Journal of Mental Health Policy and Economics最新文献

{"title":"Employer-Provided and Self-Initiated Job Accommodations for Workers with Serious Mental Illness.","authors":"Marjorie L Baldwin, Rebecca M B White, Steven C Marcus","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Many individuals with serious mental illness (SMI) are capable of employment in regular jobs (i.e. jobs paying at least minimum wage, not set aside for persons with disabilities, and not obtained with assistance from mental health services), but they may need job accommodations to be successful. The extant literature focuses almost exclusively on accommodations for workers with SMI who are receiving employment support, so we know almost nothing about the nature or frequency of accommodations needed by workers who are independently employed.</p><p><strong>Aims: </strong>Drawing on survey data from a sample of workers with diagnoses of SMI who are capable of regular, mainstream employment, we aim to: (i) describe the nature and frequency of job accommodations workers requested from their employer or initiated on their own; and (ii) identify individual- and work-related factors associated with the probabilities of requesting or initiating accommodations.</p><p><strong>Methods: </strong>The analysis sample includes 731 workers with diagnoses of schizophrenia, bipolar disorder, or major depressive disorder, who were employed in regular jobs post-onset of SMI. Workers identified any job accommodations requested from their employer, or initiated on their own. Summary statistics describe the nature and frequency of accommodations in four categories: scheduling, workspace, supervision, job modification. Logistic regression models estimate the relationship between workers' health- and job-related characteristics and the probabilities of requesting or self-initiating accommodations.</p><p><strong>Results: </strong>Whereas 84% of workers in our sample self-initiated accommodations, only 25% requested accommodations from their employer. The most frequent accommodations of either type involved flexibility in scheduling (63% self-initiated, 24% requested), or modifications to the workspace (58%, 19%). Factors significantly correlated with the probability of requesting accommodations include: supportive workplace culture, longer job tenure, more severe cognitive/social limitations. Factors significantly correlated with the probability of self-initiating accommodations include: younger age, more severe social limitations, greater job autonomy.</p><p><strong>Discussion: </strong>This is the first study of job accommodations among a cohort of persons with SMI independently employed in regular jobs. We identify a type of accommodation, self-initiated by the worker, that has not been studied before. These self-initiated accommodations are far more prevalent than employer-provided accommodations in our sample. Key factors associated with the probabilities of requesting/initiating accommodations reflect need (e.g. compromised health) and feasibility of implementation in a particular job. Limitations of the study include the cross-sectional design which limits our ability to identify causal relationships.</p><p><strong>Implications for he","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"26 4","pages":"137-147"},"PeriodicalIF":1.6,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138812128","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":"Financial Sustainability of Novel Delivery Models in Behavioral Health Treatment.","authors":"Dominic Hodgkin, Constance M Horgan, Stephanie Jordan Brown, Gavin Bart, Maureen T Stewart","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>In the US, much of the research into new intervention and delivery models for behavioral health care is funded by research institutes and foundations, typically through grants to develop and test the new interventions. The original grant funding is typically time-limited. This implies that eventually communities, clinicians, and others must find resources to replace the grant funding -otherwise the innovation will not be adopted. Diffusion is challenged by the continued dominance in the US of fee-for-service reimbursement, especially for behavioral health care.</p><p><strong>Aims: </strong>To understand the financial challenges to disseminating innovative behavioral health delivery models posed by fee-for-service reimbursement, and to explore alternative payment models that promise to accelerate adoption by better addressing need for flexibility and sustainability.</p><p><strong>Methods: </strong>We review US experience with three specific novel delivery models that emerged in recent years. The models are: collaborative care model for depression (CoCM), outpatient based opioid treatment (OBOT), and the certified community behavioral health clinic (CCBHC) model. These examples were selected as illustrating some common themes and some different issues affecting diffusion. For each model, we discuss its core components; evidence on its effectiveness and cost-effectiveness; how its dissemination was funded; how providers are paid; and what has been the uptake so far.</p><p><strong>Results: </strong>The collaborative care model has existed for longest, but has been slow to disseminate, due in part to a lack of billing codes for key components until recently. The OBOT model faced that problem, and also (until recently) a regulatory requirement requiring physicians to obtain federal waivers in order to prescribe buprenorphine. Similarly, the CCBHC model includes previously nonbillable services, but it appears to be diffusing more successfully than some other innovations, due in part to the approach taken by funders.</p><p><strong>Discussion: </strong>A common challenge for all three models has been their inclusion of services that were not (initially) reimbursable in a fee-for-service system. However, even establishing new procedure codes may not be enough to give providers the flexibility needed to implement these models, unless payers also implement alternative payment models.