Psychiatric Multimorbidity in a Specialized Program for Severely Mentally Ill Veterans
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Psychiatric Multimorbidity in a Specialized Program for Severely Mentally Ill Veterans Ish P. Bhalla 1,2
& Debbie Deegan
2,3
& Elina A. Stefanovics
2,4
& Robert A. Rosenheck
2,4,5
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract
It has been suggested that psychiatric multimorbidity may better characterize severely impaired psychiatric patients than individual severe mental illness (SMI) diagnoses, and that these patients may be better served by centers offering integrated co-located, psychiatric and social services than in conventional clinics providing one-to-one care. We tested the hypothesis that multimorbidity is a critical characteristic of Veterans treated at a co-located multi-service Veteran’s Health Administration (VHA) program originally established to treat Veterans living with SMI. Administrative data from the VA Connecticut Health Care System from fiscal year 2012 were used to compare veterans using diverse mental health and social services at the Errera Community Care Center (ECCC), an integrated “one-stop shop” for SMI veterans, and those seen exclusively at standard outpatient mental health clinics. Bivariate and multiple logistic regression analyses were used to compare groups on demographic characteristics, psychiatric and medical diagnoses, service utilization, and psychotropic medication fills. Results: Of the 11,092 veterans included in the study, 2281 (20.6%) had been treated at the ECCC and 8811 (79.4%) had not. Multivariable analysis highlighted the association of treatment in the ECCC and younger age, lower income, homelessness, and especially multimorbidity including both multiple substance use and multiple psychiatric diagnoses. Programs originally designed to address the diverse needs of patients living with SMI and homelessness may be usefully characterized as treating patients with psychiatric multimorbidity, a term of greater clinical relevance. Effectiveness research is needed to evaluate the one-stop shop approach to their treatment. Keywords Multimorbidity . Serious mental illness . Community based mental health services . Substance use disorders
* Ish P. Bhalla [email protected] Extended author information available on the last page of the article
Psychiatric Quarterly
Introduction There has been a growing recognition that the typical patient seen in real-world psychiatric practice suffers from multiple psychiatric disorders, or multimorbidity, rather than from any one severe mental illness (SMI) [1]. Studies have shown that patients with multimorbidity have more severe symptoms and poorer functioning [2], are more likely to receive dysfunctionally fragmented care [2], and use more services at greater cost than patients with single diagnoses. Ironically patients with a single diagnosis, i.e. without comorbidity, a clinical minority, are typically the exclusive focus of research and professional education [3]. Clinical trials typically exclude patients with comorbidities and current treatment guidelines have yet to fully recognize the dis
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