Report Urges Businesses To Improve MH Coverage

State Watch

Perceived Effectiveness of Medications Among Mental Health Service Users With and Without Alcohol Dependence

Mental Health Policy and Services Five Years After the President's Commission Report: An Interview With Michael F. Hogan

There is limited empirical evidence on the extent to which perceived public stigma prevents individuals from using mental health services, despite substantial recent policy interest in this issue. This study investigated associations between perceived public stigma and mental health care seeking. This study used cross-sectional survey data from a representative sample of undergraduate and graduate students (N=2,782) at one university. A five-item scale was used to assess perceived public stigma toward mental health service use. Perceived need for help in the past 12 months and current presence of depressive and anxiety disorders were also assessed. Perceived stigma was higher among males, older students, Asian and Pacific Islanders, international students, students with lower socioeconomic status backgrounds, and students with current mental health problems. Perceived stigma was also higher among those without any family members or friends who had used mental health services and among those who believed that therapy or medication is not very helpful. Perceived stigma was negatively associated with the likelihood of perceiving a need for mental health services, but only among younger students. Among those with probable depressive or anxiety disorders, there was no evidence that perceived stigma was associated with service use. These results suggest that, at least in this population, perceived stigma may not be as important a barrier to mental health care as the mental health policy discourse currently assumes.

We model the competition among multiple pharmacy benefit managers (PBMs) for the patronage of a client organization. Each PBM selects a list of prices to be charged to the client organization for each of the branded and generic drugs within a therapeutic class (price decision) and a formulary list that assigns branded drugs to preferred or nonpreferred tiers (formulary decision). Drug manufacturers offer rebates to PBMs for drugs on preferred tier of formularies. The individuals participating in the client’s pharmacy benefit plan are the ones consuming the drugs and making purchasing decisions, whereas the client organization is paying the majority of drug cost. The choices of the individuals and the client organization are governed by different utility measures. For this complex drug distribution setting and for competing PBMs, we show the existence and uniqueness of a pure Nash equilibrium on aggregate formulary and price decisions, which represent the welfare-adjusted cost and welfare-adjusted price of each PBM’s plan, respectively. We characterize each PBM’s optimal formulary and equilibrium price decisions and discuss the impact of various model primitives. We apply our model to gain insights on the impact of mergers in the PBM industry.

In 2004, the American Academy of Pediatrics (AAP) Board of Directors formed the Task Force on Mental Health and charged it with developing strategies to improve the quality of child and adolescent mental health* services in primary care. The task force acknowledged early in its deliberations that enhancing the mental health care that pediatricians and other primary care clinicians† provide to children and adolescents will require systemic interventions at the national, state, and community levels to improve the financing of mental health care and access to mental health specialty resources. Systemic strategies toward achieving these improvements are the subject of other publications of the task force: “ Strategies for System Change in Children's Mental Health: A Chapter Action Kit ” (chapter action kit),1 “Improving Mental Health Services in Primary Care: Reducing Administrative and Financial Barriers to Access and Collaboration,”2 and “Enhancing Pediatric Mental Health Care: Strategies for Preparing a Community.”3 The task force also recognized that enhanced mental health practice will require competencies not currently achieved by many primary care clinicians; in the policy statement “The Future of Pediatrics: Mental Health Competencies for Pediatric Primary Care,”4 the task force collaborated with the AAP Committee on Psychosocial Aspects of Child and Family Health to outline these competencies and propose strategies for achieving them. This report offers strategies for preparing the primary care practice itself for provision of enhanced mental health care services. The task force proposes incrementally applying chronic care principles to the care of children with mental health and substance abuse problems as primary care clinicians apply them to the care of children with chronic medical conditions such as asthma. Most primary care clinicians will find that significant gaps exist between their current practice and the proposed ideal. The task force offers guidance in … Address correspondence to Jane Meschan Foy, MD, Department of Pediatrics, Wake Forest University School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157. E-mail: jmfoy{at}wfubmc.edu

The central place of psychiatry in health care worldwide.

