Funding For Mental Health Services Research Articles

The Relationship Between General Population Suicide Rates and Mental Health Funding, Service Provision and National Policy: a Cross-National Study

The main aims were to examine the relationship between general population suicide rates and the presence of national policies on mental health, funding for mental health, and measures of mental health service provision. Data on general population suicide rates for both genders were obtained from the World Health Organization (WHO) databank available on the WHO website. Data on the presence of national policies on mental health, funding for mental health and measures of mental health service provision were obtained from the Mental Health Atlas 2005, also available on the WHO website. The main findings were: (i) there was no relationship between suicide rates in both genders and different measures of mental health policy, except they were increased in countries with mental health legislation; (ii) there was a significant positive correlation between suicide rates in both genders and the percentage of the total health budget spent on mental health; and (iii) suicide rates in both genders were higher in countries with greater provision of mental health services, including the number of psychiatric beds, psychiatrists and psychiatric nurses, and the availability of training in mental health for primary care professionals. Cross-national ecological studies using national-level aggregate data are not helpful in establishing a causal relationship (and the direction of this relationship) between suicide rates and mental health funding, service provision and national policies. The impact of introducing national policies on mental health, increasing funding for mental health services and increasing mental health service provision on suicide rates requires further examination in longitudinal within-country studies.

The organisation of mental health services in post-war Bosnia and Herzegovina

Bosnia and Herzegovina (BH) is located on the western part of the Balkan Peninsula. It has an area of 51 210 km2 and a population of 3 972 000. According to the Dayton Agreement of November 1995, which ended the 1992-95 war, BH comprises two 'entities' - the Federation of Bosnia and Herzegovina (FBH) and the Republic of Srpska (RS) - and the District of Brcko. The administrative arrangements for the management and financing of mental health services reflect this. The FBH, with 2 325 018 residents, is a federation of 10 cantons, which have equal rights and responsibilities. The RS has 1 487 785 residents and, in contrast, a centralised administration. Brcko District has just under 80 000 residents.

How Medicaid Agencies Administer Mental Health Services: Results From a 50-State Survey

This brief report describes some notable variations in how state Medicaid agencies administer and fund Medicaid mental health services. Hour-long telephone interviews were conducted with all state and District of Columbia Medicaid directors or their designees. Responses indicated that Medicaid and mental health agencies were located within the same umbrella agency in 28 states, potentially facilitating collaboration. The mental health agency provided funding for some Medicaid mental health services in 32 states, and counties provided such funding in 22 states. Medicaid agencies generally delegated more authority to state mental health agencies in states where some Medicaid funding came from mental health sources and also in states where both agencies were in the same umbrella agency. The increasing role of Medicaid in funding state mental health services, combined with new federal limits on Medicaid financing of these services, underscores the importance of interagency collaboration and better alignment of Medicaid and mental health responsibilities.

The Impact of Integrating Mental and General Health Services on Mental Health's Share of Total Health Care Spending in Alberta

In April 2003 the Alberta government integrated specialized mental health services, formerly organized independently, with the health regions, which are responsible for general health services. The objective of this article is to determine whether the transfer was associated with an increase or decrease in the share of resources in the region allocated to mental health care relative to total spending for health care. The measure of the share for mental health care is the total costs for mental health care resources as a percentage of total health care spending. Resources and spending examined were those that were actually or potentially under the regions' control. Annual costs for mental health services in the province were obtained for a seven-year period (fiscal year [FY] 2000 through FY 2006) from provincial utilization records for all residents in the province. Unit costs were assigned to each visit. The trend in the share measure was plotted for each year. The share for mental health care increased overall from FY 2000 (7.6%) to FY 2003 (8.2%), but returned to pre-FY 2003 levels in the three years after the transfer (7.6%). Despite concerns expressed before the transfer by federal and provincial reports over the level of expenditures devoted to mental health care, the integration of mental health services with other health services did not result in an increase of the share for mental health care.

