Cross-system service use among psychiatric patients: data from the Department of Veterans Affairs

This study examines the cross-system use of non-Department of Veterans Affairs (VA) services in a sample of psychiatric patients from the VA in 1990. Data were collected over a two-week period on all mental health outpatients and included demographic information, diagnoses, and self-reported use of non-VA services in the previous two weeks and six months. In the entire sample, 10.6% and 23.3% reported cross-system use in the previous two weeks and six months, respectively. Predictors of cross-system use were lower VA utilization, a nonschizophrenic diagnosis, not having a VA service-connected disability, and being female. These data indicate that a substantial proportion of VA mental health patients are using non-VA services. Utilization patterns indicate that they may be substituting non-VA for VA services. These results are unlikely to be unique to VA, and rates of cross-system use will likely increase in all health care systems as financial restrictions increase.