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John E. Zeber, PhD, Laurel A. Copeland, PhD, John F. McCarthy, PhD, Mark S. Bauer, MD and Amy M. Kilbourne, PhD

John E. Zeber and Laurel A. Copeland are with the Veterans Affairs Health Service Research & Development (HSR&D) Center, San Antonio, TX, and the Department of Psychiatry, University of Texas Health Science Center, San Antonio. John F. McCarthy and Amy M. Kilbourne are with the VA Serious Mental Illness Treatment Research and Evaluation Center, Ann Arbor, MI, and the Department of Psychiatry, University of Michigan, Ann Arbor. Mark S. Bauer is with the VA Medical Center, Providence, RI, and the Department of Psychiatry, Harvard University, Cambridge, MA.

Correspondence: Requests for reprints should be sent to John E. Zeber, PhD, Veterans Affairs HSR&D, South Texas Veterans Health Care System, 7400 Merton Minter Blvd (11c6), San Antonio, TX 78229 (e-mail: zeber{at}uthscsa.edu).

Objectives. We examined associations between patient characteristics and self-reported difficulties in accessing mental health and general medical care services.

Methods. Patients were recruited from the Continuous Improvement for Veterans in Care–Mood Disorders study. We used multivariable logistic regression analyses to assess whether predisposing (demographic characteristics), enabling (e.g., homelessness), or need (bipolar symptoms, substance abuse) factors were associated with difficulties in obtaining care, difficulties in locating specialty providers, and forgoing care because of cost.

Results. Patients reported greater difficulty in accessing general medical services than in accessing psychiatric care. Individuals experiencing bipolar symptoms more frequently avoided psychiatric care because of cost (odds ratio [OR] = 2.43) and perceived greater difficulties in accessing medical specialists (OR = 2.06). Homeless individuals were more likely to report hospitalization barriers, whereas older and minority patients generally encountered fewer problems accessing treatment.

Conclusions. Need and enabling factors were most influential in predicting self-reported difficulties in accessing care, subsequently interfering with treatment dynamics and jeopardizing clinical outcomes. Efforts in the Department of Veterans Affairs to expand mental health care access should be coupled with efforts to ensure adequate access to general medical services among patients with chronic mental illnesses.