According to a recent study led by Nicholas W. Bowersox, PhD, of the Veterans Health Administration (VHA), Serious Mental Illness Treatment Resource and Evaluation Center in Michigan, veterans with serious mental illness (SMI) are not receiving appropriate and adequate care. Vets who are 70% disabled are entitled to inpatient treatment at the VHA.
However, the number of inpatient beds is decreasing as the need for care is increasing. To get a better look at the trends in SMI among veterans, and the appropriateness of admissions based on clinical evaluation, Bowersox evaluated the available inpatient beds in VHA facilities from 1999 to 2007. He looked at SMI rates among all VHA admissions and also the appropriateness of admissions with and without SMI.
The results revealed that there were close to 44,000 available beds for psychiatric inpatient treatment in the VHA in 1999, but less than 41,000 in 2007. Bowersox discovered that the duration of inpatient care decreased by over 10% during that same time, declining from an average of 33 days to only 19 days in 2007. That could contribute to the decreased number of beds. However, the rate of SMI admissions increased drastically, from 29.4% to almost 44%. That startling rise in SMI suggests that vets who desperately need inpatient care might not be able to get a bed when they need it. Further, outpatient therapeutic care increased during the nine years, which could also contribute to the lower number of beds.
Bowersox believes that these trends reveal some interesting evidence. First, the largest number of inappropriate admissions was found among vets with SMI. The decrease of beds, decrease of treatment duration, and increase in outpatient care could all be directly predictive of increased SMI in 2007.
If vets are being referred to outpatient care when they really need inpatient care, they may be more likely to need inpatient care in the future. In other words, if they don’t receive the intensive care they need when they need it, their mental health could deteriorate and make them vulnerable to future hospitalization. Sadly, this study shows that if that is the case, the VHA beds may not be available for them if and when that time arrives. Bowersox added, “These results suggest the need for increased attention to the long-term care needs of individuals with SMI.”
Bowersox, Nicholas W., PhD, Benjamin J. Szymanski, MPH, and McCarthy, John F., PhD, MPH. (2013). Associations between psychiatric inpatient bed supply and the prevalence of serious mental illness in veterans affairs nursing homes. American Journal of Public Health 103.7 (2013): 1325-31. ProQuest. Web.
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