Literature Collection

INTRODUCTION: Many adults involved in the criminal justice system have various healthcare needs. The Veterans Health Administration (VHA) operates programs to connect criminal justice-involved veterans to healthcare, including primary care. This study examined veterans in the Veterans Justice Programs (VJP) to understand which veterans are not empaneled in VA primary care and their associated characteristics and service use. METHODS: A retrospective cohort study was conducted with 20 395 veterans who participated in VJP in 2023. Data on sociodemographic characteristics, clinical status, primary care empanelment, and service utilization from VHA medical records were analyzed. RESULTS: Across the country, about 88% of veterans in VJP were empaneled in primary care who attended a mean of 3.63 (SD = 4.63) primary care visits over 12 months compared to a mean of 0.18 (SD = 0.54) primary care visits among veterans not empaneled. Bivariate analyses found that empaneled veterans in VJP were significantly less likely to have any mental health or substance use disorder than non-empaneled veterans. However, multivariable analyses revealed the characteristics most strongly and significantly associated with empanelment in primary care among VJP veterans were use of outpatient medical care (aOR = 16.53, 95% CI = 9.32-31.43), use of outpatient mental health/substance use treatment (aOR = 1.83, 95% CI = 1.27-2.70), military sexual trauma (aOR = 1.66, 95% CI = 1.35-2.06), and being non-Hispanic black (aOR = 1.61, 95% CI = 1.35-1.96 compared to Hispanic black or white). CONCLUSIONS: Empanelment in primary care is associated with use of behavioral healthcare among criminal justice-involved veterans indicating opportunities for integrated care initiatives in VHA facilities.

IntroductionIndividuals with serious mental illness (SMI), including major depression, schizophrenia, and bipolar disorder, experience disproportionately high rates of cardiovascular (CV) risk and disease. Despite this well-established connection, it remains unclear how professional society guidelines across cardiology and psychiatry address this relationship.MethodsMajor American and European CV and psychiatric society guidelines published from 2013-2023 were reviewed. Included were guidelines on primary and secondary CV disease prevention, and disease-specific guidelines for schizophrenia, bipolar disorder, and major depressive disorder. Relevant text was extracted and classified as recommendations or supporting text.ResultsTwenty-six guidelines were included (13 CV; 13 psychiatric). Psychiatric considerations appeared in 5 CV guidelines (38%), most commonly addressing mental illness treatment to improve CV outcomes (n = 5), pharmacological considerations (n = 2), and recognition of mental illness as a CV risk factor (n = 2). Only 13% of American CV guidelines included psychiatric content, compared to 80% of European CV guidelines. In contrast, 10 psychiatric guidelines (77%) included CV-related recommendations, including CV screening (n = 16), pharmacological considerations (n = 8), and risk factor control (n = 7). Among psychiatric guidelines, 40% of U.S. and 100% of European documents included CV content.ConclusionsCV considerations are more frequently addressed in psychiatric than psychiatric considerations in CV guidelines. European guidelines showed greater cross-disciplinary integration. These findings highlight the need for more unified, interdisciplinary guidance to reduce CV risk in individuals with SMI.

Peer support models have existed for decades in behavioral health care and are being developed for health care professionals to help address high rates of burnout and stress in the health care environment. Such models typically involve individuals from the same profession. With the concurrent increase of interprofessional integrated behavioral health care models, interprofessional peer support seems a viable model. This Open Forum describes how a peer support program for physicians and faculty scientists evolved to include a broader range of health care professionals, providing a framework for interprofessional peer support programs for the behavioral health care workforce.