The short answer
Mental health care uses VA's 20-day and 30-minute standards, the same as primary care, not the 28-day specialty standard. If VA can't schedule your mental health care within 20 days of your request and within a 30-minute average drive, you qualify for Community Care. Best medical interest can also qualify you.
What are the access rules for mental health?
Mental health care has its own line in VA's access standards. Under 38 CFR 17.4040(a)(1), you qualify for Community Care if VA can't schedule you with a VA provider:
- within 20 days of the date you asked for the care, unless you agreed to a later date with your VA provider; and
- within a 30-minute average drive of your home.
VA has to meet both. If it can't, you can choose Community Care under 38 CFR 17.4010(a)(4). VA's eligibility page lists the same numbers.
Does mental health use the 28-day specialty standard?
No. The regulation lists mental health care with primary care and non-institutional extended care under the 20-day and 30-minute standard. Specialty care is a separate category with 28 days and 60 minutes.
That's worth knowing because Veterans are sometimes told therapy or psychiatry is "specialty" care with a 28-day window. The regulation puts mental health in the 20-day group.
Some care connected to mental health can be harder to classify, like a neurology consult or a sleep study. The category depends on the care you actually asked for. If you're unsure which standard applies, ask VA which one it's using.
When does the 20-day clock start?
On the date you request the care. That includes:
- a first request for therapy or psychiatry;
- asking to come back after a break in care; and
- asking for a new type of mental health care.
The regulation doesn't make an exception for existing patients. The only adjustment is a later date you agree to with your VA provider. If you didn't agree to it, it doesn't count against you.
What other ways can I qualify for mental health Community Care?
The access standards aren't the only route:
- Best medical interest. You and your VA clinician agree outside care is better for you. Factors include how often you need care, continuity with a current therapist, and whether symptoms make travel hard. See Best Medical Interest.
- VA doesn't offer the care. For example, a specific treatment program VA doesn't provide.
- No full-service VA in your state.
See all six in Who Qualifies?
What mental health care can Community Care cover?
Outpatient and inpatient mental health care, including substance use treatment, is part of VA's medical benefits package. Through Community Care, that can include therapy, psychiatry and medication management, intensive outpatient programs, and residential or inpatient care when clinically needed. See:
- Therapy Referrals and Getting More Sessions
- Psychiatry and Medication Management Referrals
- Substance Use Treatment Through Community Care
Does telehealth change things?
It can. VA's rules count telehealth as an appointment, so VA may offer video care to meet the 20-day standard. If video doesn't work for you, say why and raise best medical interest. See Telehealth and Mental Health Community Care.
How do I ask?
- Send your VA team a Secure Message asking for the mental health care you need. That dates your request.
- Ask for the earliest VA appointment date and location.
- If it's more than 20 days out, or more than a 30-minute average drive, say you'd like Community Care.
- Name a provider if you have one.
- If you're told no, ask for VA's position and reason in writing.
If you're in crisis, don't wait on a referral. Call 988 and press 1, text 838255, or go to the nearest emergency room. See Free Emergency Suicide Crisis Care.
What we see in practice
The pushback we hear most often is that the 20-day standard doesn't apply, and very often that it's only for new patients. Veterans coming back to mental health care after a break hear this a lot. The regulation, 38 CFR 17.4040(a), counts from the date you ask for the care. It doesn't make an exception for people VA has treated before.
When this happens, we don't recommend arguing on the phone. Send a short Secure Message that points to the regulation and asks VA to confirm its position in writing. In our experience, that usually gets the referral moving within days. Our step-by-step approach and a copy-and-paste message are here: What to do if your Community Care referral is delayed or stuck.