Treatment of Veterans with Psychiatric Diagnoses Nationally in the Veterans Health Administration: A Comparison of Service Delivery by Mental Health Specialists and Other Providers

Gupta, Nikhil; Bhalla, Ish P.; Rosenheck, Robert A.

doi:10.1007/s10488-018-00920-z

“…The present study, based on VHA data showed intensive community-based service are provided to 18% of those receiving any specialty mental health services especially to those with multiple substance use disorders, severe mental illness, criminal justice involvement, and/or homelessness. A previous study of VHA care showed that considering all patients with psychiatric diagnoses, one-third receive no specialty mental health treatment at all and receive care for mental disorders exclusively in primary or specialty care clinic settings [67]. That study and this one taken together, thus appear to be unique in mapping the major components of VHA mental health care, a comprehensive mental health system in which most patients receive care in standard outpatient mental health and primary care clinics but distinct subgroups receive intensive community-focused care largely shaped by social determinants and SUD-related multimorbidity.…”

Section: Discussionmentioning

confidence: 99%

Social determinants of mental health care systems: intensive community based Care in the Veterans Health Administration

Bhalla

¹

,

Stefanovics

²

,

Rosenheck

³

2020

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Background: Since deinstitutionalization in the 1950s-1970s, public mental health care has changed its focus from asylums to general hospitals, outpatient clinics and specialized community-based programs addressing both clinical and social determinants of mental health. Analysis of the place of community-based programs within a comprehensive health system such as the Veterans Health Administration (VHA) may illuminate the role of social forces in shaping contemporary public mental health systems. Methods: National VHA administrative data were used to compare veterans who exclusively received outpatient clinic care to those receiving four types of specialized community-based services, addressing: 1) functional disabilities from severe mental illness (SMI), 2) justice system involvement, 3) homelessness, and 4) vocational rehabilitation. Bivariate comparisons and multinomial logistic regression analyses compared groups on demographics, diagnoses, service use, and psychiatric prescription fills. Results: An hierarchical classification of 1,386,487 Veterans who received specialty mental health services from VHA in Fiscal Year 2012, showed 1,134,977 (81.8%) were seen exclusively in outpatient clinics; 27,931 (2.0%) received intensive SMI-related services; 42,985 (3.1%) criminal justice services; 160,273 (11.6%) specialized homelessness services; and 20,921 (1.5%) vocational services. Compared to those seen only in clinics, veterans in the four community treatment groups were more likely to be black, diagnosed with HIV and hepatitis, had more numerous substance use diagnoses and made far more extensive use of mental health outpatient and inpatient care. Conclusions: Almost one-fifth of VHA mental health patients receive community-based services prominently addressing major social determinants of health and multimorbid substance use disorders. Background Care for people with psychiatric disorders has undergone extraordinary changes in the past 70 years from a focus on asylum care to a "de facto" system of diverse, largely non-institutional services [1-3]. A distinctive feature is the provision of community-based often intensive services for the most vulnerable, those long thought to be the most inadequately served [4]. In 1950, care for people with SMI, provided in over 500,000 state mental hospital beds [5], and was a target of public scorn [6]. By 1970, the majority of these beds had been closed and acute care was provided primarily in general hospitals, with longer term institutional care in nursing and board and care homes [7], and outpatient care in public clinics bolstered by newly developed antipsychotic and other psychiatric medications. By 1980, a substantial academic literature had developed decrying the failures of deinstitutionalization and the neglect of people with the

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“…The present study, based on VHA data showed intensive community-based service are provided to 18% of those receiving any specialty mental health services especially to those with multiple substance use disorders, severe mental illness, criminal justice involvement, and/or homelessness. A previous study of VHA care suggested that considering all patients with psychiatric diagnoses, one-third receive no specialty mental health treatment at all and recieive care for mental disorders exclusively in primary or specialty care clinic setiings [59]. These VHA studies, taken together, thus appear to be unique in mapping the major components of a complete contemporary mental health system in which most patients receive care in standard outpatient clinics but significant subgroups receive intensive community-focused care largely shaped by social determinants and SUD-related multimorbidity.…”

Section: Discussionmentioning

confidence: 99%

Social Determinants of Mental Health Care Systems: Intensive Community Based Care in The Veterans Health Administration

