Explaining trends in use of VA inpatient psychiatric services

We examined the expansion of Veterans Administration (now Department of Veterans Affairs--VA) inpatient psychiatric services from 1963 to 1984. Aggregate national trends in VA inpatient episodes between 1963 and 1984 document not only increased use of inpatient services but also "decentralization," or a shift to providing psychiatric services in general VA medical centers. The national trends show a dramatic increase in admissions to psychiatric bed sections over the period 1963-1978, with admissions staying at this high level from 1976-1981 and dropping only slightly in the 1980s. Admission trends were disaggregated into first admissions and readmissions to psychiatric and general hospitals in a single VA medical district for the period 1972-1981. First admissions declined over the study period for both hospital types; readmissions increased initially, but declined somewhat at the end of the period. The admission trends and patterns in source of first admissions suggest that the growth of VA services reflects psychiatric "decentralization," as well as deinstitutionalization within VA.