Impact of housing on mentally ill unhoused Veterans’ readmissions to Veterans Affairs (VA) inpatient psychiatric services

Abstract: Unhouseness, also known as homelessness, coupled with mental illness, causes health problems for some veterans; financial difficulties, unemployment, and lack of affordable housing are factors contributing to veteran unhouseness (Tsai & Rosenheck, 2015). Approximately nine percent of the entire unhoused population in the United States are veterans (United States Interagency Council on Homelessness, 2020). Unhoused veterans experience negative health outcomes impacted by environmental and socioeconomic harshness, which are also factors of subsequent psychiatric hospital readmissions (Mascayano et al., 2022). The average cost per United States Veterans Affairs (VA) hospitalization was $30,282 in FY 2019 and $40,763 in FY 2020 (Wagner, Chow, Su, & Barnett, 2023). The 2023 federal budget for VA mental health care is $13.9 billion, with $2.7 billion allocated for housing for unhoused veterans (Yarmuth, 2022). This project aims to evaluate whether housing provision upon discharge affects readmission to psychiatric hospitals for unhoused veterans with mental illness. The purpose of this project is to evaluate if post-discharge housing affects readmission rates to a VA psychiatric hospital/unit among unhoused veterans with mental illness. Studies have shown that unhoused veterans have had higher VA hospital usage for nonurgent purposes than housed veterans (Gundlapalli et al., 2017; Mascayano et al., 2022; Sfetcu et al., 2017). This project proposes the following patient, intervention, comparison, outcome, and time (PICOT) question: For unhoused veterans who have mental illness (P), does the provision of housing (I), compared to housed mentally ill veterans (C), impact readmission rates (O) during the 20-month timeframe January 2022 to August 2023(T)? The objective of this project is to review and analyze hospital data to answer the previous mentioned PICOT question and provide clinical evidence to support future interventions to improve the lives of unhoused veterans with mental illness. This project will follow Lewin’s change model with secondary data analysis. Data will be collected from electronic health records to capture data of unhoused veterans diagnosed with mental illness admitted to this hospital from January 1, 2022, to August 31, 2023, at an acute adult psychiatric unit in California. The variables to be examined include unhoused veterans diagnosed with mental illness admitted to a psychiatric unit during this time, any readmissions occurring within six months of the first admission, and any evidence of housing assistance received. Statistical data analysis will be accomplished to determine whether differences among those discharged with coordinated housing impacted readmissions.

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