Journal of Mental Health Policy and Economics最新文献

{"title":"Early Impacts of a Medicaid Value-Based Payment Policy on Quality of Care in a Large Population with Serious Mental Illness.","authors":"Michael William Flores, Benjamin Lê Cook, Paloma Luisi, Lindsay Cogan, Jia Ren, Elizabeth Nichols, Sharon-Lise T Normand, K John McConnell, Catherine Holmes, Gareth Parry, Ana Progovac, Akhil Reddy, Marcela Horvitz-Lennon","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>In the US, several states including New York State (NYS) have adopted Medicaid value-based payment (VBP) policies to improve healthcare quality and reduce spending. However, the impacts of these policies on vulnerable Medicaid beneficiaries with high behavioral health needs including those with serious mental illness (SMI) are unknown.</p><p><strong>Aims of the study: </strong>To inform policy efforts to improve the value of Medicaid-funded care by examining the early impacts of NYS's VBP policy implemented in 2017 on the quality of healthcare received by adult beneficiaries with SMI.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study to examine the association of the VBP policy with healthcare quality among adult Medicaid beneficiaries with SMI. We estimated difference-in-differences models comparing VBP-exposed and unexposed beneficiaries during the period preceding VBP implementation (2014-2016) and in 2018, a full year following implementation. Quality was assessed with 10 validated and SMI-relevant measures of mental healthcare quality (e.g., adequate Adherence to Antipsychotic Medications for Individuals with Schizophrenia, and Follow-up after Hospitalization for Mental Illness, 30-day), physical healthcare quality (e.g., Diabetes Screening for People with Schizophrenia or Bipolar Disorder who are using Antipsychotic Medications; Comprehensive Diabetes Care, Eye Exam), and overall healthcare quality (All-Cause Readmissions). Models for all outcomes adjusted for concurrent policies, and models for acute care measures also adjusted for need variables.</p><p><strong>Results: </strong>Our diverse cohort included 172,420 person-years with SMI, with 28.5% VBP-exposed. The largest diagnostic groups were schizophrenia and bipolar disorder (42.2% and 41.3%, respectively). The VBP-exposed and unexposed beneficiaries differed on most characteristics, with the unexposed being slightly younger, less diverse, and healthier relative to the VBP-exposed. After adjusting for covariates, VBP-exposure was associated with changes in only two of the 10 quality measures compared with the VBP-unexposed group: a 1.8- percentage-point (pp) increase in adequate Adherence to Antipsychotic Medications for Individuals with Schizophrenia (95% CI, 0.5-3.2) and a 1.4-pp decrease (95% CI, -2.6 to -0.1) in Diabetes Screening for People with Schizophrenia or Bipolar Disorder who are using Antipsychotic Medications.</p><p><strong>Discussion: </strong>A year following its implementation, a Medicaid VBP policy that involved varying degrees of provider risk-bearing had few quality impacts, one positive and one negative, among the state's beneficiaries with SMI. Our study, the first to examine VBP quality impacts with several validated measures of mental, physical, and overall healthcare quality, has some limitations, including that we cannot rule out time-varying unmeasured confounding, nor can we isolate the effects of type ","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"29 2","pages":"57-64"},"PeriodicalIF":1.7,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148253918","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Geographic Access to Mental Health Facilities for People with Disabilities.","authors":"Annetta R Zhou, Nicolas De Mello, Nicole Maestas","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>The need for mental health care is growing in the U.S., yet care is elusive for many patients. Among people experiencing mental illnesses, those with disabilities often face additional obstacles when seeking care. Therefore, proximity to mental health services is especially important for this population. Although regional differences in travel distances to mental health facilities have been documented, their implications for individuals with disabilities are not well understood.</p><p><strong>Aims of the study: </strong>This study compares geographic proximity to mental health facilities between individuals with and without disabilities. We also compare geographic access to facilities across counties with different characteristics, including having high versus low shares of residents with disabilities.</p><p><strong>Methods: </strong>This study links American Community Survey population data with mental health facility locations from the Mental health and Addiction Treatment Tracking Repository (MATTR) to estimate the number of people living within a 30-minute drive of a facility. We calculate these estimates overall, and by population and county characteristics. We also estimate a multivariate county-level regression in which the population share in each county that lives within a 30-minute drive of a mental health facility is regressed on county characteristics.