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MST screening and access to mental health treatment

Kimerling R, Gima K, Smith MW, Street A, King S, Frayne S. MST screening and access to mental health treatment. Poster session presented at: Association of Military Surgeons of the United States Annual Meeting; 2006 Nov 5; San Antonio, TX.

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Objectives: VHA implemented universal screening for Military Sexual Trauma (MST) in 2001, but no systematic evaluation of this national program has been conducted. We examined whether screening facilitates access to mental health treatment among veterans who report MST. Methods: Screening data from the MST data archive were linked to outpatient utilization data from the national Patient Care Database. We identified 3,671,109 male veterans and 166,907 female veterans who were a) screened for MST between 7/1/01 and 3/30/05; b) had valid “yes” or “no” responses to screening; and c) who had at least one VHA outpatient visit in the screening year. For each year, we compared outpatient mental health utilization in the 6 months prior to MST screening with utilization in the 6 months subsequent to screening among veterans with a positive screen versus those with a negative screen, stratified by gender. Trends over time were also examined. Results: The annual proportion of positive MST screens ranged from 19.5% to 23.1% for women, and 1 – 1.4% for men. Within each year, a larger proportion of MST+ veterans, as compared to MST- veterans, were utilizing mental health services at the time of screening (in 2004, 28.9% vs. 9.2% for women; 30.8% vs. 8.7% for men). For each year, the proportion of new episodes of mental health care was significantly greater (p < .0001) for MST+ veterans than for MST- veterans (in 2004, 23.7% vs. 12.3% for women; 17.8% vs. 9.6% for men). The proportion of new treatment episodes increased over time among both MST+ and MST- groups, but there was a greater increase in new episodes over time among MST+ as compared to MST- patients. Implications: MST is associated with greater utilization of mental health services, and detection of MST appears to facilitate access to treatment among untreated patients. Time trends suggest access has improved since the clinical reminder was first adopted. Impacts: These findings support the conclusion that VHA’s universal screening policy improves access to mental health treatment for MST. Compliance with MST screening should be encouraged as investigators study the link between screening and treatment. VHA should ensure sufficient capacity for MST treatment programs.

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