Mental health in New Zealand

New Zealand's healthcare system has undergone significant changes in recent times, among them being the establishment in 1993 of a purchaser/provider split and the specific attention given to the development of mental health services. Funding for mental health services (Fig. 1) increased from NZ$270 million in 1993/94 to NZ$866.6 million per annum in 2004/05, a real increase (adjusted for inflation) of 154% (Mental Health Commission, 2006). The bi-partisan political commitment sustaining this funding has had a major impact on the development of recovery-based and culturally specific models of care unrivalled by few countries in the world. However, recent reports (Mental Health Commission, 2006) indicate that, particularly with regard to access, much still remains to be done to address the mental health needs of New Zealanders.

The relationship between elderly suicide rates and mental health funding, service provision and national policy: a cross-national study

Elderly suicide rates may be influenced by mental health funding, service provision and national policy. A cross-national study examining the relationship between elderly suicide rates and (i) the presence of national policy on mental health, (ii) funding for mental health, and (iii) measures of mental health service provision was undertaken by utilizing data from the World Health Organization website. The main findings are: (i) there is no relationship between suicide rates in both sexes in both elderly age-bands and different measures of mental health policy, except they were increased in countries with a substance abuse policy; and (ii) suicide rates in both sexes in both elderly age-bands were higher in countries with greater provision of mental health services, including the number of psychiatric beds, psychiatrists, psychiatric nurses, and the availability of training in mental health for primary care professionals. Cross-national ecological studies using national-level aggregate data are not helpful in establishing a causal relationship (and the direction of this relationship) between elderly suicide rates and mental health funding, service provision and national policies. The impact of introducing national policies on mental health, increasing funding for mental health services and increasing mental health service provision on elderly suicide rates requires further examination in longitudinal within-country studies.

Time Trends and Predictors of Suicide Among Mental Health Outpatients in the Department of Veterans Affairs

Using merged Veterans Affairs (VA) and National Death Index data, this study examined changes in suicide rate among three cohorts of VA mental health outpatients during a time of extensive bed closures and system-wide reorganization (1995, N = 76,105; 1997, N = 81,512; and 2001, N = 102,184). There was a decreasing but nonsignificant trend in suicide rates over time-13.2, 11.4, and 10.3 per 10,000 person-years, respectively. Multivariable predictors of suicide included both younger and older ages (U-shaped association). At the facility level, there was an association between greater per capita outpatient mental health expenditure and reduced suicide risk. The model also showed a protective effect associated with increased mental health spending on inpatient services, and that outpatients at facilities with larger mental health programs, as measured by patient volume, were at greater risk for suicide than were those in smaller programs. Although more chronic patients may have been underrepresented to some extent as a result of the sampling methodology, these findings provide generally reassuring evidence that overall suicide rates have not been adversely affected by VA system changes. Nevertheless, they highlight the importance of funding for mental health services as well as the implications of changing demographics in the VA population.

First Encounters: A Psychiatric Emergency Program

There is a health care crisis in the United States. Our nation spends more dollars on health care annually than any other country, yet the number of uninsured and underserved people continues to escalate. Concomitantly, the number of ED visits also has risen and has been reported to have increased by as much as 14% in recent years.1 A contributing factor to increased ED utilization is the decrease in funding for mental health services, including limited outpatient and clinic services, as well as a decreasing number of inpatient psychiatric beds and, in some cases, the closure of entire psychiatric programs.

WHO's Assessment Instrument for Mental Health Systems: Collecting Essential Information for Policy and Service Delivery

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.

Mentally Ill Could Pay Price for Bush Budget Cuts

Mentally Ill Could Pay Price for Bush Budget Cuts

Doing My Best: Poverty and Self-Care Among Individuals With Schizophrenia and Diabetes Mellitus

Diabetes mellitus (DM) is more common among individuals with schizophrenia/schizoaffective disorders than among the general population. Eleven mental health consumers diagnosed with comorbid schizophrenia/schizoaffective disorder and DM participated in a grounded theory study that examined their approaches to diabetic self-care. The resulting model, Evolving Self-Care, describes the process by which respondents developed health beliefs about the self-care of dual illnesses. One subcategory of the model, Doing My Best, was further analyzed to examine the social context of respondents' diabetic self-care. Limited financial resources and material deprivation interfered with access to the resources necessary for adequate diabetic self-care. Mental health providers are encouraged to provide treatment and patient education that are consistent with the real world living situations of individuals with schizophrenia. Policymakers at the federal and state levels need to address the impact of financing of mental health services on the overall health of vulnerable individuals with serious mental illnesses.

