Robbing Peter to pay Paul: did New York State's outpatient commitment program crowd out voluntary service recipients?
OBJECTIVE
This study examined whether New York State's assisted outpatient treatment (AOT) program disadvantaged voluntary service recipients by directing services toward court-ordered individuals.


METHODS
Administrative data from the New York State Office of Mental Health were linked with Medicaid claims from 1999 through 2007 to compare trends in utilization of enhanced outpatient services by involuntary and voluntary service recipients with serious mental illness. Multivariable time series analysis was used to examine the likelihood that voluntary care seekers (N=3,295) either did not initiate or did not receive assertive community treatment or intensive case management during any month as a function of the number of AOT orders in the system.


RESULTS
New York State appropriated new resources for enhanced community-based mental health services to implement AOT. During the first three years of the AOT program, most of the expansion in enhanced services was directed toward individuals under court-ordered treatment, which appears to have affected voluntary care seekers by lowering their odds of initiating enhanced services and raising their odds of having these services discontinued or no longer receiving them. However, after the first three years of AOT, enhanced service provision expanded steadily among both voluntary and involuntary recipients.


CONCLUSIONS
In tandem with New York's AOT program, enhanced services increased among involuntary recipients, whereas no corresponding increase was initially seen for voluntary recipients. In the long run, however, overall service capacity was increased, and the focus on enhanced services for AOT participants appears to have led to greater access to enhanced services for both voluntary and involuntary recipients.
Swanson
Jeffrey W
JW
Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Box 3071, Durham, NC 27701, USA. jeffrey.swanson@duke.edu
Van Dorn
Richard A
RA
Swartz
Marvin S
MS
Cislo
Andrew M
AM
Wilder
Christine M
CM
Moser
Lorna L
LL
Gilbert
Allison R
AR
McGuire
Thomas G
TG
D000328:Adult; D000553:Ambulatory Care / Q000706:statistics & numerical data*; D003134:Commitment of Persons with Psychiatric Disorders; D003156:Community Mental Health Services / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007345:Insurance Claim Review; D016013:Likelihood Functions; D008297:Male; D001523:Mental Disorders / Q000628:therapy; D008875:Middle Aged; D009518:New York