</p><p><strong>Results: </strong>Most of the U.S. population (96.2% of individuals without disabilities and 94.8% of individuals with disabilities) lives within a 30-minute drive of one or more mental health facilities. However, geographic access to mental health facilities is low in rural counties, where more than one quarter of the population does not have access to a mental health facility within a 30-minute drive. Compared to non-rural counties, rural counties have a higher concentration of individuals with disabilities and higher rates of clinician-diagnosed depression or self-reported severe depression. After controlling for rurality, state, population, racial composition, income, and depression prevalence at the county level, the share of a county's population within a 30-minute drive of a facility remains negatively correlated with the share of the county's population with disabilities.</p><p><strong>Discussion: </strong>Overall geographic access to mental health facilities is high in the U.S., and there is only a small disparity between individuals with and without disabilities. However, geographic access to mental health facilities is lacking in rural communities. This pattern is especially costly for people with disabilities because of their relatively high concentration in these areas. People with disabilities likely face additional barriers to accessing care compared with people without disabilities living in the same location.</p><p><strong>Implications for health care provision and use: </strong>The lack of nearby mental health facilities re","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"29 2","pages":"65-73"},"PeriodicalIF":1.7,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13660771/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148253883","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Effects of Medicaid Expansion on Mental Health for White, Black, and Hispanic Americans: Estimates for 2014-2022.","authors":"Timothy Brown, Alison Cuellar, Genevieve Graaf, Victoria R Green, Jorge A Morales Alfaro, Lonnie R Snowden","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>The Affordable Care Act expanded Medicaid as a state option. Despite potential for Medicaid expansion to improve mental health for low-income adults, among whom Hispanic and Black adults are overrepresented, Medicaid expansion research has mostly overlooked differential mental health impacts.</p><p><strong>Aims of the study: </strong>This study examines whether Medicaid expansion improved mental health overall and across white, Black, and Hispanic adults.</p><p><strong>Methods: </strong>Using 2011-2022 Behavioral Risk Factor Surveillance System data, we identified 474,801 Medicaid-eligible adults aged 18-64. State Medicaid expansions (2014-2021) were analyzed using the Callaway and Sant'Anna difference-in-differences estimator. Five mental health outcomes were examined overall and by race/ethnicity. Robustness was assessed through evaluation of 16 concurrent state-level policies against the common shocks criterion, including empirical testing of the two policies that satisfy the criterion. Validation tests assessed insurance coverage, cost barriers, elderly (age ≥65) placebo, and immigration enforcement as a moderator for Hispanics.</p><p><strong>Results: </strong>Of 20 equations (5 outcomes across overall, Black, Hispanic, and white subsamples), 18 exhibited parallel trends. Among Hispanic adults, frequent mental distress (14+ poor mental health days) decreased by 2.7 percentage points (p < 0.001); controlling for the sole identified policy confounder (medical marijuana) strengthened this to 5.3 percentage points (p = 0.003). Any poor mental health days also decreased by 5.4 percentage points (p = 0.048). In the full sample, frequent mental distress decreased by 1.2 percentage points (p = 0.032), any activity-limiting days decreased by 2.0 percentage points (p = 0.043), and the number of activity-limiting days decreased by 1.9 days (p = 0.001). Among white adults, activity-limiting days decreased by 1.7 days (p = 0.020). Among Black adults, expansion increased insurance coverage by 6.5 percentage points (p = 0.032); the number of poor mental health days showed a reduction of 0.7 days (p = 0.054), with Black subgroup minimum detectable effects (MDEs) 1.1-2.6 times full-sample MDEs. Validation tests confirmed insurance coverage increased 7-9 percentage points and cost barriers decreased 4-5 percentage points. Of 16 concurrent state-level policies evaluated against the common shocks criterion, two satisfied both conditions for potential confounding. Including recreational marijuana policies produced results identical to baseline. Including medical marijuana policies strengthened the Hispanic result.</p><p><strong>Discussion: </strong>Medicaid expansion reduced frequent mental distress and poor mental health days among Hispanic adults. Activity-limiting days declined in the full sample and among white adults. Among Black adults, there were marginally significant mental health improvements. Limitations include reliance","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"29 2","pages":"41-56"},"PeriodicalIF":1.6,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148253905","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unveiling the Value of Early Depression Screening in U.S. Adults: A Systematic Review of Clinical Benefits and Economic Returns.","authors":"Ya'akov M Bayer, Tzion Dadon, Ephraim Schreiber","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Major depressive disorder (MDD) in U.S. adults is common, disabling, and costly. Screening is recommended when follow-up is available, yet uptake remains uneven, and digital tools raise governance risks.