Use of VA aftercare following military discharge among patients with serious mental disorders

OBJECTIVE: This study examined the use of Department of Veterans Affairs (VA) aftercare services among patients with serious mental disorders who were discharged from the military after a first admission to a Department of Defense (DoD) hospital. METHODS: Administrative data from the DoD and VA health systems were linked to identify active-duty servicemen and -women who were hospitalized in a military hospital with a diagnosis of major depression, bipolar disorder, or schizophrenia between 1993 and 1996 and who were subsequently discharged from the military. Split population survival analysis was used to examine separately the correlates of contact with VA outpatient mental health services and, among those who had contact, the time to contact after military discharge. RESULTS: Fifty-two percent of 2,861 identified individuals had received outpatient care from VA mental health clinics by the end of September 1998. The rate of contact was lower than in virtually all studies of aftercare following hospital discharge. Women, older persons, and persons with schizophrenia or bipolar disorder were more likely to contact VA outpatient mental health services than men, younger persons, and those with major depression. Among those who made contact, older persons had a longer time to contact. CONCLUSIONS: Many people who leave the military because of serious mental illness do not receive aftercare from the VA. The reasons for such low rates of contact are not clear. Identifying patients who need aftercare but do not receive it and ensuring that they have access to needed services remains an important challenge for the DoD and the VA.