Reinstitutionalization following psychiatric discharge from the VA

Cheryl Irmiter and colleagues conducted a longitudinal study to evaluate the prevalence, timing, and risk factors for reinstitutionalization of Veterans Affairs (VA) patients with serious mental illness (SMI).  Analysis was based on FY1998-2005 data and the sample was drawn from the VA National Psychosis Registry. They found that 86% of patients were reinstitutionalized to any VA setting, 68% to inpatient psychiatric units and, of those, within one year, on average.

[D]emographics for individuals who are more likely to be rehospitalized/reinstitutionalized are in line with earlier research. Researchers identified that non-marital status [35], co-occurring substance use disorders [36] homeless [37, 38] and co-morbid medical issues [38–40] among individuals with SMI are high risk indicators for ‘‘revolving’’ through institutions for care. […]

A limitation of the study is the lack of information for the patients who seek treatment outside of the VA. However, patients in the VA diagnosed with SMI receive a majority of mental and physical health care within this national system [27].


27. Bobo, WHC, Messina M, Pavlovcic F, Levandowski D, Griege T: Characteristics of repeat users of an inpatient psychiatry service at a large military tertiary care hospital. Mil Medical 169(8):648–653, 2004

35. Walton MA, Mudd SA, Blow FC, Chermack ST, Gomberg ESL: Stability in the drinking habits of older problem drinkers recruited from nontreatment settings. Journal of Substance Abuse Treatment 18:169– 177, 2000

36. Olfson M, Mechanic D, Boyer CA, Hansel S, Walkup J, Weiden PJ: Assessing clinical predictions of early rehospitalization in schizophrenia. Journal of Nervous and Mental Disease 187(12):721–729, 1999

37. Osher F: An Overview of Homelessness and Mental Illness. U.S. Department of Health and Human Services Public Health Service Substance Abuse and Mental Health Services Administration Center for Mental Health Services and The American Psychiatric Association Committee on Poverty, Homelessness and Psychiatric Disorders, Chicago, Illinois, 2002

38. Sullivan G, Han X, Moore S, Kotrla K: Disparities in Hospitalization for Diabetes Among Persons With and Without Co-occurring Mental Disorders. Psychiatric Services 57(8):1126–1131, 2006

39. Kilbourne A, Switzer G, Hyman K, Crowley-Matoka M, Fine M: Advancing Health Disparities Research Within the Health Care System: A Conceptnal Framework. American Journal of Public Health 96(12):2113, 2006

40. Jeste D, Alexopoulous G, Bartels S, Cummings J, Gallo J, Gottlieg G, Halpain M, Palmer B, Patterson T, Reynolds C, Lebowitz B: Consensus Statement on the upcoming crisis in geriatric mental


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