Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

Requiring some patients to get mental health treatment saves money

30.07.2013
Mandating outpatient treatment for certain people with severe mental illness, while controversial, results in substantial cost savings by cutting hospitalizations and increasing outpatient care, according to a financial analysis led by researchers at Duke Medicine.

The finding – focusing on a program in New York termed Assisted Outpatient Commitment, or "Kendra's Law" - provides a key piece of information in the ongoing policy debate about appropriate treatment approaches for people with serious mental illness. The issue has been particularly heated in light of recent mass shootings by gunmen who have had mental health diagnoses.

Appearing July 30, 2013, in the American Journal of Psychiatry, the study found that treatment costs for a group of frequently hospitalized patients declined 50 percent in New York City after the first year of an outpatient commitment program, and dropped another 13 percent the second year. Even larger cost savings were reported in five other New York counties that were also part of the analysis.

All but a handful of states have some form of involuntary outpatient commitment program, which requires certain high-risk patients to participate in community-based treatments. But the programs have only been used sporadically in most states. Impediments include concerns about costs, potential coercion of vulnerable people and liability for patients who harm themselves or others.

"At least from a cost standpoint, our evidence shows that outpatient commitment programs could be an effective policy," said lead author Jeffrey W. Swanson, PhD., M.A., a professor in psychiatry and behavioral sciences at Duke University. "In many cases, people who are opposed to outpatient commitment programs say they're going to waste money by spending public resources on a few people with court-ordered treatment, at the expense of people who want treatment and can't get it. It's part of the problem of the fragmented, underfunded mental health system."

Swanson and colleagues conducted a comprehensive cost analysis of New York's assisted outpatient treatment program, which mandates community-based care for severely mentally ill patients who have a history of revolving-door admissions to psychiatric hospitals. Such admissions are the most expensive component of mental health services.

The researchers analyzed services used by 634 patients under court order to participate in community care, including 520 patients in New York City and 114 from other counties.

Psychiatric hospitalization rates fell steeply among participants in the program. During the year before mandated community treatment, 180 of the 520 New York City participants were admitted to a state psychiatric hospital, and 373 were admitted to a psychiatric unit at other hospitals. In the year after starting the program, 70 were admitted to a state psychiatric hospital and 245 were admitted at other hospitals. Similar declines occurred in counties outside of New York City.

"These are people who are extraordinarily ill, and for whom long periods of hospitalization have previously been the only solution," said co-author Marvin S. Swartz, M.D., professor of psychiatry and behavioral sciences and head of the division of Social and Community Psychiatry at Duke. "This shows that these patients can be successfully treated in the community with intensive programs and a court mandate."

As hospitalizations fell, so did costs. People selected for the program had incurred, on average, more than $104,000 in mental health service costs during the preceding year. These costs declined to $59,924 per patient in New York City, and $53,683 among the other county participants, in the first year of the program. In the second year of the program, costs continued to decline, to $52,386 for the New York City participants and $39,142 for those in the counties.

The savings were realized even as expenses for outpatient services more than doubled, with patients increasingly using case management support and transportation services, making clinical visits, seeking addiction treatments and refilling prescriptions for medications.

"You wind up preventing the crises by keeping people in community treatment, and that's much less expensive," Swanson said. "You don't have to prevent that many hospitalizations to have a big cost offset, because hospitalizations are so expensive compared to outpatient treatments and services."

While patients in the mandatory program used more mental health services, the program had a mixed impact on criminal justice system involvement, which affects many people with untreated serious mental illness. Fewer of the study participants were arrested and jailed after initiating mandatory outpatient treatment, but the costs associated with their incarcerations were roughly the same.

"Outpatient commitment is not designed to reduce the risk of violence; rather, it's designed to make sure someone who has been in and out of a psychiatric hospital a number of times gets treatment that can help them," Swanson said. "At the same time, the laws that create these programs are often passed in response to a violent incident involving a person with mental illness."

Swartz said the research adds context to policy debates about how to care for people with severe mental illness, particularly in times of tight public budgets, and suggests that involuntary outpatient treatment programs might serve as an alternative to high-cost involuntary hospital admissions.