</p><p><strong>Aims of the study: </strong>To synthesize U.S. evidence on depression burden, screening uptake, and test performance, and the clinical and economic value of early detection linked to structured follow-up, including digital and AI-based approaches.</p><p><strong>Methods: </strong>Systematic review guided by PRISMA 2020 (2000 through March 2025) across four databases and U.S. reports; dual screening and descriptive synthesis using predefined inclusion criteria and standardized extraction templates were conducted independently.</p><p><strong>Results: </strong>From 3,224 records, 112 studies were included. Depression prevalence reached 8.3 percent in adults and over 20 percent in young adults by 2022. While primary care screening rates vary (48 to 60 percent), PHQ-9 performance remains robust (88 percent sensitivity and specificity). Linking screening to collaborative care doubled remission rates (from 18 to 40 percent), cut hospitalizations by 20 percent, and reduced missed workdays from 9 to 4. Economically, integrated care is highly efficient (ICER: 15,000 to 35,000 dollars per QALY) with a 5 to 1 ROI in older adults. Digital tools reduce costs but face over 40 percent attrition; passive sensing shows high accuracy (0.89) but remains limited by privacy concerns.</p><p><strong>Discussion: </strong>Value concentrates where systems deliver timely follow-up, treatment initiation, and monitoring; screening without capacity yields limited benefit. Limitations include heterogeneous comparators, model dependence on adherence and fidelity, and privacy, bias, and equity risks for digital tools.</p><p><strong>Implications for health care provision and use: </strong>Standardize PHQ 2 then PHQ 9 workflows with EHR and portal automation, clear follow-up timelines, and stepped-care escalation.</p><p><strong>Implications for health policies: </strong>Tie incentives to screening plus documented follow-up, support under-served settings, and require privacy and bias-monitoring standards for digital screening.</p><p><strong>Implications for further research: </strong>Run pragmatic payer-specific evaluations and head-to-head cost-utility comparisons of digital versus questionnaire-based screening with longer follow-up and equity endpoints.</p>","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"29 1","pages":"3-14"},"PeriodicalIF":1.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147515595","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"PERSPECTIVE: Community Health Centers: The Missed Opportunity to Widely Integrate Mental and Primary Health Care in France.","authors":"Matthias Brunn, Wladimir Hindryckx, Elodie Malvezin","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Access to mental health care and its integration with primary care remain critical challenges worldwide. In France, these problems are compounded by fragmented provision, poor coordination, and limited reimbursement for psychotherapy, despite the country's high levels of health expenditure.</p><p><strong>Aims: </strong>This perspective examines how community health centers (centres de santé) can contribute to integrated care, understood as the systematic coordination of physical and mental health services across providers. We analyze the case of the Centre de Santé de Belleville in Paris as an illustration of how CDS can host significant mental health capacity for vulnerable populations, and explore why the model remains marginal in the French health system.</p><p><strong>Methods: </strong>We combine analysis of national policy reports, academic literature, and internal audit data from the Belleville center to situate CDS within French health system dynamics. A Strengths, Weaknesses, Opportunities, and Threats (SWOT) grid is used to summarize the model.</p><p><strong>Results and discussion: </strong>The Belleville case illustrates that CDS can deliver integrated mental and primary care, with salaried teams of general practitioners, psychologists, and a psychiatrist serving a disproportionately vulnerable population. However, structural weaknesses - financial fragility, fragmented representation, reputational risks, and the enduring dominance of the self-employed, independent physician (\"liberal medicine\") - limit their wider diffusion. Policy windows linked to financing reform, workforce shortages, and broader frames such as sustainability occasionally elevate CDS on the agenda, but institutional path dependency keeps them peripheral.</p><p><strong>Implications: </strong>Community health centers in France illustrate how institutional legacies and professional power can constrain the adoption of organizational models aligned with policy goals. For international readers, the case underlines the importance of political economy and system values - in this case, liberal universalism - in shaping the possibilities for integrating mental and primary health care.</p>","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"29 1","pages":"15-22"},"PeriodicalIF":1.