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Objective: Persons with serious mental illness face adverse psychiatric and medical outcomes, and their care is associated with a large burden of health care costs. Care management, in which assessment, care planning, and care coordination are provided, is a common model of support, yet the evidence supporting its use among psychiatric populations is mixed. A systematic review and a meta-analysis were undertaken to determine the impact of care management on clinical outcomes, acute care utilization, cost, and satisfaction among adults with serious mental illness., Methods: A multidatabase literature search was performed. Articles were included if they compared standard outpatient care plus care management with standard outpatient care alone for adults with serious mental illness and reported on one or more predefined outcomes. Randomized controlled trials (RCTs) and other study designs were permitted for inclusion in the systematic review. The meta-analysis included only RCTs., Results: For the systematic review, 34 articles representing 28 unique studies were included. Fifteen of these articles, representing 12 unique studies, were included in the meta-analysis, which indicated that care management was associated with small, statistically significant improvements in psychiatric symptoms, overall quality of life (QOL), and mental QOL (Hedges' g range 0.13-0.26). In addition, care management was associated with a small, statistically significant reduction in inpatient psychiatric hospital days (Hedges' g=0.16, p=0.02)., Conclusions: Care management is associated with fewer psychiatric symptoms and greater QOL for persons with serious mental illness. Further work is needed to determine which components of the intervention are associated with effectiveness.

Objective: This study examined mental health service use outcomes for children receiving integrated care via a collaborative-practice model (CPM). The study hypothesis was that the delivery of intensively integrated clinical care within pediatrics, combined with community-based parent support from family support specialists (FSSs), would facilitate mental health or substance use disorder treatment access and engagement for youths at risk of experiencing disparities., Methods: The study sample consisted of 228 children referred by pediatricians for outpatient child psychiatry evaluation within an urban safety-net hospital system in 2013. In the pilot clinic, 32 youths were referred to the CPM intervention. Among the remaining seven clinics, 196 youths were referred to usual care (control group). Differences in treatment access and engagement between the intervention and control groups were assessed using propensity-score weighted logistic regression models., Results: Holding all else constant, children receiving the CPM intervention had four times higher odds of accessing psychiatric evaluations than children in the usual care control group (adjusted odds ratio [AOR]=4.16, p<.01). The odds of engagement (i.e., participation in follow-up appointments) were seven times greater for youths in the CPM than youths in the control group (AOR=7.54, p<.01)., Conclusions: Access and engagement were significantly higher for children receiving CPM than for usual care participants. This suggests that integrated CPM warrants further investigation as an approach for improving the odds that children and families will receive needed mental health or substance use disorder treatment.

Physical comorbidities associated with mental health conditions contribute to high health care costs. This study examined the impact of having a usual source of care (USC) for physical health on health care utilization, spending, and quality for adults with a mental health condition using Medicaid administrative data. Having a USC decreased the probability of inpatient admissions and readmissions. It decreased expenditures on emergency department visits for physical health, 30-day readmissions, and behavioral health inpatient admissions. It also had a positive effect on several quality measures. Results underscore the importance of a USC for physical health and integrated care for adults with mental health conditions.

Objective: A random-effects meta-analysis of studies that used Markov transition probabilities (TPs) to describe outcomes for mental health service systems of differing quality for persons with serious mental illness was implemented to improve the scientific understanding of systems performance, to use in planning simulations to project service system costs and outcomes over time, and to test a theory of how outcomes for systems varying in quality differ., Methods: Nineteen systems described in 12 studies were coded as basic (B), maintenance (M), and recovery oriented (R) on the basis of descriptions of services provided. TPs for studies were aligned with a common functional-level framework, converted to a one-month time period, synthesized, and compared with theory-based expectations. Meta-regression was employed to explore associations between TPs and characteristics of service recipients and studies., Results: R systems performed better than M and B systems. However, M systems did not perform better than B systems. All systems showed negative as well as positive TPs. For approximately one-third of synthesized TPs, substantial interstudy heterogeneity was noted. Associations were found between TPs and service recipient and study variables Conclusions: Conceptualizing systems as B, M, and R has potential for improving scientific understanding and systems planning. R systems appear more effective than B and M systems, although there is no "magic bullet" system for all service recipients. Interstudy heterogeneity indicates need for common approaches to reporting service recipient states, time periods for TPs, service recipient attributes, and service system characteristics. TPs found should be used in Markov simulations to project system effectiveness and costs of over time.

