Care for Mentally Ill Vets at VA Centers May Differ Across U.S.

More research urged to explore why discrepancies exist and how they should be addressed

WEDNESDAY, Oct. 19 (HealthDay News) -- The U.S. Department of Veterans Affairs rivals other health care systems in the quality of care it provides to mentally ill veterans, but there are huge discrepancies in the level of care offered in various facilities across the country, according to a new study.

Investigators with RAND Corporation, a non-profit research organization, also noted that mental health services for veterans don't come cheap, costing more than $12 billion in 2007 alone.

"While the VA does a better job at providing mental health services than other health care systems, there is still substantial room for improvement," the study's lead author, Dr. Katherine Watkins, a senior natural scientist with RAND, said in a news release from the corporation. "With some changes, the VA could provide even better and more cost-effective care for the nation's veterans, as well as serve as a model for other health care systems."

In examining the array of services provided to mentally ill veterans as well as differences in the level of care across the United States, the researchers analyzed information on veterans treated for at least one of five different mental illnesses (schizophrenia, bipolar I disorder, post-traumatic stress disorder, major depression and substance-use disorders). They found treatment for mental illnesses and substance abuse disorders is more costly than treatments for other medical conditions.

The average health care costs for each veteran followed was $12,337, which is nearly three times higher than the $4,579 for those not included in the study. The study, published online and in the November print issue of the journal Health Affairs, also found the veterans had four times as many critical inpatient discharges and three times as many outpatient visits as other veterans.

Although the nearly 840,000 veterans included in the study represented about 15 percent of those who took advantage of VA services in 2007, they accounted for almost 33 percent of the total health care costs. The researchers said this was due to increased use of inpatient and outpatient physical and mental health care services.

Increased prevalence of post-traumatic stress disorder, in particular, helped push the number of veterans diagnosed with mental illness and substance abuse disorders between 2004 and 2008 to more than 906,000 -- a surge of 38 percent, the investigators found.

There were large discrepancies, however, in the level of care in different facilities across the United States, such as whether veterans with post-traumatic stress disorder received the recommended behavioral therapy, the study showed. In assessing 23 performance indicators to track the kind of care veterans got, the researchers found three facilities had rates of about 75 percent, and nine were below 25 percent.

Although 60 percent of veterans took medication for the acute treatment of depression, just 16 percent received drug therapy for alcohol dependence, the study revealed. The researchers also found less than one-third of the veterans diagnosed with schizophrenia or bipolar disorder received ongoing treatment with antipsychotics or mood stabilizers.

The study authors noted that the findings do not reflect cases where patients refused services or did not fill their prescriptions.

In addition to the VA's ongoing efforts to improve services to veterans, the study concluded, more research is needed to explore why discrepancies in the level of care around the country exist and how they should be addressed.

More information

The U.S. Department of Veterans Affairs provides more information on health care services for veterans.

Mary Elizabeth Dallas SOURCE: RAND Corporation, news release, Oct. 19, 2011

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