Although the expectancy that the severity of dual diagnoses may, on average, exceed the severity of the constituent conditions and thereby be more closely associated with physical health problems and self-harm, alternative explanations implicate disparities in healthcare engagement. Desai et al. (2002) examined the records of 90,240 veterans with chronic physical health conditions to report that dually diagnosed veterans were less likely to be engaged by healthcare providers than veterans without mental illness and portending the need for case managers to provide intensive treatment engagement interventions among high risk veterans. Regardless, dually diagnosed veterans seem to experience a greater degree of physical health impairment, as evidenced by gross and fine indicators of physical health across comparison groups, including healthy, substance diagnosed, or mentally ill veteran controls.