The United Way of Greater Los Angeles commissioned a study conducted by the University of Southern California (USC) that chronicled the consumption of public services by four homeless people over a two-year period. The study reported five principal cost areas: substance abuse, physical health, mental health, criminal justice, and housing.  The study found that permanent housing solutions yield a 43% cost savings.  For two years, the total cost to provide public services without permanent housing was over $80,000 greater than the cost to provide permanent housing in addition to support services.  When permanent housing was provided, mental health services were the only area with increased costs; however, the associated benefits of regularly seeking mental health services had positive impacts on the system.

From the report:

In order to analyze the costs of public services, investigators focused first on the two-year period before the individu­als were placed in permanent supportive housing. During that time period, two of the four had gone through detox six times costing $23,382. Two of the four had been hospitalized (removal of kidney stone and bladder infection) at a cost of $20,250. All four had used the hospital emergency room for health and alcohol issues (19 visits), costing an additional $7,885. All four had been arrested at least once ($2,756) and spent time in jail ($8,545). One of the four had also served 90 days in prison ($12,060).

United Way of Greater Los Angeles. (2009). Homeless cost study.

Full report: http://www.unitedwayla.org/getinformed/news/Documents/HomelessCostStudy_09_r2_v3.pdf

This study uses data from August 2006 to July 2007 to determine the distribution of psychotropic drug prescriptions by medical specialty.  The authors find that 59 percent of psychotropic prescriptions were written by general practitioners, 23 percent by psychiatrists and 19 percent by other physicians. 

Mark, T. L., Levit, K. R., Buck, J. A. (2009). Psychotropic Drug Prescriptions by Medical Specialty. Psychiatric Services, 60, 1167. DOI: 10.1176/appi.ps.60.9.1167 http://psychservices.psychiatryonline.org/cgi/pdf_extract/60/9/1167 

Authors: Tami L. Mark, Katharine R. Levit, Jeffrey A. Buck.

This article examines recent changes to Medicaid and their effects on mental health services, noting that one group of changes will further limit mental health funding flexibility while increasing provider accountability and  state authority.  The author contends that another group changes will promote "person-centered" treatment and community-based care. 

Buck, J. A. (2009). Recent changes in Medicaid policy and their possible effects on mental health services. Psychiatric Services, 60, 1504-1509. DOI: 10.1176/appi.ps.60.11.1504 http://ps.psychiatryonline.org/cgi/content/abstract/60/11/1504

Authors: Jeffery A. Buck.

This toolkit, created by CHCS’ Collaborative on Improving Managed Care Quality for Youth with Serious Behavioral Health Needs, offers best practices implemented by managed care organizations (MCOs), challenges and lessons learned, and opportunities for continued innovations in care for children and youth with serious behavioral health needs.

From CHCS:

Although Medicaid managed care programs are covering children with serious behavioral health disorders, limited funds for program evaluation have prevented most from examining their impact on children’s behavioral health care. The 10-year, SAMHSA-funded Health Care Reform Tracking Project found that in roughly 45% of Medicaid managed care programs, the impact of managed care on children’s behavioral health care (e.g., service utilization, quality, cost, and family satisfaction) was unknown, and in 63% of programs, impact on clinical and functional outcomes was unknown. Notably, SAMHSA found that the Medicaid fee-for-service system did not provide such data either. 16 This Collaborative provided a timely opportunity for participating MCOs to look more closely at their data for this population, and develop new data to inform and track quality enhancements.

Center for Health Care Strategies, Inc. (2009). Improving Medicaid managed care for youth with serious behavioral health needs: a quality improvement toolkit. Kamala Allen and Sheila A. Pires.

Full toolkit: http://www.chcs.org/usr_doc/Improving_Medicaid_Managed_Care_for_Youth_with_Serious_Behavioral_Health_Needs_Toolkit.pdf

This Rand Corporation report analyzes a Department of Defense pilot project that lifted two key TRICARE requirements on mental health counselors.  It evaluates the pilot’s affect on the utilization, expenditures, and outcomes of mental health treatment for military personnel and their families.

From the Report:

This study stemmed from a perception among licensed mental health counselors that their administrative requirements are a barrier to mental health care for TRICARE patients. Temporarily lifting these requirements did not increase the perceived access beneficiaries had to mental health care, but did affect the types of providers and care they sought. It could not be determined, however, whether this affected clinical outcomes or quality of care. Future efforts to offer military personnel and their families greater access to mental health care should examine not only whether unmet demand can be met, but also how expanding access affects quality of care.

The Rand Corporation. (2009). Expanding access to mental health counselors under TRICARE. Meredith, Lisa S., Tanielian, Terri, Greenberg, Michael D., Suarez, Ana, & Eiseman, Elizabeth.

Full Report: http://www.rand.org/pubs/research_briefs/2009/RAND_RB9454.pdf

This report by the Substance Abuse and Mental Health Services Administration (SAMHSA), developed using data from the 2008 National Survey of Drug Use and Health (NSDUH) found that 8.3 million adults (3.7 percent) had serious suicidal thoughts in the past year, 2.3 million (1.0 percent) made a suicide plan, and 1.1 million (0.5 percent) attempted suicide.  The study also found that younger adults were more likely to consider suicide that older adults and that only 62.3 percent of those who attempted suicide last year received medical attention.

From the report:

Suicidality is a major public health problem that affects many Americans and their families every year. Suicidality ranges from suicide ideation (i.e., thoughts of suicide and making suicide plans) to suicide attempts to completed suicide. Over 32,000 adults committed suicide in 2006; however, these represent only a fraction of the individuals who consider or attempt suicide. Gaining a better understanding of suicidal thoughts and behaviors among adults may help to identify individuals at risk for suicide, to inform the development of screening tools, and to inform mental health and general practitioners on treatment planning.

Responding to a need for national data on the prevalence of suicidality, a brief series of questions on suicidal thoughts and behaviors was added to the National Survey on Drug Use and Health (NSDUH) questionnaire in 2008. In previous NSDUHs, suicidality questions were asked in the module on major depressive episode (MDE), and suicidality estimates could be generated only for persons who met the criteria for MDE. The new 2008 questions ask all adult respondents aged 18 or older if they had serious thoughts of suicide in the past year. If they had serious thoughts of suicide, respondents were asked if they made plans to commit suicide and if they attempted suicide in the past year. If they reported having made a suicide attempt, respondents were asked if they received medical attention for their suicide attempt; if they received medical attention, they were asked if they stayed in a hospital overnight or longer for their suicide attempt.

This issue of The NSDUH Report examines suicidal thoughts and behaviors among adults aged 18 or older; data are presented by age group, gender, and past year substance use disorder. All findings in the report are based on 2008 data.

Substance Abuse and Mental Health Services Administration (SAMHSA) Office of Applied Studies (OAS) & RTI International. (2009). The NSDUH Report: Suicidal Thoughts and Behaviors among Adults.

Full report: http://oas.samhsa.gov/2k9/165/Suicide.htm