Specialty mental health care improves patients' outcomes: Findings from a nationwide program to monitor the quality of care for patients with substance use disorders

Objective: To describe the implementation of a nationwide program to monito r the quality of treatment for substance use disorders in the Department of Veterans Affairs, and to examine how the provision of outpatient mental he alth care, and the duration and intensity of care, relate to patients' outc omes. Method: Clinicians completed a baseline Addiction Severity Index (ASI ) on more than 34,000 patients with substance use disorders; more than 21,0 00 (63%) were reassessed with the ASI an average of 12 months later. Nation wide health service utilization databases were used to obtain information a bout patients' diagnoses and their use of services during an index episode of care. Results: On average, patients who received specialty outpatient me ntal health care experienced better risk-adjusted outcomes than did patient s who did not receive such care. Patients who had longer index episodes of mental health care improved more than did those who had shorter episodes. T here was some evidence that the duration of care contributed more to better outcomes among patients with only substance use disorders, whereas the int ensity of care was more important for patients with both substance use and psychiatric disorders. Conclusions: The provision of specialty outpatient m ental health care, and longer episodes of specialty care, were associated w ith better risk-adjusted substance use, symptom and social functioning outc omes for patients with substance use disorders. More emphasis should be pla ced on ensuring that these patients enter specialty care and on keeping the m in treatment.