Mental health services of the Veterans Administration, United States, 1986.

The mental health services of the Veterans Administration (VA) form an important component of the organized mental health care delivery system in the United States. The 140 VA organizations delivering mental health care represented 3 percent of all mental health organizations in the U.S. in 1986, but accounted for approximately 11 percent of the average daily inpatient mental health census and 8 percent of outpatient mental health visits in organized settings. Their 33,000 full-time equivalent (FTE) staff and $1.4 billion in expenditures devoted to mental health care were approximately 7 percent of the respective totals for all mental health organizations. Between 1983 and 1986, the number of VA organizations offering mental health care increased by only 1, but inpatient mental health additions increased by 22 percent. Average length-of-stay for these inpatients declined by almost as much. Outpatient mental health additions increased by 30 percent, and FTE staff in VA mental health services grew by 10 percent. Mental health services were provided by VA organizations in all States except Alaska, Hawaii, Montana, and North Dakota in 1986. (Veterans are free to make use of programs outside their State of residence.) The largest numbers of mental health services, additions, and episodes were found in States with very large populations, such as California, New York, and Texas. However, the highest rates of additions and episodes per 100,000 civilian population were generally in States with small populations, and often in rural States. For example, Maine, South Dakota, Wyoming, and West Virginia were among the States with the highest rates of additions and episodes. Reflecting the composition of the total population in VA facilities, of 315,630 in VA mental health services, over 95 percent were male, a relatively large percentage (17 percent) were 65 or over, and very few were under 18 years old. About two-thirds were white, non-Hispanic; one-fourth were black, non-Hispanic; and 8 percent were Hispanic. About one-sixth were suffering primarily from drug or alcohol abuse; almost all the rest suffered primarily from mental illness. In November 1986, approximately 36,000 staff persons worked in VA mental health services. About 84 percent of these worked full-time; 9 percent, part-time; and 7 percent, as trainees. The staff included approximately 2,800 psychiatrists, 700 other physicians, 1,600 psychologists, 1,800 social workers, and 7,200 nurses. Three-fourths of the expenditures for VA mental health services went for staff, with other operating expenses consuming most of the remainder.