Issues in Medicaid Policy and System Transformation: Recommendations From the President's Commission

Issues in Medicaid Policy and System Transformation: Recommendations From the President's Commission

Special Housing Trusts Foster Independence

Special Housing Trusts Foster Independence

Living with mental illness in Australia: Changes in policy and practice affecting mental health service consumers

The movement of large numbers of people from psychiatric hospitals in the 1960s changed the face of mental health services in Australia. This paper explores some of the issues facing people living with mental illness in the community today and the impact of social policy, legislative change and funding of services on their lives, with particular reference to New South Wales. The growth of support and advocacy groups in the 1970s and 1980s, and their role alongside psychologists and other health workers in bringing about change in the provision and type of mental health services, are examined. Opportunities for advocacy and real input into the quality of service provisions have increased, and many people living with disabilities are active in contributing to policy development and advocacy services. However, the level of funding of mental health services and the resources available to care for people living with mental illness in the community remain low and, in many cases, inadequate to provide proper quality care for people living with mental illness.

Long journey to recovery for Kiwi consumers: Recent developments in mental health policy and practice in New Zealand

Mental health services worldwide are undergoing significant changes in philosophy and direction due to the rising influence of the consumer or service user movement. This paper explores some key developments in the history of social policy, legislative change and funding of mental health services in New Zealand, especially since the landmark 1996 Mason Report. The growth in consumer networks and consumer participation in the aftermath of this report at multiple levels of the mental health service system is examined, with a particular focus on the adoption of the recovery approach as the guiding principle for the nation's mental health strategy. Consumers and carers are now active in contributing to strategy, policy and service development, nationally and locally. Opportunities for advocacy, advice and input into the quality of service provision have increased for many people living with mental illness. However, although government policy and systems are designed to drive services towards consumer empowerment and the recovery approach, there is still a long way to go before a fuller paradigm shift and greater consumer participation are achieved for people living with mental illness in the New Zealand community.Many of the developmental stages in mental health services outlined by Smith and Gridley (2006) in New South Wales and across Australia were happening simultaneously in Aotearoa: New Zealand. Today, traditional psychiatric hospitals such as Cherry Farm, Lake Alice, Tokanui, Sunnyside and Porirua no longer exist, and psychiatric units have been integrated into general hospitals and the general health system. This significant step in de-stigmatising mental illness has been accompanied since the mid-1990s by increasing changes in the relationship between mental health service consumers and providers.Mental health consumers and their family or whanau members are exercising their voice, and assuming increasingly crucial roles in policy formulation as well as service design and delivery. This influence is, in turn, helping to shape changes in professional mental health thinking and practice. Today it is generally accepted that service consumers are to be seen as people who have something valid to say about the treatment and care they are given or have to receive, and the services and systems that deliver that care.The first half of this paper provides an overview of key developments and pressures in New Zealand mental health policy and practice that laid the ground for the watershed 1996 Mason Report and the subsequent increased consumer participation. The second half focuses on the post-Mason Report era, particularly the expansion in consumer activism at multiple levels of the mental health service system, and the adoption of the recovery approach as the guiding principle for the nation's mental health system. We then identify some key challenges to a fuller paradigm shift and greater consumer participation for people living with mental illness in the New Zealand community in the 21st century. (A Table is available on request that summarises some of the major developments in policy, legislation and provision of services for people living with mental illness since early colonial New Zealand. Brunton (1997) offers a very rich and more localised account of the direct impact of these major developments for the West Coast, South Island mental health services since 1872.)

Transitions between the public mental health system and jail for persons with severe mental illness: a Markov analysis

Proposed changes to the mental health care system are usually debated in terms of either health benefits or costs savings. However, because of the extensive intersection between the mental health system and the criminal justice system, changes in the organization and financing of mental health services may change the jail detention rate. We analyze jail incarcerations for felonies and non-felonies following the start of a public managed mental health care program in King County, Washington (including Seattle). We analyze unique data that tracks individuals in and out of the public mental health, Medicaid, and criminal justice systems for 1993-1998. In this manuscript we examine individuals with severe mental illness who were enrolled in the Washington state Medicaid program. The final sample size has monthly observations on 6766 unique individuals aged 18-64. We estimate Markov models of the monthly transition probabilities among living in the community with no public mental health treatment, receiving inpatient or outpatient mental health or substance abuse services, or being in jail for either a felony or non-felony charge. The transition probabilities are adjusted for demographics and policy changes that occurred during our study period. There is little evidence of any change in the jail detention rate for severely mentally ill users of the county mental health system in contrast with other SMI individuals following the public managed care program.

