy and electroconvulsive therapy.
Suicide
Factors that contribute to suicide in veterans include the inability to sleep, mental health disorder,
PTSD, MDD, etc. According to an article in the American Journal of Public Health, sleep
disturbances including insomnia and nightmares are strongly associated with suicidal thoughts in
veterans11. With 18 to 22 veterans committing suicide daily, risk assessment and intervention are
paramount. Private and public health care professionals must be aware of patients’ military
history and be able to recognize suicide-risk factors, regardless of age. Young veterans ages 18-
44 years of age are at higher risk of suicide12 and veterans, aged 50 years and older were still
almost twice likely to commit suicide versus non-veterans (69% and 37% respectively).

D. General Program Plan (See Appendix A)

The MHSV program aims to ensure that veterans (age 18-65) have access to needed
mental health care services and resources in San Bernardino County. The services including
counseling and social support will provide education regarding mental illness, treatment options,
symptoms, and support recovery. Our organization “Give Me More” is proposing to support
MHSV programs and improve access to mental health services for veterans in San Bernardino
County. The program will consist of a team of licensed staff, mental health specialists (a
psychiatrist, psychotherapist, or other behavioral health specialist), several trainees and
volunteers. The specialists will help identify the problem and recommend treatment that might
include medications, talk therapies and social support services. The MHSV program will focus
on community outreach by partnering with existing programs and organizations to strengthen
community relations and raise awareness of resources available for veterans. MHSV program
will also provide services such as respite for family members, or other family caregivers of
current or former veterans facing mental health challenges to help their families under challenges
and improve the ability to support their veteran members.

Description of the Target Population

The services will be targeted to veterans in need of
mental health services in San Bernardino County. San
Bernardino has the fourth highest veteran population in all of
California13. Any veteran age from 18 to 65 will be able to use
our services regardless of military branch, gender and
ethnicity. According to the Department of Veteran Affairs
since 2005, there has been a steady increase in veterans
returning home creating a need for mental health care services
that are provided through federal benefits. The Department of

10
“Veterans & Active Duty | NAMI: National Alliance on Mental Illness.”
11
Pigeon et al., “Sleep Disturbance Preceding Suicide Among Veterans.”
12
“Suicide-Data-Report-2012-Final.Pdf.”
13
“CalVet.Gov.”

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Veteran Affairs reports receiving 133% more applications in 2014 for federal benefits compared
to 200514.

A. Who will benefit?

According to the Substance Abuse and Mental
Health Services Administration (SAMHSA)15
website, approximately 50% of the U.S
veterans who returned home need mental health
services for their trauma and mental illness, and
this number is increasing dramatically among
U.S veterans. According to the National’s
Health article, U.S veterans are struggling with
mental health stigma. Currently, there are
1,893,539 veterans living in California. Among
those, 96,196 live in San Bernardino County,
which accounts for 19.6% of all veterans in
California. With such a large population spread
over the largest county in the United States, the
Source: SAMHSA website
need for mental health care and services is
demanding. After trauma events such as witnessing friends’ death or injuries, being shocked seeing the
aftermath of a battle or life-threatening during their serving time, veterans could face fear for their lives,
feel helpless or hallucinate horrible things. Understanding the needs and the benefits they are eligible for
can help veterans connect with the services they need to live a better life.
Veterans will have better access to mental health care programs at our facility and as a
result, this overall state of health will improve through this increased access. Veterans will be
involved not only as patients of the facility but also through their feedback they will help to
organize and plan services.
Lastly, another large group which will be benefited is the Veterans Affairs (VA) which
serve this same population. VA is overwhelmed with the large influx of this population in the
area and will certainly benefit from a number of their patients receiving basic mental health
services in MSHV. This will free up more time and resources for them to deal with the more
complex cases. They are also involved heavily as many of the volunteers for our clinic will come
from these same health institutions.
Approaches and Methods
San Bernardino has one of the highest veterans’ population in the state of California
according to the U.S Census. While many resources are available to them, such as education
assistance, and medical care, once they return to civilian life, MSHV wants to be the most
comprehensive resource for veterans’ mental health care. Mental health care is often a
stigmatized subject and can be confusing for returning veterans to navigate for the first time.
However, our program is designed to get in contact with newly returning and established
veterans and start the path towards treatment. This begins with outreach, to diagnosis, treatment,
and ongoing managed care. Not only will we create an individualized plan to manage a patient’s
care but allow for education and workshops for family members and other community members
to learn about the importance of taking care of mental health, specifically for veterans. By doing

14
“San Bernardino County - Official Website.”
15
“SAMHSA - Substance Abuse and Mental Health Services Administration.”