</p><p><strong>Implications for health care provision and use: </strong>For providers who receive time-limited grant funding to implement these novel delivery models, one key lesson is the need to start early on planning how services will be sustained after the grant ends.</p><p><strong>Implications for health policy: </strong>For research funders (e.g., federal agencies), it is clearly important to speed up the process of obtaining coverage for each novel delivery model, including the development of new billable service codes, and to plan for this","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"26 4","pages":"149-158"},"PeriodicalIF":1.6,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10752219/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138812131","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":"Value-Based Insurance Design: Clinically Nuanced Consumer Cost-Sharing for Mental Health Services.","authors":"Nicole M Benson,&nbsp;A Mark Fendrick","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>While consumer cost-sharing is a widely used strategy to mitigate health care spending, numerous studies have demonstrated that even modest levels of out-of-pocket cost are associated with lower use of medical care, including clinically necessary, high-value services. Within mental health care, increases in cost-sharing are associated with reductions in use of mental health care and psychotropic medication use. Further, these reductions in mental health services and treatments can lead to downstream consequences including worsening of psychiatric illness and increased need for acute care and psychiatric hospitalization. Thus, there is a need for clinically informed solutions that explicitly balance the need for appropriate access to essential mental health services and treatments with growing fiscal pressures faced by public and private payers. Value-Based Insurance Design (VBID) describes a model where consumer cost-sharing is based on the potential clinical benefit rather than the price of a specific health care service or treatment.</p><p><strong>Aims of the study: </strong>Describe value-based insurance design and applications in mental health care.</p><p><strong>Results, discussion and implications for health policies: </strong>For over two decades, clinically nuanced VBID programs have been implemented in an effort to optimize the use of high-value health services and enhance equity through reduced consumer cost-sharing. Overall, the evidence suggests that VBID has demonstrated success in reducing consumer out-of-pocket costs associated with specific, high value services. By reducing financial barriers to essential clinical services and medications, VBID has potential to enhance equity. However, the impact of VBID on overall mental health care spending and clinical outcomes remains uncertain.</p>","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"26 3","pages":"101-108"},"PeriodicalIF":1.6,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41133397","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":"LETTER: The Effect of Mental Disorders on Caregiver Workforce Participation: The Hidden Societal Cost.","authors":"Jens Peter Eckardt","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>No abstract.</p>","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"26 3","pages":"131"},"PeriodicalIF":1.6,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41151836","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":"Perspectives on Financing Strategies for Evidence-Based Treatment Implementation in Youth Mental Health Systems.","authors":"Maddison N North, Alex R Dopp, Jane F Silovsky, Marylou Gilbert, Jeanne S Ringel","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Evidence-based treatments (EBTs) are critical to effectively address mental health problems among children and adolescents, but costly for mental health service agencies to implement and sustain. Financing strategies help agencies overcome cost-related barriers by obtaining financial resources to support EBT implementation and/or sustainment.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Aims: &lt;/strong&gt;We sought to (i) understand how youth mental health system decision-makers involved with EBT implementation and sustainment view key features (e.g., relevance, feasibility) that inform financing strategy selection and (ii) compare service agency, funding agency, and intermediary representative perspectives.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Method: &lt;/strong&gt;Two surveys were disseminated to 48 representatives across U.S. youth mental health service agencies, funding agencies, and intermediaries who were participating in a larger study of financing strategies. Quantitative and qualitative data were gathered on 23 financing strategies through quantitative ratings and open-ended responses. Data were analyzed using descriptive statistics and rapid content analysis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The financing strategies rated as most relevant include braided funding streams, contracts for EBTs, credentialing/rostering providers, fee-for-service reimbursement (regular and increased), and grant funding. All other strategies were unfamiliar to 1/3 to 1/2 of participants. The six strategies were rated between somewhat and quite available, feasible, and effective for EBT sustainment. For sustaining different EBT components (e.g., delivery, materials), the mix of financing strategies was rated as somewhat adequate. Qualitative analysis revealed challenges with strategies being non-recurring or unavailable in representatives' regions. Ratings were largely similar across participant roles, though funding agency representatives were the most familiar with financing strategies.