Mortality among Veterans with serious mental illness who were lost to VHA care

Abstract: Importance: Continuity of care for Veterans with serious mental illness (SMI) is a priority for the Veterans Health Administration (VHA), as gaps in care are common and associated with increased mortality. Objective: To assess mortality rates and causes of death among Veterans with SMI who were lost to VHA care and identified for the SMI Re-Engage program, compared to all Veterans receiving VHA care. Design, Setting, and Participants: Using VHA administrative data, we identified 9,013 Veterans with schizophrenia-spectrum or bipolar disorders who had been out of VHA care for at least one year and were eligible for SMI Re-Engage in 2016–2017. Mortality outcomes were compared to a reference population of all Veterans who received VHA care from 2015–2019. Main Outcomes and Measures: The age-standardized mortality ratio (SMR) was calculated for SMI Re-Engage Veterans relative to the reference population. Causes of death were determined using the VHA/DoD Mortality Data Repository. Results: Of 9,013 Veterans identified for SMI Re-Engage, 802 (8.9%) died by the end of 2019. The SMR was 1.96 (95% CI: 1.82–2.09), indicating nearly double the mortality risk compared to Veterans engaged in VHA care. The most common causes of death were heart disease (22.3%) and cancer (14.5%), followed by chronic lower respiratory disease (8.0%) and dementia/nervous system diseases (7.5%). Conclusions and Relevance: Veterans with SMI who are lost to VHA care experience significantly higher mortality, primarily from preventable or manageable conditions. These findings highlight the critical importance of primary care continuity and proactive re-engagement efforts for this vulnerable population.