Antipsychotic Medication Prescriptions for Homeless and Unstably Housed Veterans in the Veterans Affairs Health Care System

Objective: Many homeless and unstably housed (HUH) adults have severe mental illnesses that are managed with antipsychotic medications. The US Department of Veterans Affairs (VA) is the largest provider of homeless services, but there has been little study of psychotropic medication prescriptions for HUH veterans.

Methods: Using national VA administrative data in 2017, rates and characteristics associated with prescriptions for antipsychotic medications for veterans using VA health care services (N = 2,882,993), including HUH veterans (n = 266,855), were analyzed.

Results: Among HUH veterans, 17.6% had an antipsychotic prescription within 1 year of indication of HUH and 4.3% had prescriptions for 3 or more antipsychotic medications, which was higher than the 2.2% of non-HUH veterans with 3 or more antipsychotic prescriptions. Controlling for sociodemographic and clinical characteristics, HUH veterans were more than 3 times as likely to have an antipsychotic prescription as other veterans. However, among HUH veterans with an ICD-10-documented psychotic or bipolar disorder, HUH veterans were less likely to have prescriptions for first-generation and second-generation antipsychotics compared to their non-HUH counterparts (odds ratios for any antipsychotic < 0.5). Less than 2% of both HUH and non-HUH veterans had received long-acting injectable second-generation antipsychotic medications, and less than 0.2% were on clozapine treatment.

Conclusions: These findings provide a snapshot of antipsychotic prescription practices for HUH veterans in the VA health care system. The higher rates of antipsychotic prescriptions for HUH veterans overall, but potential underprescribing of antipsychotics for HUH veterans with severe mental illness, suggest there are opportunities for improving antipsychotic prescription practices in this population, including increasing use of long-acting injectable medications.