1003 — Assessing VA Mental Health Intensive Case Management: Program Effects on Mental Health Services Use

Slade EP (VISN5 MIRECC), McCarthy JF (SMITREC), Valenstein M (SMITREC), Dixon L (VISN5 MIRECC), Ignacio R (SMITREC), Visnic S (SMITREC), Welsh D (SMITREC)

Objectives:
Since its implementation in fiscal year 2000, Mental Health Intensive Case Management (MHICM) has been the VA's flagship case management program for severely impaired persons with serious mental illness. However, given the striking decline in VA psychiatric inpatient lengths of stay and the rapid expansion of the MHICM program, it is important to reassess its impact. In this study, we assessed the effects of MHICM initiation on psychiatric inpatient, partial hospital, and outpatient mental health services utilization during the 12 months following enrollment.

Methods:
Using data from the VA's National Psychosis Registry and the MHICM Registry, we identified all patients who enrolled in MHICM between FY01-04 and a comparison sample of 28,204 patients who were MHICM-eligible in this period but did not enroll (MHICM-eligible non-enrollees). MHICM eligibility criteria required > 30 days or > = 3 episodes of psychiatric hospitalization, diagnosis of schizophrenia or bipolar disorder, and residence within 60 miles of a VA hospital. MHICM enrollees (N = 2,102) were propensity score matched to 2,102 MHICM-eligible non-enrollees. Matched non-enrollees closely resembled (abs(t) < 1.10) MHICM clients on all study covariates, which included inpatient and outpatient mental health services use in the prior 12 months, demographics, homelessness, service connection, and substance use diagnosis. We used OLS regression analyses and instrumental variables analyses of matched data to assess effects of MHICM initiation.

Results:
In OLS analyses, MHICM initiation was associated with a 24% reduction in psychiatric inpatient days (22.6 vs. 29.8 for non-enrollees; P < 0.001) and a 16% increase in partial hospitalization days (12.6 vs. 10.9 for non-enrollees; P = .055). In instrumental variables analyses, MHICM initiation was associated with a 40% reduction in inpatient days (18.0 vs. 29.8 for non-enrollees; P = .042) and a 120% increase in partial hospitalization days (23.9 vs. 10.9; P < .001).

Implications:
MHICM initiation still reduces use of inpatient psychiatric care. Although MHICM teams usually are thought to provide all of clients' outpatient care, many MHICM clients also rely on partial hospitalization programs.

Impacts:
The MHICM program continues to support severely impaired veterans' independence from institutionalized care. Unimpeded access to partial hospitalization services may be critical to ensure that all MHICM clients are fully supported.