Funding For Mental Health Services Research Articles

Evaluation approaches in mental health: Implications of the new federalism

Since the introduction of federal mental health legislation in 1963, there has been a changing emphasis on evaluation and accountability. With direct federal funding of community mental health services, accountability demands were met through expectations for local agency evaluation activities which were overseen by federal authorities. The advent of the New Federalism and the shift to block grant funding of mental health services to state mental health authorities have shifted responsibility for evaluation to the states and local programs. This paper reviews federal mental health statutes to trace the extent and locus of required evaluation activities and discusses two approaches to carrying out program evaluation: “top-down” where the evaluation topic, method, and data collection are mandated by an administering or funding body; and “bottom-up” approaches where the subject, method of study, and data to be collected are developed in response to a felt need at the local agency level. A case study of each approach as used at the state level in mental health is examined. Based on the literature and the case studies, conclusions are presented on the pro's and con's of each method in meeting accountability demands and the barriers which must be overcome for either method to be successful.

Costs of mandates for outpatient mental health care in private health insurance.

Various methods for estimating the cost of mandated mental health benefits have been devised, each resulting in substantially different estimates. These methods neglect to distinguish between the two components of cost to the insurer: social cost (due to increased utilization) and shifted cost (from other sources of payment). We apply a method we developed for estimating the two types of costs of mandates for outpatient mental health services that integrates data from insurers with information from the literature on financing of mental health services. We applied our method to legislation recently proposed in Massachusetts that would double the mandated minimum benefit level from +500 to +1,000. We expect payments by the largest carrier in the state to increase by a factor of 1.65. More than half of this increase represents shifted costs rather than new costs to society.

Inequities in the delivery and financing of mental health services for ethnic minority Americans.

Inequities in the delivery and financing of mental health services for ethnic minority Americans.

THE CHALLENGE TO MENTAL HEALTH SERVICES IN THE 1980s

Robert W. Gibson MD, is interviewed concerning the potential impact of restricted funding for mental health services in the 1980s, particularly as this applies to the practice of occupational therapy. Topics covered include the decreasing length of inpatient hospitalization; the possibility of a shifting emphasis lo the treatmcnt of the severely and chronically ill; increasing utilization of rehabilitative services; and suggestions to facilitate greater interprofessional collaboration. Thc establishment of measurable outcomes for continued or improved reimbursement of occupational therapy services is stressed, and the potential for multiprofession group practices as a cost-effective approach to reduced business and industry health care costs is suggested.

The National Plan for the Chronically Mentally Ill: a review of financing proposals.

In this, a companion piece to the preceding article, the author summarizes and examines the financing issues and recommendations set forth in the National Plan for the Chronically Mentally Ill. The major federal programs that provide assistance to chronic patients are described briefly. Sixteen proposed incremental reforms designed to fill gaps in the existing service system are listed and discussed; nine involve changes in the Medicaid program. The author also considers the options to go beyond incremental changes toward the establishment of a comprehensive program focused specifically on the needs of the chronically mentally ill. He discusses the advantages and drawbacks of three methods of organizing financing of mental health services that are described in the National Plan--a structured services program, a benefit-voucher program, and a cash transfer program.

Innovations in program and funding of mental health services for blue-collar families.

A public mental health clinic formerly serving only children and seeking to broaden its service and financial base joined with a consumer advocate, the United Auto Workers, to provide treatment to underserved blue-collar workers. Comprehensive outpatient mental health service to adults on a prepaid basis was made possible through an innovative financial arrangement with Blue Cross. The authors discuss various problems in implementing this program, which they offer as a possible model for financing community mental health services.

THE POLITICS OF MENTAL HEALTH: ORGANIZING COMMUNITY MENTAL HEALTH IN METROPOLITAN AREAS

THE POLITICS OF MENTAL HEALTH: ORGANIZING COMMUNITY MENTAL HEALTH IN METROPOLITAN AREAS Affiliation Lucy D. Ozarin CopyRight https://doi.org/10.2105/AJPH.59.10.1957-a Published Online: August 29, 2011