Grayson Norquist

Promoting Mental Health Recovery After Hurricanes Katrina and Rita What Can Be Done at What Cost

CONTEXT Concerns about mental health recovery persist after the 2005 Gulf storms. We propose a recovery model and estimate costs and outcomes. OBJECTIVE To estimate the costs and outcomes of enhanced mental health response to large-scale disasters using the 2005 Gulf storms as a case study. DESIGN Decision analysis using state-transition Markov models for 6-month periods from 7 to 30 months after disasters. Simulated movements between health states were based on probabilities drawn from the clinical literature and expert input. SETTING A total of 117 counties/parishes across Louisiana, Mississippi, Alabama, and Texas that the Federal Emergency Management Agency designated as eligible for individual relief following hurricanes Katrina and Rita. PARTICIPANTS Hypothetical cohort, based on the size and characteristics of the population affected by the Gulf storms. Intervention Enhanced mental health care consisting of evidence-based screening, assessment, treatment, and care coordination. MAIN OUTCOME MEASURES Morbidity in 6-month episodes of mild/moderate or severe mental health problems through 30 months after the disasters; units of service (eg, office visits, prescriptions, hospital nights); intervention costs; and use of human resources. RESULTS Full implementation would cost

Quality of care for depressed elderly pre-post prospective payment system: differences in response across treatment settings.

1133 per capita, or more than

Mental Health, Disabilities, and Women: A Policy-Oriented Data Review

12.5 billion for the affected population, and yield 94.8% to 96.1% recovered by 30 months, but exceed available provider capacity. Partial implementation would lower costs and recovery proportionately. CONCLUSIONS Evidence-based mental health response is feasible, but requires targeted resources, increased provider capacity, and advanced planning.

Spillover Effects of Benefit Expansions and Carve-Outs on Psychotropic Medication Use and Costs

We evaluated the quality of care for depressed elderly patients (n=2,746) hospitalized in general medical hospitals (n = 297) before or after implementation of Medicares Prospective Payment System, focusing on whether the response to time period differed for hospitals that in the post-PPS period had no psychiatric unit, an exempt psychiatric unit, or a nonexempt unit, and by ward placement within hospitals with psychiatric units. Quality of care increased over time, and for most measures of quality of care the level of improvement did not differ significantly across different types of hospitals or by ward placement. The intensity of use of therapeutic services, such as rehabilitation, occupation, or recreation therapy, increased over time, particularly in nonexempt psychiatric units and hospitals without psychiatric units, such that these locations caught up some over time in the level of use of these services to the level for exempt psychiatric units. Several outcomes of care improved over time, and the degree of improvement in the rate of inpatient medical and psychiatric complications and other outcomes was significantly greater for psychiatric units that were exempt post-PPS than for nonexempt treatment locations.

Evaluation of Outcomes With Citalopram for Depression Using Measurement-Based Care in STAR*D: Implications for Clinical Practice

Ongoing development and reform of health care systems worldwide are directing the attention of policymakers to the significance of mental disorders and ensuing disabilities. While this awareness has encouraged empirical work and scientific literature on disabilities associated with mental disorders, insufficient attention has been paid to issues of gender in the context of mental disorder and disability. This paper draws on four data sets-the 1994-96 Disability Survey; the 1992 National Health Interview Survey (NHIS); Social Security Disability Programs; and the recent international measure of Disability-Adjusted Life Years-to explore relationships among gender, mental disorders, and disability in the United States and to consider the special needs presented by women disabled by mental disorders for service development and service configuration. Generally younger than women disabled by physical disorders, women with mental disorders tend to be in their prime child-bearing years. While in the United States private sector managed care programs increasingly are perceived as the most reasonable way to provide health services in a fiscally responsible way, there appears to exist an implicit notion that managed care is intended exclusively for provision of acute care and preventive services. There is little discussion or exploration of the use of managed care systems for rehabilitation generally, or of the particular rehabilitation needs of young women. The implications for the additional “burden” of disabilities along with the potential risk factor of traditional female roles require serious consideration and enlightened policies. Mental

Limitations of Diagnostic Criteria and Assessment Instruments for Mental Disorders: Implications for Research and Policy

This paper extends the previous literature examining the impacts of managed behavioral health care carve-outs and mental health parity mandates on mental health and substance abuse (MH/SA) specialty treatment use and costs by considering the effects on psychotropic prescription medication costs. We use multivariate panel data methods to remove underlying secular growth trends, driven by increased demand for improved MH/SA treatment related to pharmaceutical innovations. We find that psychotropic medication costs continued to increase after the introduction of a substantial benefit expansion and carve-out to a managed behavioral health organization (MBHO), offsetting large declines in inpatient specialty MH/SA costs. However, we find evidence that the MBHO may have restrained growth in prescription medication spending.