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Discussion: &lt;/strong&gt;Despite the breadth of innovative financing strategies, expert representatives within the youth mental health services ecosystem had limited knowledge of most options. Experts relied on strategies that were familiar but often did not adequately support EBT implementation or sustainment. These findings underscore more fundamental issues with under-resourced mental health systems in the U.S.; financing strategies can help agencies navigate EBT use but must be accompanied by larger-scale system reforms. Limitations include difficulties generalizing results due to using a small sample familiar with EBTs, high agreement as a potential function of snowball recruiting, and limited responses to the open-ended survey questions.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Implications for health care provision and use: &lt;/strong&gt;Although EBTs have been found to effectively address mental health problems in children and adolescents, available strategies for financing their implementation and sustainment in mental h","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"26 3","pages":"115-190"},"PeriodicalIF":1.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10947519/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41170299","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":"PERSPECTIVE: Economic and Policy Research Interests Highlighted in the 25th NIMH-Sponsored Mental Health Services Research Conference.","authors":"Jennifer L Humensky, Michael C Freed, Susan T Azrin, Mary Acri, Denise Pintello","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The National Institute of Mental Health (NIMH) remains committed to addressing real-world challenges with delivering high quality mental health care to people in need by advancing a services research agenda to improve access, continuity, quality, equity, and value of mental healthcare nationwide, and to improve outcomes for people with serious mental illnesses (SMI). The NIMH-Sponsored Mental Health Services Research Conference (MHSR) is a highly productive venue for discussing topics of interest to NIMH audiences and disseminating NIMH's latest research findings directly to mental health clinicians, policy makers, administrators, advocates, consumers, and scientists who attend.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Aims: &lt;/strong&gt;This Perspective summarizes and provides highlights from the 25th MHSR. It also reviews three papers presented at the 25th MSHR and subsequently published in the June 2023 special issue of The Journal of Mental Health Policy and Economics (JMHPE).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The authors review three papers published in the June 2023 special issue of JMHPE, identifying common themes across the papers and illustrating how the papers' findings promote key areas of NIMH research interests.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Three important areas are highlighted in this review: (i) service user engagement in the research enterprise, (ii) financing the implementation of the 988 Suicide and Crisis Lifeline, and (iii) methods to predict mental health workforce turnover.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Discussion: &lt;/strong&gt;These three papers illustrate key areas in which policy research can help to promote quality mental health care. One notable common theme across the papers is that of the role that end users play in the research enterprise. The papers focus on (i) service users and the value they bring to informing the practice of research, (ii) policy makers and the information they need to make evidence-informed decisions, and (iii) provider organization leadership, by using an innovative machine learning process to help organizations predict and address staff turnover.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Implications for health care: &lt;/strong&gt;NIMH encourages and often requires strong research practice partnerships to help ensure findings will be of value to end users and make their way into the practice setting. The three papers reviewed in this perspective are exemplars of how necessary stakeholder partnerships are to improve care for those with mental illness.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Implications for health policies: &lt;/strong&gt;The highlighted papers (i) provide recommendations for structural changes to research institutions to increase service user engagement in all aspects of the research enterprise, (ii) identify policy solutions to improve fiscal readiness to address increased demand of 988, and (iii) pilot a novel data-driven approach to predict mental health workforce turnover, a significant problem in community mental health clinics, offering health system ","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"26 3","pages":"109-114"},"PeriodicalIF":1.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11040969/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41171276","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":"Mental Health Problems and Risky Health Behaviors among Young Individuals in Turkey: The Case of Being NEET.","authors":"Deniz Karaoglan,&nbsp;Nazire Begen,&nbsp;Pinar Tat","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The concept of neither in active employment nor in education and training (NEET) is quite important because it potentially addresses a broad array of vulnerabilities among the young, touching on issues of unemployment, early school leaving, and labor market discouragement.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Aims of the study: &lt;/strong&gt;In this study, we examine the relationship between being NEET and the probability of having mental health problems and risky health behaviors (namely smoking and alcohol consumption), as well as being obese among young individuals in Turkey. This research also aims to investigate the association between mental health problems/risky health behaviors and parental socio-economic status.