Objective: This study aimed to fill a gap in the literature on effectiveness of employment accommodations by comparing employment outcomes for individuals with psychiatric disabilities who received or did not receive accommodations, with models informed by a conceptual approach blending static labor supply theory, Sen's capability approach, and the International Classification of Functioning., Methods: Data for the study came from a longitudinal, four-year eight-state multisite demonstration project funded by the U.S. Department of Health and Human Services' Substance Abuse and Mental Health Services Administration. All participants had been recruited from clinical populations receiving outpatient psychiatric services. The effects of job accommodations on hours worked were assessed with generalized linear modeling (N=1,538). The effects of job accommodations on duration of employment were assessed with a parametric duration model analysis (N=1,040) that incorporated multiple spells of employment among individuals over the study period., Results: Controlling for covariates suggested by the conceptual model, analyses showed that individuals who reported job accommodations on average worked 7.68 more hours per month and those who reported receiving accommodations worked 31% longer, with each job accommodation reported decreasing the risk of job termination by nearly 13%., Conclusions: Results demonstrate that job accommodations show potential to improve employment outcomes for individuals with psychiatric disabilities receiving supported employment services, indicating that job accommodations should be stressed in policy and continuing education efforts for program staff and clients.

Spending on mental and substance use disorders will likely grow more slowly than all health spending through 2020. We project that spending on mental and substance use disorders, as a share of all health spending, will fall from 7.4 percent in 2009 ($172 billion out of $2.3 trillion) to 6.5 percent in 2020 ($281 billion out of $4.3 trillion). This trend is the projected result of reduced spending on mental health drugs because of patent expirations, the low likelihood of innovative drugs entering the market, and a slowdown in spending growth for hospital treatment. By 2020 the expansion of coverage to previously uninsured Americans under the Affordable Care Act (ACA), combined with the projected slowdown in Medicare provider payment rates under the ACA and the Budget Control Act of 2011, are expected to add 2.7 percent to behavioral health spending, compared to spending without these changes., (Project HOPE—The People-to-People Health Foundation, Inc.)

Objective: Numerous studies have evaluated the impacts of community housing models on outcomes of persons with severe mental illness. The authors conducted a meta-analysis of 44 unique housing alternatives described in 30 studies, which they categorized as residential care and treatment, residential continuum, permanent supported housing, and nonmodel housing. Outcomes examined included housing stability, symptoms, hospitalization, and satisfaction., Methods: Outcome scores were converted to effect size measures appropriate to the data. Effect sizes were combined to estimate random effects for housing models, which were then compared., Results: All models achieved significantly greater housing stability than nonmodel housing. This effect was greatest for permanent supported housing (effect size=.63, p<.05). No differences between housing models were significant. For reduction of psychiatric symptoms, only residential care and treatment differed from nonmodel housing (effect size=.65, p<.05). For hospitalization reduction, both residential care and treatment and permanent supported housing differed from nonmodel housing (p<.05). Permanent supported housing achieved the highest effect size (.73) for satisfaction and differed from nonmodel housing and residential care and treatment (p<.001 and p<.05, respectively)., Conclusions: The meta-analysis provides quantitative evidence that compared with nonmodel housing, housing models contribute to stable housing and other favorable outcomes. The findings also support the theory that different housing models achieve different outcomes for different subgroups. Data were not sufficient to fully answer questions designed to enable program planners and providers to better meet consumers' needs. It is important to answer these questions with research that uses common measures and adheres to scientific conventions.