10.1176/appi.ps.59.1.105

The 2003 Medicare Modernization Act shifted medication coverage from Medicaid to Medicare for persons dually eligible for both programs. This study examined the extent to which access to psychiatric and concomitant medications was reduced for dually eligible individuals in New York State. It also examined the extent to which consumer copayments and state costs were changed when the act was implemented in 2006. Data were from psychiatric medication Medicaid claims in 2002 for the 36,842 dually eligible adults with severe mental illness and from the 2006 formulary data of New York State's 15 prescription drug plans available after the Medicare Modernization Act was implemented. The study simulated how dually eligible persons in New York State would fare under the plans' random and best-fit enrollment scenarios, taking into account the additional coverage provided by New York State's 2006 safety net policy. Implementation of the Medication Modernization Act reduced drug availability and increased usage restrictions. A study-defined generosity measure estimated a 51%+/-19% reduction in access. Dually eligible individuals with depression experienced the largest treatment gap. Cost changes to the state were essentially budget neutral, primarily because of the required claw-back payment. Consumer copayments increased percentage-wise, but actual dollar amounts remained small; increases were higher under best-fit enrollment compared with random enrollment. Without a generous safety net policy, dually eligible beneficiaries, especially those with depression, are likely to experience large gaps in their medication coverage and somewhat higher out-of-pocket costs. Treatment gaps were somewhat reduced by placement in best-fit plans, and such placement resulted in no added financial burden to the state. However, this resulted in higher consumer copayments--payments that are small in the actual dollar amount but that might have an impact on spending and on medication access for a largely poor consumer group.

Information about mental health systems is essential for mental health planning to reduce the burden of neuropsychiatric disorders. Unfortunately, many low- and middle-income countries lack systematic information on their mental health systems. The objectives, scope, structure, and contents of mental health assessment and monitoring instruments commonly used in high-income countries may not be appropriate for use in middle- and low-income countries. The World Health Organization (WHO) has recently developed the WHO Assessment Instrument for Mental Health Systems (WHO-AIMS), a comprehensive assessment tool for mental health systems designed for middle- and low-income countries. WHO-AIMS was developed through an iterative process that included input from in-country and international experts on the clarity, content, validity, and feasibility of the instrument, as well as a pilot trial. The resulting instrument, WHO-AIMS 2.2, consists of six domains: policy and legislative framework, mental health services, mental health in primary care, human resources, public information and links with other sectors, and monitoring and research. These domains address the ten recommendations of the World Health Report 2001 through 28 facets and 155 items. All six domains need to be assessed to form a basic, yet broad, picture of a mental health system, with a focus on health sector activities. WHO-AIMS provides essential information for mental health policy and service delivery. Countries will be able to develop information-based mental health policy and plans with clear baseline information and targets. Moreover, they will be able to monitor progress in implementing reform policies, providing community services, and involving consumers, families, and other stakeholders in mental health promotion, prevention, care and rehabilitation. This article provides an overview of the rationale, development process, and potential uses and benefits of WHO-AIMS.

The Link Between Homeless Women's Mental Health and Service System Use

This study examined rates of utilization of mental health care among active duty and National Guard soldiers with mental health problems three and 12 months after they returned from combat in Iraq. Stigma and barriers to care were also reported for each component (active duty and National Guard). Cross-sectional, anonymous surveys were administered to 10,386 soldiers across both time points and components. Mean scores from 11 items measuring stigma and barriers to care were computed. Service utilization was assessed by asking soldiers whether they had received services for a mental health problem from a mental health professional, a medical doctor, or the Department of Veterans Affairs in the past month. Risk of mental problems was measured using the Patient Health Questionnaire, the PTSD Checklist, and items asking about aggressive behaviors and "stress, emotional, alcohol, or family" problems within the past month. A higher proportion of active duty soldiers than National Guard soldiers reported at least one type of mental health problem at both three months (45% versus 33%) and 12 months (44% versus 35%) postdeployment. Among soldiers with mental health problems, National Guard soldiers reported significantly higher rates of mental health care utilization 12 months after deployment, compared with active duty soldiers (27% versus 13%). Mean stigma scores were higher among active duty soldiers than among National Guard soldiers. Active duty soldiers with a mental health problem had significantly lower rates of service utilization than National Guard soldiers and significantly higher endorsements of stigma. Current and future efforts to improve care for veterans should work toward reducing the stigma of receiving mental health care.

