Duke study: Requiring mental health treatment saves money

Jul. 30, 2013 @ 04:51 PM

Issuing mandatory treatment may be considered controversial to some, but mandating outpatient treatment for certain people with severe mental illness results in major cost savings by cutting hospitalizations and increasing outpatient care, according to a financial analysis led by Duke Medicine researchers.

The finding contributes to the ongoing policy debate about appropriate treatment approaches for people with serious mental illness, according to a Duke Medicine release. Researchers focused on a New York program called the Assisted Outpatient Commitment, or “Kendra’s Law,” during the study.

The issue of mandatory outpatient treatment has been particularly heated due to recent mass shootings by gunmen who have mental health diagnoses, according to the release.

All but a handful of states have some form of involuntary outpatient commitment program, which requires certain high-risk patients to participate in community-based treatments.

But the programs have been used sporadically in most states due to concerns about costs, potential coercion of vulnerable people, and liability for patients who harm themselves or others, according to the release.

“At least from a cost standpoint, our evidence shows that outpatient commitment programs could be an effective policy,” lead author Jeffrey W. Swanson, a Duke University professor in psychiatry and behavioral sciences, said in a statement. “In many cases, people who are opposed to outpatient commitment programs say they’re going to waste money by spending public resources on a few people with court-ordered treatment, at the expense of people who want treatment and can’t get it. It’s part of the problem of the fragmented, underfunded mental health system.”

The researchers analyzed services used by 634 patients under court order to participate in community care, including 520 patients in New York City and 114 from other counties.

Psychiatric hospitalization rates fell steeply among participants in the program, according to the release. During the year before mandated community treatment, 180 of the 520 New York City participants were admitted to a state psychiatric hospital, and 373 were admitted to a psychiatric unit at other hospitals. In the year after starting the program, 70 were admitted to a state psychiatric hospital and 245 were admitted at other hospitals. Similar declines occurred in counties outside of New York City.

As hospitalizations fell, so did costs. People selected for the program had incurred, on average, more than $104,000 in mental health service costs during the preceding year. These costs declined to $59,924 per patient in New York City, and $53,683 among the other county participants, in the first year of the program. In the second year of the program, costs continued to decline, to $52,386 for the New York City participants and $39,142 for those in the counties.

Even as expenses for outpatient services more than doubled, the savings were realized, according to the release. Patients increasingly used case management support and transportation services, made clinical visits, sought addiction treatments and refilled prescriptions for medications.