Veterans Exiting Prison Have Extensive Treatment Needs, Particularly for Mental Health and Substance Use Issues
Veterans exiting prison experience many of the challenges of community reentry faced by the general criminal justice population. In addition, more than half report mental health or substance use disorders (SUD), and among incarcerated Veterans who served in Iraq or Afghanistan, recent research reports that 43% had an alcohol use disorder, 37% had a drug use disorder, and 38% had PTSD. To help address the needs of incarcerated Veterans reentering society, VA created the Health Care for Reentry Veterans (HCRV) program in 2007, which provides outreach to Veterans in prisons who are due for release, and links them to healthcare and other transition assistance. HCRV's primary goal is to reduce and prevent homelessness and recidivism, and to facilitate reentry. This retrospective cohort study used VA data to identify 32,155 Veterans who received an outreach visit from an HCRV specialist from FY2008 through FY2013. Investigators determined Veterans' contact with VA healthcare in the year after the HCRV visit, the prevalence of mental health and SUD diagnoses, and rates of mental health or SUD treatment entry (use of outpatient, inpatient, residential, or pharmacotherapy) and engagement (defined as 3+ outpatient visits or >7 consecutive residential days) in the first month after diagnosis.
- Of the 32,155 Veterans with an HCRV outreach visit, 18,073 (56%) had contact with VA healthcare within one year, including primary care, mental health or SUD treatment, or other VA services.
- Among Veterans with an HCRV outreach visit who had contact with VA healthcare, 69% were diagnosed with at least one mental health or substance use disorder, and 35% were diagnosed with co-occurring mental health and substance use disorders. The three most common disorders were depressive disorders, alcohol use disorder, and PTSD.
- Of Veterans diagnosed with a mental health disorder, 77% entered mental health treatment in the first month after diagnosis and 28% engaged in treatment. At one year after diagnosis, 93% of Veterans had entered and 52% had engaged in mental health treatment.
- Of those Veterans diagnosed with a SUD, 37% entered and 24% engaged in SUD treatment in the first month, while 57% had entered and 39% engaged in treatment at one year following diagnosis.
- Veterans who were female, age 55 or older, African American, unmarried, served in Iraq or Afghanistan, or who had a service-connected disability had higher odds of entering VA treatment, whereas Veterans who lived in rural areas had lower odds.
- There was limited information on Veterans who had an HCRV outreach visit but did not have contact with VA healthcare; thus, conclusions about who did not enter VA treatment are limited.
This study was funded through VA HSR&D's Quality Enhancement Research Initiative (QUERI). Dr. Finlay was supported by an HSR&D Career Development Award; Dr. Harris was supported by an HSR&D Research Career Scientist Award; and Dr. Timko was supported by an HSR&D Senior Research Career Scientist Award. Drs. Finlay, Harris, Frayne, Bowe, and Timko are part of HSR&D's Center for Innovation to Implementation, Palo Alto, CA.
Finlay A, Stimmel M, Blue-Howells J, Rosenthal J, et al. Use of Veterans Health Administration Mental Health and Substance Use Disorder Treatment after Exiting Prison: The Health Care for Reentry Veterans Program. Administration and Policy in Mental Health and Mental Health Services Research. December 21, 2015;e-pub ahead of print.