Do comprehensive, coordinated, recovery-oriented services alter the pattern of use of treatment services? Mental health treatment study impacts on SSDI beneficiaries' use of inpatient, emergency, and crisis services.
Current arrangements for financing and delivering behavioral health services to U.S. working-age adults with severe and persistent mental disorders (SPMD) have major inadequacies in funding for and access to critical elements of a recovery-oriented, comprehensive, and coordinated package of community-based treatment and rehabilitation services. This study presents results from a nation-wide 2-year randomized trial, involving 2,238 SSDI beneficiaries with SPMD, of a comprehensive intervention including evidence-based treatment and employment services. Estimates of impacts of the MHTS service intervention package, from a variety of regression specifications, showed clearly significant treatment group reductions in four outcomes (hospital stays and days, ER visits for mental health problems, and psychiatric crisis visits); these estimates suggest annual inpatient hospital treatment cost savings in excess of approximately $900 to 1,400. Negative estimated MHTS effects on three other utilization outcomes (hospital stays and days for mental health problems, overall ER visits) generally did not achieve statistical significance. Possible study implications for cost offsets from further expansions/replications of the MHTS intervention model are considered within the context of health reform.
Department of Public Policy, UMBC (University of Maryland-Baltimore County), 1000 Hilltop Circle, Catonsville, MD, 21250, USA, Salkever@umbc.edu.
David
D
Salkever
Brent
B
Gibbons
Xiaotao
X
Ran
D000328:Adult; D003419:Crisis Intervention / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D016832:Employment, Supported / Q000458:organization & administration*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D018868:Insurance, Disability; D007406:Interview, Psychological; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D054539:Medication Therapy Management / Q000458:organization & administration; D008605:Mental Health Services / Q000706:statistics & numerical data*; D008875:Middle Aged; D019964:Mood Disorders / Q000534:rehabilitation*; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data; D010346:Patient Care Management / Q000458:organization & administration*; D058991:Patient Protection and Affordable Care Act / Q000191:economics / Q000592:standards; D012559:Schizophrenia / Q000534:rehabilitation*; D014481:United States