The journal of mental health policy and economics
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J Ment Health Policy Econ · Jun 2010
Review Comparative StudyEvaluating mental health care and policy in Spain.
The reform and expansion of mental health care (MHC) systems is a key health policy target worldwide. Evidence informed policy aims to make use of a wide range of relevant data, taking into account past experience and local culture and context. ⋯ The evolution of MHC in Spain may be regarded as a useful contextual case study for other countries embarking on reform, including some in Eastern Europe and Latin America. Spain is an example of a country that has undergone substantial economic and democratic transition in a short time frame; it has seen significant economic growth in some areas and has experienced mass immigration. While it is too early to judge the effectiveness of reforms in Spain, work to date clearly indicates some of the challenges that have to be overcome. These include better harmonisation and integration between health and social care, and more attention paid to the development or monitoring mechanisms to assess progress in reform implementation and better identify any widening of geographical disparities.
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J Ment Health Policy Econ · Dec 2009
Randomized Controlled TrialCost-effectiveness of a psychoeducational relapse prevention program for depression in primary care.
Major depression is a prevalent mental disorder with a high risk of relapses and recurrences, which are associated with considerable burden for patients and high costs for society. Despite these negative consequences, only few studies have focused on interventions aimed at the prevention of recurrences in primary care patients with depression. ⋯ The relatively positive economic results for CBT-enhanced PEP imply that UC enriched with CBT (but without PEP) might be cost-effective in preventing relapses in primary care patients with depression. The actual consequences of CBT for relapse prevention will have to be studied in further detail, both from a clinical and economic point of view.
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J Ment Health Policy Econ · Dec 2009
Cost-effectiveness of integrated care for elderly depressed patients in the PRISM-E study.
One proposed strategy to improve outcomes associated with depression and other behavioral health disorders in primary care settings is to strengthen collaboration between primary care and specialty mental health care through integrated care (IC). ⋯ These results suggest that general integration has its advantages and, when such integration exists, further integrating behavioral health care into primary care might be considered as one way to improve depression in elders. The finding that ESR may be cost effective in some settings is also policy relevant. Further research is needed to analyze the components of the costs of ESR in non-VA settings and the effectiveness of IC in VA settings.
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J Ment Health Policy Econ · Mar 2009
Psychiatric disorders and the labor market: an analysis by disorder profiles.
A key societal cost of mental illness is its impact on the labor market. In examining the relationship between psychiatric disorders and the labor market, the literature to date either examines psychiatric disorders in broad classes or focuses on the impact of specific conditions. ⋯ Additional research is needed to disentangle the findings presented. For example, it is important to separate the influence of substance use disorders from mood disorder and uncover the pathways by which the different conditions in substance use disorders may influence the job market.
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J Ment Health Policy Econ · Mar 2009
Randomized Controlled TrialCost-effectiveness analysis of integrated care for people with HIV, chronic mental illness and substance abuse disorders.
Triply diagnosed patients, who live with HIV and diagnosed mental health and substance abuse disorders, account for at least 13% of all HIV patients. This vulnerable population has substantial gaps in their care, attributable in part to the need for treatment for three illnesses from three types of providers. ⋯ Future trials with interventions with lower baseline levels of integration, longer duration and larger sample sizes may show improvement or slow the decline in quality of life. Future researchers should collect comprehensive cost data, because significant decreases in the cost of hospital care did not necessarily lead to significant decreases in the total cost of health services.