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PubMed2004

Changes in the costs of treating mental health disorders: an overview of recent research findings.

This article reviews recent evidence on changes over time in the direct medical costs of treating three of the more common mental health disorders in the US: the acute (16-week) phase of major depressive disorder, the ongoing treatment of schizophrenia, and the ongoing treatment of bipolar I disorders. The three studies discussed in this article cover various time intervals over the decade from 1991 through 2000, and encompass both private sector and governmental funding sources. Although there has been a shift over time away from intensive psychosocial/psychotherapy and towards increasingly expensive psychopharmacotherapy for all three disorders, total direct medical costs of treatment for each of these three mental health disorders have been declining over time. However, a substantial portion of treatment is not supported by clinical evidence.

Drug Therapy↗
PubMed2004

Hispanic ethnicity, language, and depression: physician-patient communication and patient use of alternative treatments.

OBJECTIVE: To examine the relationship between Hispanic ethnicity and language spoken with physician communication about depression and patient use of alternative treatments for depression. METHOD: This is a secondary data analysis from a trial of depression screening conducted in four primary care clinics. Patients with Hispanic or non-Hispanic White ethnic backgrounds and those meeting DSM-III-R criteria for current major depression, minor depression, dysthymia as well as those that screened positive on a depression screening instrument (n = 141) are included in this analysis. We labeled those who screened positive for depression but did not meet DSM-IIIR criteria for a current depressive disorder as "distressed." Clinicians' use of counseling and patient use of alternative treatments were based on patient self-report. RESULTS: Forty-two percent (n = 59) of the sample stated that their physician had either told them that they had depression, treated them for depression, or recommended that they seek help for depression. Over 40% of patients spent time talking with their physicians at their current visit about what was making them depressed and 34% received counseling about depression. Hispanic ethnicity and language were not significantly related to physician communication with patients about how to overcome depression. Thirty-six percent of patients reported talking with a minister or other religious person about feelings of depression or sadness. Seventeen percent of patients had used herbal remedies or non-prescription medications and 5% had seen a curandero for feelings of depression or sadness. Hispanic ethnicity and language were not significantly related to patient use of alternative treatments for depression. CONCLUSIONS: Hispanic ethnicity and language were not significantly related to physician-patient communication about depression or patient use of alternative treatments for depression. Physicians should make sure to ask patients about all of the types of things they are doing to help overcome their depression.

Choice Behavior↗
PubMed2003

The current and future state of mental health insurance parity legislation.

Health insurance plans typically provide less coverage for mental health and chemical dependency treatment than for general medical services. In 1996 the federal government responded to these inequities by passing the Mental Health Parity Act, requiring equal annual lifetime dollar limits for mental health benefits. However, provisions within the law are easily circumvented, rendering it relatively ineffective as implemented. The Senator Paul Wellstone Mental Health Equitable Treatment Act of 2003 measures (S. 486 & H.R. 953) currently in Congress would expand the language and effectiveness of the Mental Health Parity Act. This paper reviews the limitations of both the 1996 federal law and existing state laws, and explains why federal action to expand the Mental Health Parity Act is so critical to people with mental illnesses.

Forecasting↗
PubMed1983

Psychotherapy and health insurance.

The Australian health insurance industry has been critical of psychiatry. The data on patterns of claims which have been the focus for some of their concerns are reviewed. The evidence on the efficacy of psychotherapy is also reviewed. Psychotherapy has been shown to be an effective treatment for persons with incapacitating neurotic and personality disorders, a treatment too important to be endangered by dissent over health insurance payments. Proposals for a peer review process for long term psychotherapy are mooted in the expectation that agreement between the health insurance industry and psychiatry would benefit those patients in need of psychotherapy.

Australia↗
PubMed2004

[The long-term care insurance system and geriatric psychiatry].

The long-term care insurance system targets people who require support because of mental or physical disturbances due to aging. This overlaps in many areas with the field of geriatric psychiatry, which is expected to play a significant role in diagnosis and hospitalization in the long-term care insurance system. Representative of the former is the forgetfulness clinic, and representative of the latter is the "senile dementia disorder center". When a person at home or in a nursing facility becomes seriously demented or suffers serious physical illness, he is generally hospitalized. However, there is an ongoing project which allows group homes to care for the seriously demented or physically damaged elderly. Under the long-term care insurance system, there are many problems that should be dealt with by geriatric psychiatry. One essential issue is the lack of basic research on judgment abilities and mental competency, even though users are expected to select services and make their own decisions under this system. Once there is a social support system for the care-requiring elderly, it is necessary to assess the decision-making ability of individual elderly. If this ability is sufficiently maintained it should be respected to the utmost. If it is impaired, we must have a viewpoint on how to provide care through a social system. A consensus has yet to be reached on informed consent for the demented elderly, and this issue should be considered with a focus on geriatric psychiatry.

Aged↗
PubMed2002

Predicting the use of outpatient mental health services: do modeling approaches make a difference?

Studies attempting to project the impact of providing health coverage to the uninsured population have demonstrated considerable variation in the estimated costs of mental health care. Different modeling approaches to project health care use and costs have been shown to address some data characteristics well, but not all of them. Using data from Health Care for Communities, a recent national household survey, this paper attempts to estimate and predict the use of mental health outpatient services if insurance coverage were extended to the uninsured. The study employs two-part models, with the second part based on an ordinary least squares (OLS) approach and a generalized linear model (GLM), and a zero-inflated negative binomial model (ZINB). Estimates and predictions are not sensitive to the modeling approaches chosen, although the ZINB model out performs the two-part models in terms of out-of-sample prediction.

Community Mental Health Services↗
PubMedDate not supplied

Adverse selection and generosity of alcohol treatment benefits.

Concerns about attracting disproportionate numbers of employees with alcohol problems limit employers' willingness to offer health plans with generous alcohol treatment benefits. This paper analyzes two potential avenues of adverse selection, namely biased enrollment into plans and biased exit from plans offered by 57 employers between 1991 and 1997. We compare alcohol treatment use rates and costs of new and old enrollees between more generous and less generous plans; we also analyze disenrollment rates and enrollment duration by plan generosity for users and nonusers of alcohol treatment services. To avoid confounding benefit generosity with other plan features, in particular the use of managed care mechanisms, we compare plans that were administered in the same way by a large managed behavioral health care organization. Overall, we find no evidence of adverse selection into more generous plans. Contrary to the selection hypothesis, treatment costs of new members compared to old members are lower in firms with more generous treatment benefits than in firms with more limited benefits. Also, users of alcohol treatment services do not remain disproportionately enrolled longer in plans with generous benefits.

Alcoholism↗
PubMed1999

What about the patient?

Our mental health care system fails to serve the very people whose suffering that system ostensibly exists to alleviate. This article relates the stories of 3 people who fell through the cracks of this system. An alternative approach, the Integrated Services Agency (ISA), has been implemented in California and offers hope to persons with schizophrenia. The ISA approach focuses on the expressed needs of the members it exists to serve, and both members and staff have experienced changes in their roles and expectations. Staff and members have learned that engagement with the "outside world" involves taking risks but that risk avoidance only perpetuates the status quo. The ISA approach rewards growth and patients' being well rather than rewarding docility and illness. Medication is neither ordered nor assigned, but chosen in a collaboration between staff and members. ISAs have returned care to the mental health care system.

California↗