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147515618","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Cost-Utility of a Workplace Mental Health Program for Employees with Common Mental Disorders (FRIAA Project).","authors":"Nadine Mulfinger, Tamara Waldmann, Regina Herold, Jeannette Weber, Meike Heming, Manuel Feißt, Christoph Kröger, Marieke Hansmann, Harald Gündel, Nicole R Hander, Eva Rothermund-Nassir, Reinhold Kilian","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Common mental disorders (CMDs) are a leading cause of sickness absence and early retirement due to health problems. Early identification and treatment of CMDs may have a positive impact on prognosis and associated economic costs, including healthcare expenditure, lost productivity, and the societal burden. The effectiveness of workplace psychotherapeutic interventions has been studied, but information on cost-effectiveness in this population is lacking.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Aims of the study: &lt;/strong&gt;This study evaluates the cost-effectiveness of the FRIAA intervention for employees with CMDs compared to care as usual (CAU), with the aim of reducing sickness absence and preventing early retirement.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We used data from a multicenter randomized controlled trial involving 549 employees with mental health problems in different companies located near five study centers in Germany, who provided data at nine- and 15-month follow-up. A total of 545 records were available for the economic evaluation (EE). 278 participants were assigned to the intervention group (FRIAA), and 267 participants were assigned to the CAU condition. On average, intervention participants received eight intervention sessions. The use of health and social care services was assessed using the Client Sociodemographic and Service Receipt Inventory (CSSRI) at nine- and 15-month follow-up. Data were transformed to a 12-month reference period. Quality of life was measured using the EQ-5D-5L questionnaire. Cost-utility analysis was performed by calculating additional costs per one additional quality adjusted life year (QALY).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The annual cost difference between FRIAA and CAU was euro 3,484.29 (95 % confidence interval [CI] euro 1,033.91 to euro 5,934.67), which was significant (p = 0.005). We estimated the average QALY in the CAU group to be 0.768 (SD = 0.200) and in the FRIAA-group to be 0.789 (SD = 0.192). The difference in QALY between FRIAA and CAU was 0.021 (95 % CI -0.013 to 0.055), which was not significant (p = 0.203). The incremental cost-utility ratio (ICUR) showed that the intervention was associated with costs of euro 165,918.57 for one additional year of full health.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Discussion: &lt;/strong&gt;As far as we know, this was the first EE of a psychotherapeutic consultation at work called FRIAA. Compared to CAU, FRIAA did not result in improved quality of life in terms of QALYs, nor favourable cost-utility for FRIAA compared with CAU. The FRIAA intervention cannot be considered cost-effective compared to CAU.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Implications: &lt;/strong&gt;This EE found that differences in costs were significant (with higher costs in the FRIAA group), while no statistically significant differences in QALYs were observed between the study groups. In addition, the cost-utility for FRIAA compared with CAU was not favourable. Participants with CMDs may need more time to integrate what they discuss in p","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"29 1","pages":"23-35"},"PeriodicalIF":1.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147515592","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost-Effectiveness of Transcranial Magnetic Stimulation for Methamphetamine Use Disorder during Pregnancy.","authors":"Rana Jawish, Abdelrahman G Tawfik, Brian Mickey, Adam J Gordon, Robert Silver, Marcela C Smid, Casey R Tak","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Methamphetamine use disorder (MUD) during pregnancy is associated with adverse maternal and perinatal outcomes, including increased risk of preterm birth, cesarean delivery, neonatal intensive care unit admission, placental abruption, and maternal or perinatal death. For the few evidence-based treatments for MUD, including transcranial magnetic stimulation (TMS) and injectable naltrexone with bupropion combination, there are few data available for pregnant individuals.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Aims of the study: &lt;/strong&gt;We completed an exploratory model applying existing knowledge in clinical practice and available research to examine the potential cost-effectiveness of TMS compared to the combination of injectable naltrexone with bupropion or care as usual in a population of pregnant individuals with MUD. We aim to utilize the outcome of this analysis to inform future trial designs that examine TMS efficacy and safety in MUD during pregnancy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A decision tree model was developed to evaluate the direct medical costs and clinical outcomes of TMS compared to injectable naltrexone with bupropion or usual care for pregnant individuals with MUD. The analysis included three strategies from the start of pregnancy through delivery, focusing on mode of delivery, gestational age, and infant birth weight. The primary outcome was the percentage of full-term vaginal deliveries of infants with normal birth weight. The analysis was conducted from a third-party payer perspective, considering only direct medical costs, and used a $50,000 willingness-to-pay threshold to determine cost-effectiveness.