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Justice-involved Veterans: Mental health and substance use disorder conditions and utilization of care
Finlay AK, Smelson D, Timko C, McGuire J, Rosenthal J, Sawh L, Bowe T, Harris AH. Justice-involved Veterans: Mental health and substance use disorder conditions and utilization of care. Poster session presented at: AcademyHealth Annual Research Meeting; 2014 Jun 9; San Diego, CA.
Research Objective: We examined mental health (MH) and substance use disorder (SUD) conditions and utilization rates of MH and SUD treatment among patient of the Veterans Health Administration (VHA) involved with the criminal justice system. Veterans comprise 10% of those in prison and other criminal justice settings and over half have MH or SUD treatment needs. The VHA connects justice-involved Veterans with VHA services through Veterans Justice Outreach (VJO) for Veterans entering the justice system, and Health Care for Reentry Veterans (HCRV) for Veterans transitioning back to the community following incarceration in prison. Connecting Veterans to SUD treatment services may help reduce criminal justice recidivism and homelessness; thus, we examined whether these programs provided treatment access and linkage to treatment for these vulnerable populations.
Study Design: Using VHA health records from fiscal years 2008-2012, we selected all Veterans who had contact with the VJO or HCRV programs. MH conditions included: PTSD, personality disorders, depressive disorders, anxiety disorders, schizophrenia, affective psychosis, and other psychosis. SUD conditions included: alcohol use disorder, and drug use disorders. Utilization of MH or SUD treatment included the number of MH or SUD outpatient visits, the number of MH or SUD inpatient/residential stays, and use of pharmacotherapy services for alcohol or opioid dependence. Chi-squared and ANOVA tests were used to examine differences in condition and utilization rates between VJO and HCRV Veterans.
Population Studied: All Veterans who had contact with the VJO (n = 36,758) or HCRV (n = 26, 293) programs from fiscal year 2008-2012.
Principal Findings: Justice-involved Veterans had high rates of MH (56% VJO; 27% HCRV), SUD (68% VJP, 39% HCRV), and co-occurring conditions (45% VJP, 21% HCRV), with VJO Veterans more likely to have these conditions (p < .001). Of those with an MH condition, 94% received at least some MH treatment. VJO Veterans had more MH outpatient sessions (M = 21, SD = 35), and MH inpatient/residential stays (M = 10, SD = 35) compared to HCRV Veterans (MH outpatient visits: M = 8, SD = 22; MH inpatient/residential stays: M = 5, SD = 28). Of those with SUD, 58% received at least some SUD treatment. VJO Veterans had more SUD outpatient sessions (M = 13, SD = 28) and SUD inpatient/residential stays (M = 2, SD = 12) compared to HCRV Veterans (SUD outpatient visits: M = 5, SD = 17; SUD inpatient/residential stays: M = 1, SD = 11; p < .001). Among Veterans with alcohol dependence, use of pharmacotherapy was greater among VJO (11%) compared to HCRV (5%, p < .001). The same was true for Veterans with opioid dependence with greater use among VJO (20%) compared to HCRV (10%, p < .001).
Conclusions: Veterans entering VJO and HCRV programs are at especially high risk of having mental health and substance use disorders; these programs appear to be successful at helping them obtain needed services. Higher rates of treatment engagement among VJO Veterans may be due to the direct effects of these supportive programs, court mandated treatment, and/or easier access to VHA facilities in urban areas.
Implications for Policy, Delivery, or Practice: Closer supervision after release from prison and interventions to address treatment barriers in rural areas may increase access among HCRV Veterans.