The research aim of this proposal is to advance our understanding of the association between disability benefits, service use (medical, mental health, rehabilitation), race, and clinical presentation among trauma victims with severe posttraumatic stress disorder (PTSD) and other associated mental illnesses. It is well accepted that persons with mental illnesses often experience severe occupational impairment and related financial hardships associated with their psychiatric condition. Recent advances in clinical and rehabilitative services, and changes in public opinion and subsequent legislative reform toward welfare and the Work Incentives Improvement Act of 1999, have led policy makers to reconsider multiple aspects of the current disability policies. Unfortunately, rehabilitative efforts have not been shown to significantly increase the work-related income of persons with psychiatric disabilities. Furthermore, we know relatively little about how public disability benefits affect work behavior or use of other services available within various public systems. At present the VA system offers a unique opportunity to study the relationship between clinical symptoms, associated disability, and service use because it is a large, closed system which provides a broad range of medical, mental health, and social services. Furthermore, the clients served by the VA system (i.e., veterans) are of interest in that they represent a population that has high percentages of rural and minority members. Thus, the VA system represents the chance to study a range of variables that are of general interest to policy makers, advocates, and key stakeholders concerned with the welfare of mentally ill persons. In this study we will learn more about the relationship between service use and a number of relevant variables (e.g., race, symptom reporting, disability seeking, employment) by examining archival data, including administrative and medical records, on approximately 450 trauma victims with severe PTSD served within the VA system. These data may have implications for our understanding of service delivery systems for trauma victims with severe PTSD and other associated mental illnesses, including the important interface with associated psychiatric disability and rehabilitation efforts. This proposal is responsive to Health People 2010 and the Bridging Science and Service report recommendation regarding rehabilitation and interventions (recommendation #9).
