Assertive Community Treatment in Veterans Hospital Administration: Estimating Demand for Mental Health Intensive Case Management Teams in a Time of Changing Need

Background/Purpose: The number of Veterans with behavioral health disorders is large and increasing and is one of the most pressing public health issues facing our nation today. Similar to assertive community treatment (ACT), the most widely-studied evidence-based practice for persons with mental illness, the Veteran Administration’s version of ACT – Mental Health Intensive Case Management (MHICM) – reduces hospitalizations and improves functioning for Veterans with mental illness. Veterans Hospital Administration’s (VHA) policy provides guidance on MHICM eligibility: (1) a diagnosis of severe mental illness; (2) severe functional impairment; (3) inadequately served by conventional outpatient treatment; and (4) high levels of service utilization; however, empirical estimates of the number of Veterans who need MHICM do not exist.

Methods: To address these gaps in our knowledge, we use four years of VHA program evaluation data (2007 – 2010) to define and estimate MHICM-eligible veterans using a range of eligibility algorithms. These estimates are compared to the estimates derived from current VA policy.

Findings: During our five-year study period, mental health diagnoses among Veterans increased by 25.3% and MCHIM-qualifying diagnoses increased by 28.6%. MHICM-eligibility estimates ranged from 50% to less than 1% depending on the restrictiveness of the estimating algorithm.

Implications: The number of Veterans who have behavioral health diagnoses are increasing, as are the numbers of Veterans who have MHICM-eligible diagnoses. Administrative data can be used to estimate the need for MHICM, and to inform the development of a flexible, patient-focused continuum of VA behavioral health care that aligns service intensity with intensity of need.