County-Level Estimates of Need for Mental Health Professionals in the United States

From the Editor-In-Chief Health AffairsVol. 28, No. 3: Mental Health Care: Better, Not Best Mental Health Care In America: Not Yet Good EnoughSusan DentzerPUBLISHED:May/June 2009Free Accesshttps://doi.org/10.1377/hlthaff.28.3.635AboutSectionsView PDFPermissions ShareShare onFacebookTwitterLinked InRedditEmail ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsDownload Exhibits TOPICSMental healthPharmaceuticalsSocial Security Disability Insurance R ichard frank and Sherry Glied chose the title Better But Not Well for their seminal 2006 work on U.S. mental health care since 1950. Better But Not Good Enough would be an apt title for this thematic issue of Health Affairs, published with the support of the MacArthur Foundation. The United States has clearly crossed a watershed in the past year, with passage of federal parity legislation finally burying the nonscientific distinction between “mental” and “physical” illness. But to say there’s been progress in understanding these brain disorders—not to mention in the care provided those suffering from them—doesn’t negate the fact that there’s still much farther to go. Consider how the science of mental illness has evolved since Health Affairs ’ first MacArthur-funded section on the subject in 1990. Among myriad discoveries made since then is that roughly 80 percent of the genes expressed elsewhere in the human body are also expressed in the brain. That helps explain the fact that the chemical compound serotonin has wildly different bodily functions—serving, for example, as a brain neurotransmitter as well as a key substance in the blood, liver, and gastrointestinal tract. Yet while we know that conditions like depression and anxiety are linked to disruptions in the brain’s serotonin pathways, we still have no firm understanding of how selective serotonin reuptake inhibitors (SSRIs) like Prozac really work. Needless to say, any interaction between brain serotonin and serotonin in the stomach remains beyond our comprehension. So in the meantime, our scientific understanding lacking, we medicate the depressed with SSRIs and other drugs and give antipsychotics to those with schizophrenia. We’re gratified when the drugs work for many patients, as well they do. But as the papers in this volume make clear, we are also flummoxed in sorting out science from pseudoscience, or even putting to use the evidence we have before we get even better data. This is true throughout health care, but the anomalies seem truly devastating in mental health care.Take the mounting evidence of the useful role of prevention and early intervention—probably employed even less in mental health care than elsewhere. In this issue’s Report from the Field, writer Steve Bogira quotes Chicago mental health clinic head Dr. Carl Bell as saying he feels as if he’s in the “iron lung business,” providing care that is increasingly out of step with science. This lag is compounded by the fact that mental health treatment, especially for lower-income populations, is still a low-priority societal activity—often brought into focus only amid terrible tragedy. We now know that the April 2007 shootings at Virginia Tech were preceded two years earlier by an episode in which the shooter, Seung-Hui Cho, was ordered by a Virginia special justice to seek outpatient mental health treatment that he never got. It’s therefore dismaying to read of one subsequent finding by the state’s mental health law reform commission—that about half of those who were evaluated for emergency services by the state’s community service agencies were people much like Cho, who weren’t currently in treatment.Clearly, well beyond implementation of parity laws, much remains to be done to improve both treatment and quality of life for the mentally ill. Robert Drake and colleagues focus on Social Security Disability Insurance, since more than a quarter of adults on SSDI have a primary psychiatric impairment. Most want to work but are limited to no more than twenty hours a week—when the evidence suggests that “supported employment” would both save money and help them do better.What’s more, many proposals now popping up as health reform initiatives could improve mental health treatment immeasurably. Comparative effectiveness research has already established that the older generic antipsychotics work as well as a class as the newer, branded, more expensive atypical ones. And stepped-up quality improvement efforts, write Audrey Burnam and colleagues, could increase the effectiveness of mental health treatments provided to veterans. Come to think of it, how about aiming for this title for Health Affairs’ next theme issue on mental health care: Why Not the Best? Loading Comments... Please enable JavaScript to view the comments powered by Disqus. DetailsExhibitsReferencesRelated Article MetricsCitations: Crossref 2 History Published online 1 May 2009 InformationCopyright 2009 by Project HOPE - The People-to-People Health Foundation, Inc.PDF downloadCited ByEmployee Assistance Programs: Evidence and Current Trends19 November 2012Theory in practice: Helping providers address depression in diabetes care*Journal of Continuing Education in the Health Professions, Vol. 30, No. 3

The Role of Providers in Mental Health Services Offered to American-Indian Youths