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Empirical analyses are conducted by utilizing 2014, 2016, and 2019 rounds of Turkish Health Survey (THS) datasets. We conduct multivariate logit techniques through the analysis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The results suggest that the probability of having mental health problems and the prevalence of obesity increases if the young individual is NEET. In addition, we find that there is no significant association between being NEET and having risky health behaviors if the young individual is inactive NEET. However, our results suggest that both the probability of smoking and alcohol consumption increases for unemployed NEETs.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Discussion: &lt;/strong&gt;To the best of our knowledge, there is a lack of evidence of systematically and thoroughly examined associations between mental health/risky health behaviors and NEET status in Turkey, as well as southern European, developing, or Muslim countries with similar socioeconomic levels. In addition, some of the previous studies have concentrated on specific populations such as young individuals living in mental health centers or males in military institutions. Therefore, the group of NEETs participating in this study may be a large representative sample for all NEETs in the population. The main limitation is that our data set is constructed by merging health surveys, it allows for only cross-sectional comparisons and thus it makes it difficult to claim a causal relationship. Thus, future studies may contribute to the literature by employing panel data or making experimental research.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Implications for health policies and further research: &lt;/strong&gt;The policies and interventions should be considered to prevent young individuals from becoming NEET and to re-integrate them into society. For instance, creating more education opportunities or programs to facilitate the direct transition from school to the labor market should be the main objective of policymakers. Also, a series of mental health and social skill support programs such as incorporating mental health services into youth career support initiatives can be implemented for increasing youth's confidence and job readiness. The findings on smoking and alcohol consumption point o","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"25 3","pages":"105-117"},"PeriodicalIF":1.6,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40373656","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 Effect of Being Unemployed on Mental Health: The Spanish Case.","authors":"Israel Escudero-Castillo,&nbsp;Francisco Javier Mato Diaz,&nbsp;Ana Rodriguez-Alvarez","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The lack of work appeared to be linked to several symptoms related to poor mental health. Likewise, the reverse relationship, namely the influence of poor mental health on the risk of job loss, has also been analysed, i.e. distress could lead to a poorer work performance culminating in potential job loss. Thus, the bidirectional nature of the relationship between unemployment and mental health makes the accurate estimation of causal relationships a complex matter, leaving room for additional research on the subject.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Aims of the study: &lt;/strong&gt;The aim of this research is to analyse the influence that unemployment could have on mental health taking into account the bidirectional nature that exists between both concepts.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;In order to tackle the causal effect of being unemployed on mental health, we present a biprobit model taking into account the presence of dummy endogenous regressors and we compare these results with those obtained from a standard univariate probit. Our identification strategy exploits geographical information on the unemployment rates as instrument. We use Spanish cross-sectional data from the 2006, 2011 and 2017 years.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Based on the results, the paper concludes that unemployed persons in Spain could be subject to a 5.4% higher probability of suffering symptoms related to a common mental disorder (versus 11% obtained using a standard probit).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Discussion: &lt;/strong&gt;The results obtained confirm a negative impact of unemployment situation on mental health. In other words, the probability of unemployed people suffering a mental disorder seems superior to that for individuals with a job. Moreover, the marginal effect obtained from a univariate probit model without the possibility of controlling the mental health selection effects, proves the existence of a problem of simultaneity that would have overestimated the effect of being unemployed on mental health.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Implications for health care provision: &lt;/strong&gt;It is hoped that the conclusions obtained here prove useful in the implementation of specific mental health care provision aimed at unemployed people. In this context, the evidence obtained should result in the incorporation of health assistance as an essential part in response to the needs of this collective.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Implications for health policies: &lt;/strong&gt;These special needs of unemployed people should be contemplated not only from a health care provision but also as part of a broader system that incorporates the mental health care of unemployed persons as part of more general public health policies. Finally, these results suggest that mental health-related objectives should be considered when planning, implementing, and evaluating active labour market policies for the unemployed.