Allocation Of Mental Health Resources Research Articles

Adult mental health needs and expenditure in Australia.

Relatively little international work has examined whether mental health resource allocation matches need. This study aimed to determine whether adult mental health resources in Australia are being distributed equitably. Individual measures of need were extrapolated to Australian Areas, and Area-based proxies of need were considered. Particular attention was paid to the prevalence of mental health problems, since this is arguably the most objective measure of need. The extent to which these measures predicted public sector, private sector and total adult mental health expenditure at an Area level was examined. In the public sector, 41.6% of expenditure variation was explained by the prevalence of affective disorders, personality disorders, cognitive impairment and psychosis, as well as the Area's level of economic resources and State/Territory effects. In the private sector, 72.4% of expenditure variation was explained by service use and State/Territory effects (with an alternative model incorporating service use and State/Territory supply of private psychiatrists explaining 69.4% of expenditure variation). A relatively high proportion (58.7%) of total expenditure variation could be explained by service utilisation and State/Territory effects. For services to be delivered equitably, the majority of variation in expenditure would have to be accounted for by appropriate measures of need. The best model for public sector expenditure included an appropriate measure of need but had relatively poor explanatory power. The models for private sector and total expenditure had greater explanatory power, but relied on less appropriate measures of need. It is concluded that mental health services in Australia are not yet being delivered equitably.

Allocation of resources and psychosis.

This commentary reviews current expenditure on psychosis in Australia, identifies discretionary expenditure that could be used more efficiently, discusses the factors influencing resource allocation and intervention selection decisions, and suggests priorities for change. Cost-of-illness findings from the Low Prevalence Disorders Study (LPDS), and related service use and psychosocial data, are used to highlight patterns of expenditure on psychosis and potential resource allocation issues. Arguments are also presented suggesting that mental health resource allocation in Australia should be informed primarily by treatment efficiency, equity and humanitarian considerations, not differences in the global burden of disease. However, our evidence-base about the effectiveness and costs associated with individual treatments, programmes, and organizational structures is also shown to be limited. The patterns of service use and expenditure on psychosis suggest certain imbalances, including an over-reliance on hospitalization, low levels of supported community accommodation, and inadequate provision of evidence-based psychosocial treatments, rehabilitation and supported employment programmes. We need to identify and develop efficient interventions and programmes, re-orientate our services to better utilize those interventions, increase community awareness, improve monitoring of outcomes and costs, and undertake timely evaluations at multiple levels, from the individual to the societal perspective.

Distributive justice in Medicaid capitation: the evidence from Colorado.

In 1995, the state of Colorado began a new funding program for the provision of mental health services to Medicaid recipients. Medicaid funding was restructured from a fee-for-service system into a capitated managed care system. The restructuring altered the way in which mental health resources were allocated within Colorado's mental health system. This article explores the ethical principles inherent in the allocation of mental health resources within Colorado. The allocation system before and after the capitation pilot is analyzed according to three models of distributive justice. Under capitation, access to care corresponds to egalitarian ideals, while service delivery and outcomes follow a more utilitarian philosophy. Results from several empirical studies of the Colorado Medicaid system are used to support this ethical analysis. The analysis leads to the suggestion that the fair-opportunity rule may be a useful principle for developing just distribution systems in other states in the future.

Economic Thinking about Mental Health Resource Allocation

Economic Thinking about Mental Health Resource Allocation

The significance of self-reported anxious symptoms in first-grade children

It is generally believed that prior to the middle to late elementary school years children's reports of anxious symptoms represent nothing more than transient developmental phenomena. In light of the limited empirical study of this issue and its import to the allocation of mental health resources, the present study seeks to provide empirical evidence of the significance of anxious symptoms in children younger than 7. Specifically, utilizing an epidemiologically defined population of 1197 first-grade children, followed longitudinally from the fall to spring of first grade, we examine the stability, prevalence and caseness of children's self-reports of anxious symptoms. Self-reported anxious symptoms proved relatively stable over 4-month test-retest interval. In addition, they appeared to have a significant impact on academic functioning in terms of reading achievement. These findings on stability, caseness, and prevalence suggest children's self-reported anxious symptoms in the early elementary school years may have clinical significance. However, further study is necessary before firm conclusions can be drawn.

Ontario Child Health Study. I. Methodology.

We developed the methodology for a community survey to determine the prevalence of emotional and behavioral disorders among children 4 to 16 years of age in Ontario, Canada. Our discussion includes the objectives of the survey, the measurement of disorder, sampling methods and survey design, and a description of the data collected and instrumentation. Among 2052 households with eligible children, 1869 (91%) participated in the survey. The results can be used to help plan the future allocation of mental health resources in Ontario.

Selection Factors in the Dispensation of Therapy: The Matthew Effect in the Allocation of Mental Health Resources

This paper suggests that mental health resources are frequently delivered to those who are most as patients in the eyes of service providers rather than to those who are most in need. Analysis of a census of the inpatient population of New York State hospitals finds a strikingly consistent pattern: The younger, more motivated, more communicative, and more competent patients are more likely to receive attention. Less desirable patients, those most in need, are more likely to receive no social therapy at all. This is seen to be a manifestation of Merton's Matthew effect and a demonstration that even when it comes to the treatment of psychiatric patients, the familiar dictum advantage accumulates appears to hold.

Allocation of Mental Health Resources in a Military Setting: A Community Mental Health Approach

Allocation of Mental Health Resources in a Military Setting: A Community Mental Health Approach