The Mental Health Treatment Study.

Abstract

Security Disability Insurance (SSDI) beneficiaries with primary psychiatric impairments comprise the largest, fastest growing, and most costly population in the SSDI program. The Mental Health Treatment Study provides a comprehensive test of the hypothesis that access to evidence-based employment services and behavioral health treatments, along with insurance coverage, can enable SSDI beneficiaries with psychiatric impairments to return to competitive employment. It will also examine which beneficiaries choose to enter an employment study under such conditions. Currently in the field in 22 cities across the U.S., the MHTS aims to recruit 3,000 SSDI beneficiaries with psychiatric impairments into a randomized controlled trial. This paper describes the MHTS, its background, and its process and outcome assessments.

The disability system and programs to promote employment for people with disabilities

“…The MMS intervention was composed of two parts: a systemic review of symptoms and functioning by an experienced nurse prior to each prescriber visit and an "algorithmic approach" to MMS that employed diagnosis specific decision trees. Frey et al (2011) found that the MHTS improved several employment, earnings, and health outcomes for treatment group members and that participation rates were generally strong among those offered services. Frey et al noted that the strong participation rates (14 percent of those solicited participated) potentially reflect high unmet demand for these types of services.…”

“…However, these benefits came at significant intervention cost, as each treatment group member received $6,986 worth of services each year. Although the demonstration did not conduct a formal benefit-cost analysis, Frey et al (2011) noted that MHTS had impacts in other areas that would be important in assessing the net benefits of the demonstration. For example, MHTS created important service linkages to ensure that beneficiaries received and adhered to their prescription drug medication, as well as provided other mental health supports that had impacts elsewhere, including reduced hospitalizations.…”

Mental Illness and Mental Health: Is the Glass Half Empty or Half Full?

“…94 Recent data reveal that the proportion of SSDI awards for psychiatric disorders has increased from 11% in 1981 to 41% in 2006. 93 These startling figures suggest that while third parties often seek to raise the bar that defines the threshold for SMI, powerful financial incentives can drive both clinicians and patients to jump higher by overrating the severity and chronicity of functional impairments associated with mental illness. Unfortunately, this practice may disincentivize recovery, and could, ironically, result in denial of future health care coverage based on preexisting conditions.…”

“…92, p 253 of psychiatric symptoms, and psychotic symptoms in particular, 92 such that mental disorders have become the single largest source of disability, 93 with about one-third of mental health beneficiaries carrying a diagnosis of schizophrenia. 94 Recent data reveal that the proportion of SSDI awards for psychiatric disorders has increased from 11% in 1981 to 41% in 2006.…”

Improving the Quality of Care for Serious Mental Illness

“…There have been numerous efforts to engage in QI focused on supported employment. Some have been highly effective, while others have been frustrated, mostly by organizational or fi nancial constraints (Drake et al, 2013;Frey et al, 2008Frey et al, , 2011Hamilton et al, 2013 ;McHugo et al, 2007 ).…”