Predictors of High-Intensity Psychiatric Service Utilization by Veterans Health Administration Patients With Early Psychosis

Objective: People with early episode psychosis (EEP) have more negative care outcomes than do people with later episode psychosis (LEP), including higher levels of high-intensity psychiatric service use. It is unclear whether these differences are best explained by clinical differences between these two groups or whether people with EEP have specific treatment needs. An assessment of the treat-ment needs of patients with EEP can help inform the imple-mentation of national treatment programming designed to provide better care to this group. Methods: Administrative data were used to compare char-acteristics of Veterans Health Administration patients who had EEP (i.e., a psychotic diagnosis, diagnosis history of <_4 years, and age <_30 years; N=4,595) with those with LEP (i.e., a psychotic diagnosis, longer diagnosis history, and older age; N=108,713) who received care during a 1-year evaluation period. The authors generated logistic regressions to assess the potential impact of EEP status on the likelihood of receipt of emergency department (ED) and inpatient psychiatric admissions while controlling for other patient characteristics. Results: Patients with EEP had elevated psychiatric comor-bidity and mental health severity yet received equivalent outpatient mental health services. Patients with EEP were more likely to have had an ED visit for the treatment of a mental health condition and inpatient psychiatric admis-sions; this pattern persisted in analyses that controlled for group differences. Conclusions: Patients with EEP have unique mental health treatment needs. The development and implementation of EEP-specific treatments could help address these needs and reduce the number of patients using higher levels of psychiatric services within large health care systems.