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so, we hope to create a supportive lifestyle for the veterans on an individual, familial, and
community level.
A. Vision
To be the leading and most sustainable mental health care clinic and resource center for
all current and future veterans in San Bernardino county.
B. Mission
To provide mental health care services and programs to Veterans through a culturally-
diverse, community-based services organization with emphasis on person centered care,
integration of complex care and behavioral health initiative.
C. Objective
The overall objective of this proposal is to increase access, services, programs,
opportunities to mental healthcare of veterans’ ages 18-65 years old living in San Bernardino
County.
By the end of the funding year (2022), MSHV will serve at least 30% of the veterans
diagnosed and newly diagnosed of mental health illness living in San Bernardino County through
the person-centered care approach (goal setting), motivational interview, counseling, adult day
care programs (Nursing, Physical and Occupational Therapists), and therapeutic activities
D. Veteran Satisfaction and Feedback (See Appendix B)
In order to gauge our effectiveness towards our target population, the MSHV will
conduct an initial (pre) survey completed by veterans to determine how they view their current
mental health care, lifestyle, and needs. Once an initial baseline data is collected, veterans will
also be asked to do a follow up survey that will examine their updated view on their mental
health care status, lifestyle, if their previous needs had been addressed, and any new needs arise.
Additionally, they will be an opportunity for recommendations. Case managers will be
responsible for ensuring patients complete and return their survey. The data collected will be
discussed at the providers’ next monthly meeting regarding the patient to make adjustments or
continue with the treatment plan.
E. Managed care
Providing managed care is one of the most valuable assets we have in our program. From
the initial encounter, the MSHV will be able to assist and direct veterans to the proper resources,
all while having a unified system to keep track of their mental health progress. The first step is to
get our community outreach specialist and volunteers to gain new participants. This will be done
by working in conjunction with local VA hospitals, universities, community centers, and senior
care facilities to help find veterans who would benefit from our program. Educational resources
and workshops will able be done in conjunction to help create awareness of the need and
resources provided through MSHV.
Once a veteran chooses to enroll in our program, our clinical staff will begin to diagnose
and assess a patient's current situation, and begin a treatment plan in conjunction with therapists,
psychiatrists, and any intervention support groups as recommended. Additionally, our program
will work in conjunction with other veteran services, to provide a simple transition to other
resources, such as education, non-mental health care related concerns, and job placement. The
managed care team will meet once a month to discuss the veterans plan, progress, and make any
recommendations.
In order to keep track of our patient utilization, each time a veteran meets with one of our
clinic, administrative or community outreach staff, a digital document will be created. This way,
our program will be able to track how often each service is used, and by which veteran to

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determine if there is a greater demand to improve highly sought resources. The pre-doctoral and
practicum students will analyze, clean, and interpret this data into a bi-annual report.
F. Community Outreach
Our plan to assist veterans in their recovery is to also create a more supportive system in
their home life, and in the community. To do so, the MSHV will conduct monthly workshops
and community outreach opportunities. These events are designed to help address any stigma,
confusion or concerns a veteran’s families or support system may experience. Our activity
coordinator and outreach specialist will be responsible for organizing each event and
encouraging family members and community members to attend. Our workshops will include
mental disorders explained in layman's terms, how to recognize symptoms that a veteran may
need mental care support, common medical treatments, and how to best accommodate and care
for a person who has been diagnosed. In order to evaluate the effectiveness if new knowledge is
gained, participants over the age of 16 will be asked to complete a pre and post survey. These
surveys are designed to assess knowledge and attitudes toward mental health care in veterans.
The results will then be evaluated and asses by our practicum students to verify an increase of
knowledge from our workshops. In order to incentivize participants, and small incentive will be
given out each month to encourage repeat participation.