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;In this experimental model, TMS demonstrated the lowest overall cost and highest effectiveness, yielding 76% full-term vaginal deliveries with normal-weight infants, compared to 44% for injectable naltrexone with bupropion combination and 39% for no intervention. Sensitivity analyses confirmed the robustness of TMS as a cost-effective intervention.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Discussion: &lt;/strong&gt;Our exploratory model found that TMS was cost-effective compared to injectable naltrexone and bupropion or usual care, potentially improving outcomes at low costs. This study provides preliminary data supporting TMS being a promising cost saving option for MUD during pregnancy. The study's limitations include absence of direct TMS efficacy data in pregnant populations, necessitating the use of extrapolated data, small sample size, and short-term nature of efficacy data in non-pregnant populations. Additionally, there was insufficient data on the adverse effects of the interventions on fetuses and infants, highlighting the need for studies to confirm safety and efficacy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Implications for health care provision and use: &lt;/strong&gt;Both TMS and the combination of injectable naltrexone and bupropion show potential for treating pregnant individuals with MUD. However, neither treatment is FDA-approved ","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"28 4","pages":"125-132"},"PeriodicalIF":1.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146012720","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"PERSPECTIVE: Self-Funded Group Health Plans: A Public Mental Health Threat to Employees?","authors":"Meiram Bendat, Katherine G Kennedy","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>With nearly one in four Americans estimated to have a mental illness and only half of them receiving treatment in a given year, access to affordable, quality mental health care remains out of reach for many. Although health insurance is intended to promote access to mental health care, approximately 35 million Americans covered by self-funded group health plans sponsored by private employers may be unaware that their health plans are not subject to federal standards for medical necessity and network adequacy, key terms that determine the availability of coverage and can significantly limit their access to essential treatment. The Employee Retirement and Security Act of 1974 (\"ERISA\") governing self-funded group health plans does not require them to base their definitions of medical necessity for covered services on generally accepted standards of care. Nor does ERISA require them to follow or disclose network adequacy standards. To the extent network adequacy standards are often undisclosed, if they exist at all, plan participants can be exposed to significant out-of-network financial liabilities when in-network mental health services are unavailable. ERISA's judicial review provisions further disadvantage plan participants by requiring courts to defer to employer benefit interpretations and by severely restricting available relief. To improve access to affordable, high quality mental healthcare for participants in self-funded health plans, the following reforms are crucial: a federal definition of medical necessity, time and distance standards for network adequacy, hold harmless provisions for out-of-network costs due to network inadequacy, and removal of restrictions on judicial review and available remedies.</p>","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"28 4","pages":"121-124"},"PeriodicalIF":1.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146012746","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost-Utility of Repetitive Transcranial Magnetic Stimulation (rTMS) among Treatment Resistant Depression Patients.","authors":"Anna-Kaisa Vartiainen, Elisa Rissanen, Ismo Linnosmaa","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Depression has a high prevalence worldwide and because of its recurrent nature, it represents a major economic burden on society. It is important to identify and evaluate effective treatments to avoid the health disutilities and costs related to poor health. Repetitive transcranial magnetic stimulation (rTMS) is a neuromodulatory technique which is clinically safe, non-invasive, and effective for major depressive disorder and it is used for treatment after at least two failed antidepressant medication trials. The availability of rTMS treatment is still limited in many countries.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Aims of the study: &lt;/strong&gt;The main study objective was to evaluate the cost-effectiveness of add-on rTMS therapy compared with pharmacotherapy in patients with treatment-resistant depression in Finland from a societal perspective.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A one-year Markov-model with two-month cycles was analysed to compare costs and quality adjusted life years (QALYs). Medical and productivity costs were included in the analysis. The data for the model (transition probabilities, resource utilization, utilities) were sourced from published literature, a national unit cost report, and Finnish expert opinions. Incremental cost-effectiveness ratio was calculated. Uncertainty was assessed using univariate and multivariate probabilistic sensitivity analyses and scenario analyses.