Comorbid alcohol and drug use disorders are treatable and have substantial effects on outcomes and health care utilization in people with schizophrenia. While these substance use disorders (SUDs) are thought to be common in patients with schizophrenia, it has been difficult to characterize prevalence and treatment utilization of this population, since administrative data and medical records may not identify patients with schizophrenia who have an SUD diagnosis.
Special Feature: The Cost and Quality of VA Mental Health Services
U.S. veterans have higher rates of serious mental health and substance use disorders than civilians. Prolonged and repeated deployments to Afghanistan and Iraq have magnified these problems. RAND assessed the cost, quality, and capacity of VA care for these disorders.
How much health care is used by veterans with mental health and substance use disorders, and how much does it cost?Click to Enlarge
Veterans with mental illness and substance use disorders represent a large and growing population with severe and complex disorders. Despite representing only 15 percent of the U.S. Department of Veterans Affairs' (VA's) patient population in 2007, veterans with these problems accounted for one-third of all VA medical costs.
What is the VA's capacity to deliver mental health and substance use care to veterans?Click to Enlarge
Basic and specialized mental health services were reported to be widely available, and services have been expanding. The study found that therapies which are linked to improved outcomes have increased substantially, as have suicide prevention services.
What is the quality of mental health care received by veterans, and how does the quality compare with that delivered in the private sector?Click to Enlarge
It is generally as good as or better than care delivered by private plans. The team found that the VA had higher levels of performance than private providers for seven out of nine indicators. However, care is given at less than existing capacity, and less than a third of those targeted for specialized therapy receive it.
How does quality given by the VA vary?Click to Enlarge
Quality of care varies across regions and populations. Overall, no regional network is above or below the average, but treatment rates varied as much as 20% across networks. Veterans over age 65, veterans under age 35, and veterans who resided in rural areas were less likely to receive appropriate services.
Are veterans satisfied with the care they receive?Click to Enlarge
Overall, veterans' perceptions of VA mental health services were quite favorable: on a 10 point scale, 42% of veterans rated VA mental health care at 9 or 10, and 74% reported being helped by counseling or treatment received in the prior 12 months. Still, only 32 percent perceived improvement in their problems or symptoms.
More Research on Veterans' Mental Health
Insomnia Severity as a Mediator of the Association Between Mental Health Symptoms and Alcohol Use in Young Adult Veterans2017
Insomnia severity accounts in part for the impact of symptoms of depression and PTSD on alcohol use in young adult veterans.
Associations between the relationship behaviors of young veterans and their spouses and measured sleep quality suggest that interventions to decrease hostility could improve both marital and physical health.
Testimony presented before the Senate Appropriations Committee, Subcommittee on Military Construction, Veterans Affairs, and Related Agencies on April 27, 2017.
A Randomized Controlled Trial of a Web-Based, Personalized Normative Feedback Alcohol Intervention for Young-Adult Veterans2017
One month after a single 10-minute intervention to adjust perceptions of peer drinking behavior, young veterans reported significant reductions in their drinking compared with control participants.