G. Activities and Timeline (See Appendix C)

Fiscal year July 2019-June 2020
Quarter 1
→ Conduct a monthly meeting with local heads of VA offices, San Bernardino
County Behavioral Health Unit, Community and Faith leaders, insurance representatives
➔ Recruit and hire key personnel
➔ Train volunteers and staff
➔ Begin asking for referrals (networking)
➔ Implementation Marketing of strategy (niche app
Quarter 2
➔ Establish number of patients and based line (ends quarter 4)
➔ Schedules analysis of new patients
➔ Coordinates appointments of patients with multi-disciplinary team members
➔ Updates Electronic Health Record (EHR)
➔ Train volunteers and staff
➔ Person centered care approach starts
➔ Hold monthly MDT meeting
➔ Assess the goals of the patients
Quarter 3
➔ Coordinate appointments
➔ Train volunteers and staff
➔ Continue person centered care
➔ Hold monthly MDT meeting
➔ Updates Electronic Health Record (EHR)

Quarter 4
➔ Coordinate appointments
➔ Train volunteers and staff

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 ➔ Continue person centered care
➔ Hold monthly MDT meeting
➔ Updates Electronic Health Record (EHR)
➔ Reassess the goals set
Program Evaluation Plan
A. Logic Model (See Appendix D)
Inputs: We will be working closely with the Department of Behavioral Health,
Department of Veteran Affairs along with the local political leadership support and community
partners. Funding will come from grants and donations and our administrative staff will manage
and distribute information within our facility, report expenses, and track facility budget. Our
clinical staff will do consult on information about mental health resources for clients/patients,
insure that the veterans have access to needed mental health services. Our trainees and volunteers
will assist staff members with events, and classes such as peer-to-peer support, family-to-family
support to ensure patient’s family members get a better understanding about mental illnesses.
Activities: Our program will collaborate with local leaders Department of Veteran
Affairs and Department of Behavioral Health at monthly meetings. We also collaborate with
with other stakeholders monthly. Recruiting and hire key personnel is also critical for our
program. We will raise awareness of the new resources available to veterans.
Outputs: Outputs will include support that we will get from other organizations and
policymakers. Quarterly staff training will ensure staff and volunteers will be highly trained. By
providing clients/patients the mental health care that they need we will be able to retain our
clients/patients. After building rapport with the community and patients through community
outreach and positive mental health outcomes, we will have the communities support to continue
providing high quality mental health services.
Outcomes: Short-term outcomes: We will get baseline number of clients/patients. We
will be able to create community outreach programs to increase awareness among veteran
community of mental health care available. Medium-term outcomes: We will get positive change
in mental health and behavioral processes. Our medium-term goal is to increase the number of
veterans who are in need of mental health care seeking access to mental health care services.
Longer-term outcomes: Our main goals are to maintain the mental health changes and behavioral
process for a better health outcome among veteran community.
Pre-Post measures: By using surveys and monitoring the number of clients/patients, we
will be able to keep track of the numbers of patients receiving health care services. We can also
keep track on the numbers of suicide cases within our target county.

B. SWOT Analysis

Strengths Weaknesses

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 ● Highly qualified and trained staff ● Financing ads and marketing for
● Mental health care service integrated with services offered at MHSV
behavioral health care ● Possible issues retaining clients
● Services are free for veterans during ongoing treatment
● Collaboration with local organizations who ● Rapport with veterans,
serve veterans community members, and local
● Partnership with community stakeholders organizations
● Referrals to outside organization when
needed

Opportunities Threats

● Improve mental health among veterans in ● Stigmas surrounding mental

San Bernardino County health and seeking help or
● Reduce the stigmas associated with mental treatment
health ● Stigmas and struggles associated
● Reduce substance abuse and addiction with behavior health
● Establish other MHSV organizations in
Southern California with high populations
of veterans

Organizational Capacity and Project Management

A. Brief Description of the Organization (See Appendix E)
Mental Health Services Veterans, a non-profit organization, was established in 2012. It
has more than five years in providing services to veterans with mental health disorders/substance
abuse of the Los Angeles, Riverside, San Bernardino and San Diego Counties. Currently,
MHSV administers several grant funded programs including Nutrition Services, Employment
and Training Program, Permanent Supportive Housing, and Homeless Prevention Programs.
The board of directors is made up of dedicated, passionate medical and non-medical
personnel. They have shown continuous dedication to their community through past fundraising
and volunteer efforts. The current Board is made up of physicians, physician assistants, nurses,
pharmacists, social workers and community leaders.

