The impact of California's full-service partnership program on mental health-related emergency department visits.
OBJECTIVE
This study examined the effects of California's 2005 Mental Health Services Act (MHSA) on the use of mental health-related emergency department visits. It focused on one MHSA program, the full-service partnership program, and hypothesized that individuals with public insurance who participate in the higher-quality full-service partnership program would have fewer emergency department visits compared with clients with public insurance who receive usual care.


METHODS
Data were obtained from the Short-Doyle/Medi-Cal (Medicaid) file, the Data Collection and Reporting system, and the Consumer and Service Information System, all maintained by the California Department of Mental Health. The analytic sample covered 931,218 observations (155,203 adults) ages 18 and older from January 2007 to June 2008. The data represented clients from seven counties, which made up 48.5% of the California population. Fixed-effects logistic regression was used and included a continuous measure of time, in quarters, in the full-service partnership program; separate quarter indicators; and quarter-county interaction terms. The model thus controlled for both time-invariant personal characteristics (including personality as well as psychiatric and medical history as of entry into the study) and all time-varying county-level characteristics.


RESULTS
Relative to persons receiving usual care, the odds of full-service partnership participants visiting the emergency department were 54% less after four quarters of treatment and 68% less after six quarters.


CONCLUSIONS
The full-service partnership program was highly effective in reducing emergency visits. A statewide cost-effectiveness study should be conducted to determine the economic viability of the program.
Petris Center, School of Public Health, University of California at Berkeley, 50 University Hall, MC 7360, Berkeley, CA 94720-7360, USA. timothy.brown@berkeley.edu
Timothy Tyler
TT
Brown
Jessica
J
Chung
Sun-Soon
SS
Choi
Richard
R
Scheffler
Neal
N
Adams
D000328:Adult; D002140:California; D003156:Community Mental Health Services / Q000379:methods / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D004637:Emergency Services, Psychiatric / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data; D001523:Mental Disorders / Q000534:rehabilitation; D008605:Mental Health Services / Q000191:economics / Q000331:legislation & jurisprudence; D008875:Middle Aged; D012189:Retrospective Studies; D014481:United States