Financing Mental Health Care in Spain: Context and critical issues

Background: Financing and the way in which funds are then allocated are ke y issues in health policy. They can act as an incentive or barrier to system reform , can pri- oritise certain types or sectors of care and have long term consequences for the planning and delivery of services. The way in which these issues can impact on the funding of mental health services across Europe has been a key task of the Mental Health Economics European Network. (MHEEN) This paper draws on information prepared for MHEEN and provides an analysis of the context and the main issues related to mental health financing in Spain. Methods: A structured questionnaire developed by the MHEEN group was used to assess the pattern of financing, eligibility and coverage for mental healthcare. In Spain contacts were made with the Mental Health agencies of the 17 Autonomous Communities (ACs), and available mental health plans and annual reports were reviewed. A direct col- laboration was set up with four ACs (Madrid, Navarre, Andalusia, Catalonia). Results: In Spain, like many other European countries mental healthcare is an integral part of the general healthcare with universal coverage funded by taxation. Total health e xpenditure accounted for 7.7% of GDP in 2003 (public health expenditure was 5.6% of GDP). Although the actual percentage expended in mental care is not known and esti- mates are unreliable, approximately 5% of total health expenditure can be attributed to mental health. Moreover what is often overlooked is that many services have been shifted from the health to the social care sector as part of the reform process. Social care is dis- cretionary, and provides only limited coverage. This level of expenditure also appears low by European standards, accounting for just 0.6% of GDP. Comments: In spite of its policy implications, little is known about mental healthcare f inancing in Spain. Comparisons of expenditure for mental health across the ACs are prob- lematic, making it difficult to assess inequalities in access to services across the country. The limited data available on mental healthcare expenditure suggests that level of funding for mental health is low compared with many of the EU-15 countries. This may indicate inefficient and inequitable funding given the significant contribution of mental disorders to the overall burden of ill health. Attention needs to be directed to redressing both the information deficit and also in using a range of financing mechanisms to promote greater investment in mental health.

Two Reports Point Government To More Effective MH System

Two Reports Point Government To More Effective MH System

The Impact of Capitated Financing on Psychiatric Emergency Services

Studies of capitated financing of mental health services have generally focused on the cost and utilization of services. Relatively little research has addressed whether capitation has an impact on the effectiveness of the mental health system as a whole. This study examined the impact of capitation on hospital emergency department visits, a widely cited indicator of the effectiveness of the other components of the system. In 1995 Colorado's Medicaid program instituted capitation for mental health services in two areas of the state, one in which reimbursement of not-for-profit providers was directly capitated and another in which not-for-profit providers partnered with a for-profit managed behavioral health organization. The analysis examined variation over time in the number of emergency department visits by adults who had a primary mental or substance use disorder. Using interrupted time-series methods, visits in areas where reimbursement was capitated were compared with visits in areas where providers continued to be reimbursed on a fee-for-service basis. A total of 105 weeks for each area was examined; capitation was implemented at week 53. The number of psychiatric emergencies treated in capitated areas declined by 814 (28 percent) below the 2,908 psychiatric emergencies expected from trends, cycles, and levels in fee-for-service areas. Findings were similar for for-profit and not-for-profit areas. The decrease persisted through the end of the first year after capitation. In Colorado the implementation of capitation was associated with a sustained decrease in utilization of psychiatric emergency services provided by hospital emergency departments. Our findings suggest that capitation does not necessarily reduce the quality of care provided to clients.

Financing of mental health services: an international perspective

Financing is a critical factor in the realisation of a viable mental health system. It is the mechanism by which plans and policies are translated into action through the allocation of resources. Financing is essential for operations and the delivery of services, for the development and deployment of a trained workforce, and for the required infrastructure and technology (Chernichovsky & Chinitz, 1995; World Health Organization, 2003). Financing mechanisms can also be used to facilitate change and introduce innovations in systems (World Health Organization, 2003).