B. People
The critical and key personnel who will be crucial in the project are as follows:
● Staff /Clinical Psychologists
Job description: Clinical psychologists assess, diagnose, and treat mental, emotional,
and behavioral disorders. Clinical psychologists help people deal with problems ranging from
short-term personal issues to severe, chronic conditions. Clinical psychologists are trained to use
a variety of approaches to help individuals. Although strategies generally differ by specialty,
clinical psychologists often interview patients, give diagnostic tests, and provide individual,
family, or group psychotherapy. They also design behavior modification programs and help
patients implement their particular program.
● Alcohol & Drug Interventionist

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 Job description: They focus on helping people overcome addiction and dependency
to drugs and alcohol. The involvement of a substance abuse counselor usually begins in an
intervention or intake setting. At this point, the counselor is trying to determine the severity of
the issue and any extenuating circumstances that might help or hinder the process of recovery.
● Director of Outreach
Job description: Conduct outreach, identify and develop new potential markets and
referral sources, attend networking meetings and events that would produce referrals, manage
advertising contracts and spearhead community marketing events.
● Director of Training
Job description: Directs the design, planning, and implementation of corporate
training programs aligned with the objectives and strategy of the company. Collaborates with
functional management teams to assess ongoing and future training and development needs as
well as effectiveness of established programs. Develops a program delivery schedule that
provides training as needed and in locations that work for the participants. Provides engaging
communications about program information to encourage participation and highlight the value
and benefits of training
● Executive Director
Job description: The Executive Director is responsible for overseeing the
administration, programs and strategic plan of the organization. Other key duties include
fundraising, marketing, and community outreach. The position reports directly to the Board of
Directors.
● Director of Clinical Services
Job description: Directs the operations, programs, and activities in clinical area. Plan,
direct, and coordinate patient care activities to maintain standards of patient care, and advise
medical staff in matters related to clinical services by performing the following duties personally
or through subordinate staff
● Psychiatrist
Job description: Evaluates patients by interviewing patient, family, and other persons;
conducting physical examinations; observing behaviors; reviewing medical history and related
documents; selecting, administering, and interpreting psychological tests; ordering laboratory
tests and evaluating results. Develops treatment plans by determining nature and extent of
cognitive, emotional, developmental, social, and behavioral disorders; establishing treatment
goals and methodologies.
● Advanced Practice Registered Nurses
Job description: Orders and interprets diagnostic and therapeutic tests relative to
patient’s age-specific needs. Prescribes appropriate pharmacologic and non-pharmacologic
treatment modalities Implements interventions to support the patient to regain or maintain
physiologic stability, including but not limited to serving in the first assisting role.
● Activity Coordinator
Job description: Works as an active team member providing support to participants
which may include assistance with activities of daily living. The Activities Coordinator will help
to maintain an organized, sanitary program environment, and ensure that daily supplies for
programs and activities are maintained and organized.
● Licensed Clinical Social Worker

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 Job description: Assess and assist those living with addiction problems in counseling
and group therapy sessions. Act as advocates and help clients gain access to resources while
confronting their personal issues, such as mental illness, addiction, and abuse
● Social Workers
Job description: Assess and treat individuals with mental, emotional, or substance
abuse problems, including abuse of alcohol, tobacco, and/or other drugs. Activities may include
individual and group therapy, crisis intervention, case management, client advocacy, prevention,
and education.
While the key personnel are new as a group, their years of service to the community will
prove invaluable in this endeavor. The members of our board have over 75 years combined
experience in medicine and over 10 years’ experience working in the veterans community. The
board members have selected based on experience, proven dedication and commitment in
understanding the veterans’ needs.
Currently, there are already 5 administrative staff and 10 volunteers. The volunteers will
be scheduled regularly as "first Wednesday" or "second Wednesday".
● Office Manager
● Administrative Services Assistant
● Administrative Assistant, Business Manager
● Administrative Office Assistants
● Practicum Students
● Pre-Doctoral Interns
● Community Outreach Specialist
● Volunteers

