Homeless veterans may benefit from improved prescribing of antipsychotics

Opportunities exist to improve clinicians’ antipsychotic prescribing practices for homeless or unstably housed veterans, according to study results published in Journal of Clinical Psychiatry.

“While there remain concerns about side effects and variability in response to antipsychotic medications, rigorous large-scale studies have found that antipsychotic medications are effective in preventing symptom relapse and rehospitalization among adults with schizophrenia,” Jack Tsai, PhD, of the National Center on Homelessness Among Veterans at the U.S. Department of Veterans Affairs (VA), and colleagues wrote. “However, access to and use of antipsychotic medications among homeless adults remain a concern. Several studies have found that being homeless can make it difficult to obtain and securely store medications, adhere to medication regimens and stay engaged with treatment and regularly refill medications.”

According to the researchers, the VA operates the largest comprehensive health care and homeless service system in the US. Although the VA system has deployed and evaluated numerous service models that included supported housing, transitional housing and rapid rehousing services, data are sparse regarding how antipsychotic medications have been prescribed for homeless veterans.

Tsai and colleagues determined rates and characteristics associated with antipsychotic medication prescriptions for veterans who used VA health care services by analyzing national administrative data from 2017 of 2,882,993 veterans, of whom 266,855 were homeless or unstably housed.

Results showed 17.6% of homeless or unstably housed veterans had an antipsychotic prescription within 1 year of indication of homelessness or unstable housing and 4.3% had prescriptions for three or more antipsychotic medications. This latter figure was higher than the 2.2% of non-homeless or unstably housed veterans who had three or more antipsychotic prescriptions. Homeless or unstably housed veterans were threefold more likely to have an antipsychotic prescription vs. other veterans, after controlling for sociodemographic and clinical characteristics. However, homeless or unstably housed veterans with an ICD-10-documented psychotic or bipolar disorder were less likely to have prescriptions for first-generation and second-generation antipsychotics vs. their non-homeless or unstably housed counterparts. Regardless of housing status, less than 2% of veterans had received long-acting injectable second-generation antipsychotic medications, and less than 0.2% received clozapine treatment.

“The findings provide an important snapshot of antipsychotic medication prescriptions for [homeless or unstably housed] veterans in the VA health care system,” Tsai and colleagues wrote. “The findings suggest the need for more attention on antipsychotic medications for [homeless or unstably housed] veterans with severe mental illness, as they may represent an important piece of the puzzle in addressing homelessness.”