This Month’s Highlights

Suicide and Homelessness Among Veterans

Several reports examine suicide and early mortality among veterans and military personnel. Between 2005 and 2009, largely in response to high suicide rates, the Veterans Health Administration (VHA) increased outpatient mental health staffing by more than 50%. But suicide rates remained the same. Were the national statistics obscuring promising prevention efforts at regional levels? A VHA research team took a closer look at data from the VHA’s 21 regional Veterans Integrated Service Networks (VISNs). Ira R. Katz, M.D., Ph.D., and colleagues found that VISNs with the greatest proportional increases in mental health outpatient staffing had decreases in suicide rates of 11%–13%, whereas those with the lowest proportional staffing increases had increases of 14%–16% (page Original article: 620). To help pinpoint suicide risk, David D. Luxton, Ph.D., and colleagues examined a decade of data (2001–2011) on suicide rates among active-duty personnel after discharge from a psychiatric hospitalization. The suicide rate in this group was five times higher than the rate in the general active-duty population, with a particularly high risk in the 30 days after discharge (page Original article: 626). In the Datapoints column, Denis G. Birgenheir, Ph.D., and colleagues present analyses indicating that homelessness plays a significant role in early mortality among veterans (page Original article: 608), and findings reported in a letter to the editor link homelessness to suicide among middle-aged veterans (page Original article: 713). In Taking Issue, Dr. Katz notes that VHA's stepped-up efforts may alter the wars’ legacy of extensive illnesses and injury (page Original article: 605).

Developments in Asia

Two submissions to a new column, Mental Health Care Reforms in Asia, provide updates on efforts in China and Japan to improve services and systems. Samson Tse, M.Sc., Ph.D., and colleagues describe China’s National Mental Health Law, approved in October 2012. The law calls for building a strong community service system, and the authors describe four strategic directions for the future (page Original article: 613). In April 2013, Japan designated mental disorders as the fifth “priority disease” for national medical services, after cancer, stroke, heart attacks, and diabetes. Hiroto Ito, Ph.D., and coauthors provide an overview of Japan’s Regional Health Care Strategic Plan, which aims to reallocate resources from institutions to the community (page Original article: 617). Two research reports from China offer additional insights into the challenges that China faces in a new era. Ning Li, Ph.D., and colleagues analyzed data from a national survey that documented the prevalence of disabilities in China. Fifty-two percent of those with a mental disability had never used a mental health service. Several factors were associated with a greater likelihood of service use (page Original article: 638). Since 1980, the city of Shenzhen has developed from a small town to a teeming city, attracting millions of rural laborers looking for a better life. Zhaoguo Wei, M.S., and colleagues analyzed data from interviews with more than 7,100 of these migrant workers to determine the prevalence of DSM-IV mental disorders and service use (page Original article: 645).

High Costs of Justice Involvement

Involvement in the criminal justice system among adults with serious mental illness doubles the costs of their care. This finding is the result of a careful analysis conducted by Jeffrey W. Swanson, Ph.D., and his colleagues, who examined costs over two years (2006 and 2007) incurred by more than 25,000 adults with schizophrenia or bipolar disorder served by the Connecticut Department of Mental Health and Addiction Services. Costs to three systems—mental health, substance abuse, and criminal justice—were totaled. About a quarter of the sample was involved in the justice system, and costs for this group were about double those of the group with no involvement—$48,980 compared with $24,728 (page Original article: 630).

Integrating Care: Early Lessons

Efforts by 56 community behavioral health agencies to integrate primary care into services for adults with serious mental illness presented a shifting set of challenges, according to a report by Deborah M. Scharf, Ph.D., and colleagues on agencies that received grants in 2009 or 2010 from the Substance Abuse and Mental Health Services Administration to implement such integration. Hiring and retaining staff remained key challenges at both start-up and one year, and use of electronic medical records and other issues related to data management were found to be more challenging at one year than at start-up. For a variety of reasons, difficulty recruiting consumers to participate had become the most salient barrier at one year (page Original article: 660).