C. Referrals
The networking capabilities extend into local, state and national professional
organizations such as the:
● American Medical Association
● American Academy of Physician Assistants
● American Nurses Association
● American Pharmacists Association
● Veterans Administration Office (San Bernardino Unit)
● Substance Abuse and Mental Health Services Administration
● Hospitals (Loma Linda, Arrowhead Regional Medical Center, San Bernardino
Community Hospital)
● Local physicians specialty in veteran’s health.
● San Bernardino County Behavioral Health Department
● Insurances companies (Inland Empire Health Plan, HealthNet, Molina Healthcare, Kaiser
Permanente, Medi-Care/Medi-Cal)

D. Community Support (See Appendix F)

MSHV is working with some of the local professional groups and other local charitable
groups to form partnerships for the facility. The Partnerships could include financial and in-kind
support, dedicated volunteer hours, and leadership and administrative support. Lastly, MSHV

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also receive guidance and support from Volunteers in Healthcare, the Public Health Foundation
and the Free Clinic Foundation.
Budget and Budget justification (See Appendix G)
MSHV is asking NIH to fund the access of the mental health services for the veterans in
San Bernardino. Based on the cash flow forecast, the organization will need $2,300,000.00 for
the first fiscal year (2019-2020) to sustain the project. There will be a revenue of $582,585.00
per year.

References:
Articles:

Hundt, N., Barrera, T., Robinson, A., & Cully, J. (2014). A systematic review of
cognitive behavioral therapy for depression in Veterans. Military Medicine, 179(9), 942-9

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 Jakupcak, M., Cook, J., Imel, Z., Fontana, A., Rosenheck, R. and McFall, M. (2009),
Posttraumatic stress disorder as a risk factor for suicidal ideation in Iraq and Afghanistan War
veterans. J. Traum. Stress, 22: 303–306.

Leardmann, Cynthia A, Powell, Teresa M, Smith, Tyler C, Bell, Michael R, Smith, Besa,
Boyko, Edward J, . . . Hoge, Charles W. (2013). Risk factors associated with suicide in current
and former US military personnel. JAMA, 310(5), 496-506.

Olenick, M., Flowers, M., & Diaz, V. J. (2015). US veterans and their unique issues:
enhancing health care professional awareness. Advances in Medical Education and Practice, 6,
635–639. http://doi.org/10.2147/AMEP.S89479

Pigeon, W. R., Britton, P. C., Ilgen, M. A., Chapman, B., & Conner, K. (2012). Sleep
Disturbance Preceding Suicide Among Veterans. American Journal of Public Health, 102 Suppl
1(Suppl 1), S93-S97.

Vogt, D., Smith, B., Fox, A., Amoroso, T., Taverna, E., & Schnurr, P. (2017).
Consequences of PTSD for the work and family quality of life of female and male U.S.
Afghanistan and Iraq War veterans. Social Psychiatry and Psychiatric Epidemiology, 52(3), 341-
352.

Whiteman, S., Barry, A., Mroczek, D., MacDermid Wadsworth, S., & Tracey, Terrence.
(2013). The Development and Implications of Peer Emotional Support for Student Service
Members/Veterans and Civilian College Students. Journal of Counseling Psychology, 60(2),
265-278.

Websites:

National Academies of Sciences, Evaluation of the Department of Veterans Affairs

Mental Health Services.

CNN, “Veterans Aren’t Always Getting Mental Care They Urgently Need.”

“Depression | NAMI: National Alliance on Mental Illness.”

https://www2.census.gov/library/visualizations/2015/comm/vets/ca-vets.pdf
https://www.census.gov/quickfacts/fact/dashboard/sanbernardinocountycalifornia/INC110216
https://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?src=CF
http://cms.sbcounty.gov/portals/21/resources%20documents/cir_2015_report.pdf

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Appendix

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