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Health and Healthcare Disparities Among Veterans with Serious Mental Illness
Posted: November 08, 2017
The National Veteran Health Equity Report details patterns and provides comparative rates of health conditions for vulnerable Veteran groups. Specifically, this report is designed to provide basic comparative information on the sociodemographics, utilization patterns and rates of diagnosed health conditions among the groups over which the VHA Office of Health Equity (OHE) has responsibility with respect to monitoring, evaluating and acting on identified disparities in access, use, care, quality and outcomes. The report allows the VA, Veterans, and stakeholders to monitor the care vulnerable Veterans receive and set goals for improving their care. Chapter 7 of the Report focuses on Health and Healthcare Disparities Among Veterans with Serious Mental Illness (SMI).
Compared to the general population, individuals with SMI have between 14-30 years shorter life expectancy, depending on the study. Individuals with SMI who are treated in VA are on the lower end of this mortality gap with between 14-18 years shorter life expectancy compared to the general US population. SMI as a category has been variably defined across studies. For the purposes of this chapter, and in line with the most typical definitions of SMI, the SMI group included schizophrenia, schizoaffective disorder, bipolar disorders, major depression with psychosis, and psychotic disorders not otherwise specified. Schizophrenia is considered the hallmark disorder of SMI.
As a group, mental and substance use disorders have been the leading cause of non-fatal global disease burden and fifth in overall disease burden, which includes impact from both mortality and morbidity as measured in disability-adjusted life years (DALYs). Although depressive and anxiety disorders are more prevalent and carry higher global burden, SMI accounts for the highest disability weights. Despite the low prevalence of SMI (approximately 4% of the U.S. population), they account for the majority of patients treated at outpatient public mental health clinics, including VA.
Some of the implications for veterans spelled out in the chapter include:
In order to reduce mortality and disability in SMI, efforts should address provider attitudes towards SMI, quality of care, access to preventative medical care, and help managing chronic comorbid medical conditions. Clinicians, outside of specialty mental health, often have limited experience, discomfort, and a lack of familiarity with evidence-based practices for this population. At the organizational level, systems may lack protocols for care management, shared treatment arrangements, and effective partnerships between primary care and mental health staff. The core difficulty with treating comorbid medical and mental health is the mismatch between the patient, in whom medical and mental conditions and their treatments are interrelated, and a healthcare system with separate services for each disorder; though in VA, primary care-mental health integration is designed to address part of this concern. However, even in VA, a large, quasi-integrated system, the experience of the patient with SMI and their providers is often that of a fragmented healthcare system.
Read more from the National Veterans Health Equity Report.