Bhalla

¹

,

Stefanovics²,

Rosenheck

³

2020

Preprint

0

View full text Add to dashboard Cite

BackgroundSince deinstitutionalization in the 1950s-1970s, public mental health care has changed its focus from asylums to general hospitals, outpatient clinics and specialized community-based programs addressing both clinical and social determinants of mental health. Analysis of the place of communitybased programs within a comprehensive health system such as the Veterans Health Administration (VHA) may illuminate the role of social forces in shaping contemporary public mental health systems. MethodsNational VHA administrative data were used to compare veterans who exclusively received outpatient clinic care to those receiving four types of specialized community-based services, addressing: 1) functional disabilities from severe mental illness (SMI), 2) justice system involvement, 3) homelessness, and 4) vocational rehabilitation. Bivariate comparisons and multinomial logistic regression analyses compared groups on demographics, diagnoses, service use, and psychiatric prescription fills. ResultsAn hierarchical classification of 1,386,487 Veterans who received specialty mental health services from VHA in Fiscal Year 2012, showed 1,134,977 (81.8%) were seen exclusively in outpatient clinics; 27,931 (2.0%) received intensive SMI-related services; 42,985 (3.1%) criminal justice services; 160,273 (11.6%) specialized homelessness services; and 20,921 (1.5%) vocational services.Compared to those seen only in clinics, veterans in the four community treatment groups were more likely to be black, diagnosed with HIV and hepatitis, had more numerous substance use diagnoses and made more extensive use of mental health outpatient and inpatient care. ConclusionsAlmost one-fifth of VHA mental health patients receive specialized community-based services addressing, most prominently, major social determinants of health and multimorbid substance use disorders. BackgroundCare for people with psychiatric disorders has undergone extraordinary changes in the past 70 years from a focus on asylum care to a "de facto" system of diverse, largely non-instiutional services [1][2][3].

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“…The present study, based on VHA data showed intensive community-based service are provided to 18% of those receiving any specialty mental health services especially to those with multiple substance use disorders, severe mental illness, criminal justice involvement, and/or homelessness. A previous study of VHA care showed that considering all patients with psychiatric diagnoses, one-third receive no specialty mental health treatment at all and recieive care for mental disorders exclusively in primary or specialty care clinic setiings [64]. That study and this one taken together, thus appear to be unique in mapping the major components of VHA mental health care, a comprehensive mental health system in which most patients receive care in standard outpatient mental health and primary care clinics but distinct subgroups receive intensive community-focused care largely shaped by social determinants and SUDrelated multimorbidity.…”

Section: Discussionmentioning

confidence: 99%

Social Determinants of Mental Health Care Systems: Intensive Community Based Care in The Veterans Health Administration

Bhalla

¹

,

Stefanovics

²

,

Rosenheck

³

2020

Preprint

0

View full text Add to dashboard Cite

Background: Since deinstitutionalization in the 1950s-1970s, public mental health care has changed its focus from asylums to general hospitals, outpatient clinics and specialized community-based programs addressing both clinical and social determinants of mental health. Analysis of the place of community-based programs within a comprehensive health system such as the Veterans Health Administration (VHA) may illuminate the role of social forces in shaping contemporary public mental health systems. Methods: National VHA administrative data were used to compare veterans who exclusively received outpatient clinic care to those receiving four types of specialized community-based services, addressing: 1) functional disabilities from severe mental illness (SMI), 2) justice system involvement, 3) homelessness, and 4) vocational rehabilitation. Bivariate comparisons and multinomial logistic regression analyses compared groups on demographics, diagnoses, service use, and psychiatric prescription fills. Results: An hierarchical classification of 1,386,487 Veterans who received specialty mental health services from VHA in Fiscal Year 2012, showed 1,134,977 (81.8%) were seen exclusively in outpatient clinics; 27,931 (2.0 %) received intensive SMI-related services; 42,985 (3.1%) criminal justice services; 160,273 (11.6%) specialized homelessness services; and 20,921 (1.5%) vocational services. Compared to those seen only in clinics, veterans in the four community treatment groups were more likely to be black, diagnosed with HIV and hepatitis, had more numerous substance use diagnoses and made far more extensive use of mental health outpatient and inpatient care. Conclusions: Almost one-fifth of VHA mental health patients receive community-based services prominently addressing major social determinants of health and multimorbid substance use disorders.

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Treatment of Veterans with Psychiatric Diagnoses Nationally in the Veterans Health Administration: A Comparison of Service Delivery by Mental Health Specialists and Other Providers

Cited by 7 publications

References 39 publications

Social determinants of mental health care systems: intensive community based Care in the Veterans Health Administration

Social determinants of mental health care systems: intensive community based Care in the Veterans Health Administration

Social Determinants of Mental Health Care Systems: Intensive Community Based Care in The Veterans Health Administration

Social Determinants of Mental Health Care Systems: Intensive Community Based Care in The Veterans Health Administration

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