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Implications for further research: &lt;/strong&gt;The length and severity of the last recession, toget","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"25 3","pages":"79-89"},"PeriodicalIF":1.6,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40373219","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 Analysis of School-Based Treatments for Anxiety Disorders.","authors":"Golda S Ginsburg,&nbsp;Jeffrey E Pella,&nbsp;Eric Slade","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>School-based treatments for anxiety disorders are needed to address barriers to accessing community-based services. A key question for school administers are the costs related to these treatments.</p><p><strong>Aims of the study: </strong>This study examined the cost-effectiveness of a school-based modular cognitive behavioral therapy (M-CBT) for pediatric anxiety disorders compared to school-based treatment as usual (TAU).</p><p><strong>Methods: </strong>Sixty-two school-based clinicians in Maryland and Connecticut were randomized (37 in CBT; 25 in TAU), trained, and enrolled at least one anxious student (148 students in CBT; 68 in TAU). Students (N = 216) were ages 6-18 (mean age 10.9); 63.9% were non-Hispanic White race-ethnicity; and 48.6% were female. Independent evaluators (IEs) assessed outcomes at post treatment and at a one-year follow up. Anxiety related costs included mental health care expenses and the opportunity costs of added caregiver time and missed school days.</p><p><strong>Results: </strong>The overall M-CBT ICER value of $6917/QALY reflected both lower costs for days absent from school (mean difference: $--117 per youth; p = 0.045) but also lower QALY ratings (mean difference: -0.024; p = 0.900) compared with usual school counseling. Among youth with more severe anxiety at baseline, M-CBT had a more favorable ICER ($-22,846/QALY). Other mental health care costs were similar between groups (mean difference: $-90 per youth; p = 0.328).</p><p><strong>Discussion: </strong>Although training school clinicians in M-CBT resulted in lower costs for school absences, evidence for the cost effectiveness of a modular CBT relative to existing school treatment for pediatric anxiety disorders was not robustly supported. Findings suggest school-based M-CBT is most cost effective for youth with the highest levels of anxiety severity and that M-CBT could help reduce the costs of missed school. Interpretations are limited due to use of retrospective recall, lack of data on medication use, and small sample size.</p><p><strong>Implications for health care provision and use: </strong>Schools may benefit from providing specialized school-based services such as M-CBT for students with the highest levels of anxiety.</p><p><strong>Implications for health policies: </strong>Investment decisions by schools should take into account lower costs (related to school absences), the costs of training clinicians, and student access to CBT in the community.</p><p><strong>Implications for further research: </strong>Replication with a larger sample, service use diaries, and objective school and medical records over a longer period of time is warranted.</p>","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"25 3","pages":"91-103"},"PeriodicalIF":1.6,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40373220","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":"Certificate of Need and Inpatient Psychiatric Services.","authors":"James Bailey,&nbsp;Eleanor Lewin","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Certificate of need (CON) laws require would-be healthcare providers to obtain the permission of a state board before opening or expanding. 35 US states operate some type of CON program, though they vary widely in the specific services or equipment they target, with 25 states requiring CON for psychiatric services.</p><p><strong>Aims of the study: </strong>We provide the first empirical estimates on how CON affects the provision of psychiatric services.</p><p><strong>Methods: </strong>We use Ordinary Least Squares regression to analyze 2010-2016 data on psychiatric CON from the American Health Planning Association together with data on psychiatric facilities and services from the National Mental Health Services Survey.</p><p><strong>Results: </strong>We find that CON laws targeting psychiatric services are associated with a statistically significant 0.527 fewer psychiatric hospitals per million residents (20% fewer) and 2.19 fewer inpatient psychiatric clients per ten thousand residents (56% fewer). Psychiatric CON is also associated with psychiatric hospitals being 5.35 percentage points less likely to accept Medicare. Our estimates for CON's effect on the number of inpatient psychiatric beds per ten thousand residents and the likelihood of psychiatric hospitals accepting Medicaid, private insurance, or charity care (no charge) are negative but not statistically significant.</p><p><strong>Discussion: </strong>CON laws may substantially reduce access to psychiatric care. A limitation of our study is that there is almost no variation in which states have psychiatric-related CON laws during the time period of our data (New Hampshire is the only state to change its psychiatric services CON requirement in this period, repealing its CON program entirely in 2016). This precludes the use of preferred econometric techniques such as difference-in-difference.</p><p><strong>Implications for health policies: </strong>Our results indicate that CON laws may reduce access to inpatient psychiatric care. State policymakers should consider whether CON repeal could be a simple way of enhancing access to psychiatric care.</p><p><strong>Implications for further research: </strong>While hundreds of articles have examined the effects of CON laws, we believe ours is the first to provide empirical estimates of their effects on mental health care specifically. We hope it is not the last.</p>","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"24 4","pages":"117-124"},"PeriodicalIF":1.6,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39726824","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}