Background

Many Veterans living in rural areas have trouble getting the mental health care they need. They may live far away from specialists who can treat depression, post-traumatic stress disorder (PTSD), and substance use disorders.

The National Mental Health and Suicide Prevention (NMHSP) Extension for Community Healthcare Outcomes (ECHO) program helps close this gap by providing virtual training to health care teams. Through this program, doctors, nurses, and other providers learn how to use the most effective treatments for Veterans with mental health and addiction challenges.

The Department of Veterans Affairs (VA) Veterans Health Administration (VHA) Office of Rural Health (ORH) started the NMHSP ECHO Enterprise-Wide Initiative (EWI) in Fiscal Year 2020. This initiative focuses on reaching providers who care for rural Veterans, so more Veterans can receive timely, high-quality mental health services closer to where they live.

The NMHSP ECHO EWI offers several types of online training:

• Case-based sessions: Providers learn by discussing real-life patient cases in:
  • General Mental Health ECHO Clinic
  • Substance Use Disorder (SUD) & Addictions ECHO Clinic
• Workshops and mini-residencies: These are more intensive trainings that build clinical care skills. They include demonstrations, discussions, simulations, coaching, and feedback in key treatment areas such as:
  • SimLEARN Addiction Mini-Residencies (SLAM)
  • Ketamine/Esketamine for Treatment-Resistant Depression
  • Medications for Alcohol Use Disorder (MAUD) in Veterans with Liver Disease
  • Clozapine for Treatment-Resistant Schizophrenia

Goals and Objectives

The NMHSP ECHO program aims to improve mental health care for Veterans, especially those in rural areas, by strengthening the skills and confidence of health care providers.

The program helps by:

• Providing education: Virtual training keeps rural health care providers up to date on the latest, evidence-based treatments for mental health and substance use disorders.
• Expanding access: When more providers are trained, more Veterans can receive care in their own communities.
• Building connections: Health care teams across the country learn together, share ideas, and create stronger support networks for Veterans.
• Tracking progress: The program uses data to measure results, improve training, and make sure that Veterans benefit from what providers learn.

By offering ongoing education and support, NMHSP ECHO helps build a stronger health care system for rural Veterans. Monthly sessions on substance use disorders and mental health are offered, along with specialized workshops throughout the year on topics such as MAUD, Clozapine, and Ketamine.

Methodology

The NMHSP ECHO program uses a step-by-step approach to train providers and improve care for Veterans.

• 1. Expert-led training: Doctors and mental health specialists lead virtual sessions that focus on practical skills. Providers learn tools and strategies they can use right away in their clinics and hospitals.
• 2. Supporting health care teams: Training helps providers feel more confident treating Veterans with complex mental health and substance use concerns. This leads to better care and stronger relationships between Veterans and their clinicians.
• 3. Empowering Veterans: Through training and simulation focused on shared decision making, providers learn how to involve Veterans in treatment choices. This support helps Veterans manage their health, understand their options, and find the care that best fits their needs.
• 4. Creating long-term change: Over time, the program builds a nationwide network of trained providers. This network helps improve access to high-quality mental health and addiction care for Veterans now and into the future.

Impact on Rural Veteran Health

The NMHSP ECHO program has made a strong, measurable impact on care for Veterans, including those in rural communities.

Improved access to care:

• In Fiscal Year 2024, across 66 trainings, NMHSP ECHO trained more than 5,000 health care providers who serve over 645,000 Veterans, including more than 200,000 rural Veterans.
• Since 2021, the program has trained over 25,000 providers who care for more than 1.7 million Veterans nationwide, including about 550,000 rural Veterans across all Veterans Integrated Services Networks and all states.

Better treatment for substance use disorders:

• More than 2,000 providers have used their new skills to treat over 40,000 Veterans struggling with alcohol or opioid use.
• These trainings help providers deliver evidence-based treatments that can lower risk, support recovery, and improve quality of life.

Expanding depression treatment:

• Training in ketamine and esketamine for treatment-resistant depression has helped more clinics offer these advanced treatments to Veterans who have not improved with other medications.

Stronger Veteran–clinician relationships:

• Clinicians report feeling more confident when caring for Veterans with mental health and substance use challenges.
• Veterans report feeling more understood and supported, which can increase trust and help them stay engaged in care.

Lasting community impact:

• By training more providers, especially in rural and underserved areas, the program strengthens local health systems.
• These changes help ensure that Veterans can continue to receive high-quality mental health and suicide prevention services in the years ahead.

What Participants Say

Feedback from NMHSP ECHO training has been very positive. The program has received over 92% favorable ratings from attendees.

Participants report that:

• The training helped them improve their clinical and communication skills.
• They would recommend the sessions to their colleagues.
• They learned practical knowledge they can use directly in their work with Veterans.

This feedback shows that the training is relevant, engaging, and useful for busy providers who care for Veterans with mental health and substance use needs.

Key Takeaways

The NMHSP ECHO program has successfully met its main goals and shows strong, positive outcomes for both providers and Veterans.

• High participant engagement: Providers report that they are highly engaged in the sessions and find the content meaningful and directly related to their work.
• Positive feedback on structure and delivery: Participants value the interactive format and the effectiveness of the instructors. They describe the curriculum as well-structured and clearly delivered, and they find the support materials helpful for learning and review.
• Strong impact on career growth: Many participants say the program increased their professional confidence and supported their career development. Skills gained in the training have direct, everyday applications in their clinical practice.
• Direct impact on Veteran care: Providers who complete the training report increasing their use of evidence-based services for substance use and mental health conditions. This means more Veterans receive proven treatments that can improve their health and well-being.

Download the Printable PDF for Healthcare Providers and Researchers.

References

• Komaromy, M., Duhigg, D., Metcalf, A., Carlson, C., Kalishman, S., Hayes, L., Burke, T., Thornton, K., & Arora, S. (2016). Project ECHO (Extension for Community Healthcare Outcomes): A new model for educating primary care providers about treatment of substance use disorders. Substance Abuse, 37(1), 20–24.
• Garcia-Vassallo, G., Quinn, N. B., Moore, B. A., Chaudhry, S., Moore, D. T., Sorenson, S. T., Braddock, S., & Edens, E. L. (2025). National Addiction Workshop: A Virtual Adaptation to Support Competency Development in Opioid Use Disorder Management. Substance Use & Addiction Journal, 46(1), 127–133.

Contact

• Program Contact: David T. Moore, MD, PhD, Director, National Mental Health & Suicide Prevention ECHO, VA Connecticut Healthcare System, West Haven VA Health Care System. David.Moore2cdbc8@va.gov
• Funding Acknowledgement: Department of Veterans Affairs, Veterans Health Administration, Office of Rural Health, NOMAD #PRFY-00557.
• Suggested Citation: Moore, D. T., & Edens, E. L. (2025). National Mental Health and Suicide Prevention ECHO. Department of Veterans Affairs, Veterans Health Administration. Washington, DC: Office of Rural Health.

Rural Health - Navigation

• Office of Rural Health Home page:
  https://www.ruralhealth.va.gov/index.asp
• Enterprise-Wide Initiatives (EWI) page:
  https://www.ruralhealth.va.gov/Enterprise-Wide-Initiatives-EWI.asp
• Veterans Rural Health Resource Centers (VRHRC) page:
  https://www.ruralhealth.va.gov/Veterans-Rural-Health-Resource-Center-VRHRC.asp