Psychiatric services : a journal of the American Psychiatric Association
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The 2008 Mental Health Parity and Addiction Equity Act (MHPAEA) sought to improve access to behavioral health care by regulating health plans' coverage and management of services. Health plans have some discretion in how to achieve compliance with MHPAEA, leaving questions about its likely effects on health plan policies. In this study, the authors' objective was to determine how private health plans' coverage and management of behavioral health treatment changed after the federal parity law's full implementation. ⋯ Implementation of federal parity legislation appears to have been accompanied by continuing improvement in behavioral health coverage. The authors did not find evidence of widespread noncompliance or of unintended effects, such as dropping coverage of behavioral health care altogether.
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As the United States grapples with an opioid epidemic, expanding access to effective treatment for opioid use disorder is a major public health priority. Identifying effective policy tools that can be used to expand access to care is critically important. This article examines the relationship between state-targeted funding and technical assistance and adoption of three medications for treating opioid use disorder: oral naltrexone, injectable naltrexone, and buprenorphine. ⋯ State-targeted funding for medications may be a viable policy lever for increasing access to opioid use disorder medications. Given the historically low rates of opioid use disorder medication adoption in treatment programs, single-state agency targeted funding is a potentially important tool to reduce mortality and morbidity associated with opioid disorders and misuse.
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Multicenter Study Comparative Study
The Use of Telepsychiatry to Provide Cost-Efficient Care During Pediatric Mental Health Emergencies.
This study evaluated a videoconference-based psychiatric emergency consultation program (telepsychiatry) at geographically dispersed emergency department (ED) sites that are part of the network of care of an academic children's hospital system. The study compared program outcomes with those of usual care involving ambulance transport to the hospital for in-person psychiatric emergency consultation prior to disposition to inpatient care or discharge home. ⋯ Measured by charges and time, telepsychiatry consultations for pediatric psychiatric emergencies were cost-efficient from a hospital system perspective compared with usual care consisting of ambulance transport for in-person consultation at a children's hospital main campus. Telepsychiatry also improved clinical and operational efficiency and patient and family experience, and it showed promise for increasing access to other specialized health care needs.
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Major policy efforts are being aimed at combating the epidemic of opioid addiction and overdose deaths. In response to the epidemic, the medical community and policy makers have attempted to intervene; to date, these varied approaches have done little to reverse the increase in mortality related to opioid overdose. ⋯ The rise in fentanyl-related overdose deaths means that new approaches are needed to combat the opioid epidemic, including adoption of harm reduction strategies. Specific strategies that should be considered as part of efforts to combat the opioid crisis include safe drug consumption sites, anonymous drug-checking services, updated naloxone distribution policies, harm reduction-oriented policing, expansion of evidence-based pharmacological treatments in criminal justice and emergency department settings, and stigma-reduction messaging emphasizing the risks of fentanyl.
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The study assessed whether receiving specific types of Veterans Health Administration (VHA) Therapeutic and Supported Employment Services (TSES) between fiscal years (FYs) 2006 and 2010 (a time frame that encompasses the Great Recession) was associated with obtaining competitive employment among veterans with mental illnesses. ⋯ Although rates of competitive employment were modest across all types of services, community-based employment services were associated with higher odds of achieving competitive employment, compared with services based in a medical center. The Great Recession negatively affected the likelihood of achieving competitive employment, regardless of the employment service received.