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;rTMS patients gained an average of 0.041 additional QALYs over one year time horizon with an incremental cost of 3,514 EUR compared to pharmacotherapy alone. The result corresponds to incremental cost-effectiveness ratio (ICER) of 85,133 EUR per QALY. Sensitivity analysis points out that one of the key parameters relating to uncertainty and driving ICER is the high unit cost of rTMS treatment.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Discussion: &lt;/strong&gt;rTMS as an add-on treatment for depression has a beneficial clinical effect compared to pharmacotherapy alone, with greater costs. However, ICER was very high suggesting that rTMS may not be cost-effective acute treatment for TRD patients in Finland. If the unit cost of the rTMS treatment can be reduced, the treatment could be cost-effective. The main limitation of this study was the short time horizon. In addition, modelling studies include assumptions, which contain uncertainty.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Implications for health care provision and use: &lt;/strong&gt;The cost-effectiveness of interventions depends on the health care decision-maker's willingness to pay. rTMS can be effective in treating depression; however, in high price level countries (high unit costs) with limited access to treatment, rTMS may not provide value for money for treating acute phase TRD patients, and it may not be recommended for public health care resources investments. It should be still noted that mental health conditions can be complex and have broad effects on an individual's life. When conducting economic evaluations of m","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"28 4","pages":"133-146"},"PeriodicalIF":1.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146012770","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"PERSPECTIVE: Social Determinants: New Possibilities for Intervention Research in Global Mental Health.","authors":"Crick Lund","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Since its launch in 2007, the field of global mental health has generated substantial research on the social determinants of mental health. Yet relatively little is known about how to intervene to address these social determinants: are such interventions feasible and effective? If they are effective, what are the mechanisms of these effects?&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Discussion: &lt;/strong&gt;This article interrogates some of the important challenges and potential approaches to consider when intervening to address the social determinants of mental health. Challenges include distal intervention targets, opaque mechanisms, intractable political and structural challenges, the need for interdisciplinary approaches, limited currently available datasets, ethical challenges when conducting trials in this field and challenges to research funders, who may be required to fund beyond their disciplinary silos and to convene inter-disciplinary review panels. Nevertheless, several approaches hold promise. First, we need to build more robust and precise theoretical models of how specific social and economic adversities lead to mental health outcomes. This is vital to clearly identify causal mechanisms that may be targeted in interventions. Second, we must test the specific mechanisms in these hypothesized causal pathways for example through including adequately powered mediation analyses in the design of our trials. Third, data need to be shared and where appropriate, pooled across multiple sites, to provide more statistical power and to take context into consideration. Finally, clear criteria need to guide the choice of which social determinants to target.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Recommendations for future research: &lt;/strong&gt;Regarding observational studies, more research is needed to measure the intergenerational transmission of poverty and mental illness and to explore the mechanisms of poverty and mental health over time. We need to understand more about the links between gender, poverty and mental health across the life course, including genetic, biological and socioeconomic risk and protective factors. In relation to intervention studies, research is needed on interventions that address proximal and more distal mechanisms, for example the impact of living environments, climate change and migration on mental health. We are on the threshold of a new era of heightened risk for a broad range of social and economic determinants triggered by climate change, conflict and migration. There is a great deal more that we could be doing to improve our resilience and responsiveness to these challenging circumstances.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Recommendations for policy: &lt;/strong&gt;Adopting a social determinants approach requires a broadened policy agenda. Global mental health advocacy must now also campaign for improved living environments, human rights and reductions in conflict to improve the mental health of populations and reduce inequities in the distribution of mental heal","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"28 3","pages":"97-103"},"PeriodicalIF":1.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145193395","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}