McCarthy JF (VA Serious Mental Illness Treatment Research and Evaluation Center (SMITREC)), Valenstein M
(SMITREC), Zivin K
(SMITREC), Kilbourne AM
Improving access to mental health services is a major VA priority. Patients may respond to access barriers by seeking care from alternative providers, which may complicate continuity of care. This study examined mental health access in relation to non-VA services utilization among VA patients with bipolar disorder.
Using survey data from the VA’s Continuous Improvement for Veterans in Care-Mood Disorders (CIVIC-MD) study (N=435), we calculated the number of non-emergency inpatient or outpatient mental health and non-mental health encounters with non-VA providers during the prior year. Poor mental health access was indicated by reports of having needed mental health care but being unable to get it. Using multivariable Tobit analysis of the latent variable “propensity to use non-VA services” (left censored for individuals with no reported non-VA use), we examined associations between mental health access and non-VA utilization. Model covariates included predisposing factors (age, gender, race, marital status, homelessness, employment status); enabling factors (service connection, proximity of VA hospitals, means of travel for VA appointments, and Medicare, Medicaid and private insurance coverage); and need factors (SF-12, PCS-12, and MCS-12 scores). 39 patients (9%) were excluded due to incomplete data. Excluded patients did not differ significantly from retained patients.
55.8% of respondents reported non-VA services use in the prior year. Among these individuals, the mean number of non-VA encounters was 15.0 (SD=25.6). Overall, 17.9% of patients reported poor mental health access. Patients who indicated having had non-VA services utilization were more likely to have reported poor mental health access (21.6% vs. 13.4%; p=0.034). In multivariable Tobit analyses, individuals with poor mental health access had greater propensity to use non-VA services (p=0.017). Further, being married, homeless, and having private health insurance were positively associated with non-VA utilization, and being older and service connected were associated with reduced likelihood of non-VA use (p < 0.05).
Mental health access barriers may cause VA patients with bipolar disorder to seek care from non-VA providers.
This study demonstrates the critical importance of assuring mental health access for veterans with bipolar disorder. Receipt of services across multiple health systems raises concerns regarding continuity of care.