title: Exploring Personal Medicine as Part of Self-Directed Care: Expanding Perspectives on Medical Necessity.
abstract: Self-directed care (SDC) offers flexibility in and control over mental health services. This study examined the types of goods and services that individuals with serious mental illness request in an SDC intervention.
  
  
  
  Data were from a randomized controlled trial that enrolled adult participants receiving Medicaid-reimbursed services, with two years of expenditures at the 50%-90% level of all Medicaid enrollees in the county and no hospitalizations within six months of the study. Data were analyzed for 60 participants randomly assigned to an SDC intervention, who were allowed to make requests for and purchase nontraditional goods and services through a noncapitated fund. Requests were coded by using the section on activities and participation of the World Health Organization's International Classification of Function, Disability, and Health (ICF) model. Descriptive statistics are presented for the categories of requests made by participants.
  
  
  
  The 60 participants made a total of 507 requests, representing 621 ICF codes. Requests ranged from 0 to 37 requests per person, with a mean of 8.45 requests. The average time to first request was 95.5 days. Most codes were in the area of self-care (19%) and general tasks and demands (19%). Among the 52 participants who made requests, the mean was 11.94 requests, which addressed an average of 5.60 unique needs.
  
  
  
  Individuals with serious mental illness identified personal-medicine strategies to address needs that are currently unmet by traditional mental health services. Self-directed care may be a service delivery option that allows consumers to access their own personal medicine and better address their needs.
authors.affiliation: Except for Ms. Maula, the authors are with the Department of Rehabilitation Sciences, Temple University, Philadelphia (e-mail: gsnethen@temple.edu ). Ms. Maula is with the Mental Health Association of Southeastern Pennsylvania, Philadelphia.
authors.forename: Gretchen
authors.initials: G
authors.lastname: Snethen
authors.affiliation: Except for Ms. Maula, the authors are with the Department of Rehabilitation Sciences, Temple University, Philadelphia (e-mail: gsnethen@temple.edu ). Ms. Maula is with the Mental Health Association of Southeastern Pennsylvania, Philadelphia.
authors.forename: Andrea
authors.initials: A
authors.lastname: Bilger
authors.affiliation: Except for Ms. Maula, the authors are with the Department of Rehabilitation Sciences, Temple University, Philadelphia (e-mail: gsnethen@temple.edu ). Ms. Maula is with the Mental Health Association of Southeastern Pennsylvania, Philadelphia.
authors.forename: Erme C
authors.initials: EC
authors.lastname: Maula
authors.affiliation: Except for Ms. Maula, the authors are with the Department of Rehabilitation Sciences, Temple University, Philadelphia (e-mail: gsnethen@temple.edu ). Ms. Maula is with the Mental Health Association of Southeastern Pennsylvania, Philadelphia.
authors.forename: Mark S
authors.initials: MS
authors.lastname: Salzer
mesh_terms: D000328:Adult; D005260:Female; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data*; D001523:Mental Disorders / Q000628:therapy*; D008605:Mental Health Services / Q000706:statistics & numerical data*; D008875:Middle Aged; D000073278:Self-Management / Q000706:statistics & numerical data*; D014481:United States