The number of patients with initial PC-MHI encounters increased from 76,985 in FY 2008 (all PC-MHI users were new in FY 2008) to 107,417 in FY 2009 (85.5% of all PC-MHI users in FY 2009) and to 149,938 in FY 2010 (78.8% of all PC-MHI users in FY 2010) (Table 1). Between FY 2008 and FY 2010, new PC-MHI users tended to be slightly younger, female, nonwhite, nonmarried, and without substantial service-connected disability status. Between FY 2008 and FY 2010, the proportion of new PC-MHI recipients of age 18–44 increased from 23.5% to 27.6%, and the proportion age 45 and older decreased. The proportion of married PC-MHI users remained similar throughout the study period (from 44.7% to 44.3%) whereas separated, widowed, or divorced proportions decreased (from 32.6% to 29.4%) from FY 2008 to FY 2010. The proportion of users with a service-connected disability of at least 70% decreased from 22.5% in FY 2008 to 17.6% in FY 2010. Also, the proportion of initial PC-MHI encounters at VAMCs fell from 78.4% in FY 2008 to 69.4% in FY 2010, and the proportion that occurred within CBOCs significantly increased, from 7.7% in FY 2008 to 22.3% in FY 2010.
New PC-MHI patients in FY 2010 were less likely than new users to have recent primary care or VA health system encounters in FY 2008. In the 12 months prior to the initial PC-MHI visit, new users with at least one primary care visit declined from 83.2% in FY 2008 to 81.4% in FY 2010. Also, in the five years prior to patients’ initial PC-MHI encounter, 14.6% of the FY 2008 cohort had not used VA services, which increased to 19.1% for the FY 2010 cohort.
Similar declines were observed in indicators of receipt of mental health treatment in the year preceding initiation of PC-MHI services. From FY 2008 to FY 2010, we observed declines in the proportion of individuals with any mental health service utilization within the past year (treatments or diagnoses), from 65.6% to 63.5%. Those with at least one mental health clinic visit in the prior year also declined, from 42.3% in FY 2008 to 37.2% in FY 2010. Further, whereas in FY 2008 36.5% of the PC-MHI initiators had received prior psychiatric diagnoses in specialty mental health clinics, this proportion decreased to 30.3% for the FY 2010 cohort.
With regard to psychiatric disorder prevalence, slight significant decreases were observed in the proportion of new users with any depression (from N=29,897, 38.8%, in FY 2008 to N=53,876, 35.9%, in FY 2010), anxiety disorders (not PTSD) (FY 2008, N=10,943, 14.2%; FY 2010, N=20,881, 13.9%), alcohol abuse or dependence (FY 2008, N=9,784, 12.7%; FY 2010, N=17,526, 11.7%), and substance abuse or dependence (FY 2008, N=12,315, 16.0%; FY 2010, N=22,630, 15.1%). However, the proportion of users with PTSD (FY 2008, N=13,572, 17.6%; FY 2010, N=26,540, 17.7%) or serious mental illness (9.1% in both FY 2008 (N=6,976) and FY 2010 (N=13,604) did not change significantly.