"If applied to the right targeted population, mandatory outpatient treatment can have a dramatic impact on the cost of mental health services," Swartz said.

In addition to Swartz and Swanson, study authors include Richard Van Dorn, Pamela Clark Robbins, Henry J. Steadman, Thomas G. McGuire and John T. Monahan.

The John D. and Catherine T. MacArthur Foundation Research Network on Mandated Community Treatment and the New York State Office of Mental Health provided support for the study.

Sarah Avery | EurekAlert!
Further information:
http://www.duke.edu

More articles from Studies and Analyses:

nachricht Europe’s Demographic Future. Where the Regions Are Heading after a Decade of Crises
10.08.2017 | Berlin-Institut für Bevölkerung und Entwicklung

nachricht Scientists reveal source of human heartbeat in 3-D
07.08.2017 | University of Manchester

All articles from Studies and Analyses >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: Fizzy soda water could be key to clean manufacture of flat wonder material: Graphene

Whether you call it effervescent, fizzy, or sparkling, carbonated water is making a comeback as a beverage. Aside from quenching thirst, researchers at the University of Illinois at Urbana-Champaign have discovered a new use for these "bubbly" concoctions that will have major impact on the manufacturer of the world's thinnest, flattest, and one most useful materials -- graphene.

As graphene's popularity grows as an advanced "wonder" material, the speed and quality at which it can be manufactured will be paramount. With that in mind,...

Im Focus: Exotic quantum states made from light: Physicists create optical “wells” for a super-photon

Physicists at the University of Bonn have managed to create optical hollows and more complex patterns into which the light of a Bose-Einstein condensate flows. The creation of such highly low-loss structures for light is a prerequisite for complex light circuits, such as for quantum information processing for a new generation of computers. The researchers are now presenting their results in the journal Nature Photonics.

Light particles (photons) occur as tiny, indivisible portions. Many thousands of these light portions can be merged to form a single super-photon if they are...

Im Focus: Circular RNA linked to brain function

For the first time, scientists have shown that circular RNA is linked to brain function. When a RNA molecule called Cdr1as was deleted from the genome of mice, the animals had problems filtering out unnecessary information – like patients suffering from neuropsychiatric disorders.

While hundreds of circular RNAs (circRNAs) are abundant in mammalian brains, one big question has remained unanswered: What are they actually good for? In the...

Im Focus: RAVAN CubeSat measures Earth's outgoing energy

An experimental small satellite has successfully collected and delivered data on a key measurement for predicting changes in Earth's climate.

The Radiometer Assessment using Vertically Aligned Nanotubes (RAVAN) CubeSat was launched into low-Earth orbit on Nov. 11, 2016, in order to test new...

Im Focus: Scientists shine new light on the “other high temperature superconductor”

A study led by scientists of the Max Planck Institute for the Structure and Dynamics of Matter (MPSD) at the Center for Free-Electron Laser Science in Hamburg presents evidence of the coexistence of superconductivity and “charge-density-waves” in compounds of the poorly-studied family of bismuthates. This observation opens up new perspectives for a deeper understanding of the phenomenon of high-temperature superconductivity, a topic which is at the core of condensed matter research since more than 30 years. The paper by Nicoletti et al has been published in the PNAS.

Since the beginning of the 20th century, superconductivity had been observed in some metals at temperatures only a few degrees above the absolute zero (minus...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

Event News

Call for Papers – ICNFT 2018, 5th International Conference on New Forming Technology

16.08.2017 | Event News

Sustainability is the business model of tomorrow

04.08.2017 | Event News

Clash of Realities 2017: Registration now open. International Conference at TH Köln

26.07.2017 | Event News

 
Latest News

Gold shines through properties of nano biosensors

17.08.2017 | Physics and Astronomy

Greenland ice flow likely to speed up: New data assert glaciers move over sediment, which gets more slippery as it gets wetter

17.08.2017 | Earth Sciences

Mars 2020 mission to use smart methods to seek signs of past life

17.08.2017 | Physics and Astronomy

VideoLinks
B2B-VideoLinks
More VideoLinks >>>