Dual Diagnosis Among Intensive Case Management Participants in the Veterans Health Administration: Correlates and Outcomes

Abstract

Objective: Persons with comorbid severe mental illness and substance use disorder (dual diagnosis) are often referred to intensive case management. There has been little evaluation in real-world settings of the process and outcomes of intensive case management for such clients. Methods: This study used evaluation data on 3422 clients of the Veterans Health Administration treated in rural and urban intensive case management programs to compare veterans with and without dual diagnosis on characteristics at program entry, service delivery, and 6-month outcomes, adjusting for baseline differences. Results: At treatment entry, participants with dual diagnosis had more severe symptoms, more indicators of suicidality, poorer quality of life, more hospitalizations, and more arrests than those without dual diagnosis. They were also younger and more likely to be male. After 6 months of treatment, 2584 participants were still attending the treatment program. A higher proportion of those with dual diagnosis had received rehabilitation, housing, substance abuse, and supportive vocational services, but not other services. The rate of treatment dropout was higher for veterans with dual diagnosis and clinicians rated their alliance with these clients lower than their clients without dual diagnosis. With regard to outcomes, improvement was observed for both groups on almost all measures. The only significant difference in 6-month outcomes was that veterans with dual diagnosis had slightly higher violence index scores than veterans without dual diagnosis. Conclusions: These data suggest practical feasibility and potential effectiveness of intensive case management for veterans with, and those without, dual diagnosis.

Keywords:

• intensive case management
• access to care
• community psychiatry
• veterans issues
• rural mental health

ACKNOWLEDGMENTS

The author acknowledges and thanks the case managers who provided the information for this article. The valuable contribution of Dennis Thompson for his help with data analyses is also acknowledged.

This article not subject to U.S. copyright law.