Online Program

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

Wednesday, November 4, 2015

Marcia Hunt, PhD, Northeast Program Evaluation Center (NEPEC), Office of Mental Health Operations, VHA, VHA and Yale University, West Haven, CT
Gary Cuddeback, PhD, Program on Mental Health Services Research, Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC
Elizabeth Bromley, MD, PhD, Semel Institute Center for Health Services and Society, University of California, Los Angeles, Los Angeles, CA
Daniel Bradford, MD, MPH, Department of Psychiatry and Behavioral Sciences, VHA VA Central Office, Mental Health Services; Duke University, Durham, NC
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.

Learning Areas:

Administration, management, leadership
Provision of health care to the public
Public health or related organizational policy, standards, or other guidelines
Public health or related research
Social and behavioral sciences

Learning Objectives:
Demonstrate how national VA program evaluation data can be used to estimate the need for intensive services for Veterans with severe mental illness.

Keyword(s): Mental Health Treatment &Care, Veterans' Health

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been involved with mental health services research for over 12 years. I am a co-investigator on the project and was heavily involved in all aspects of the study.
Any relevant financial relationships? Yes

Name of Organization Clinical/Research Area Type of relationship
Veterans Administration Mental health services research Consultant

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.