Monday, October 11, 2004

Why Are Community Treatment Orders Controversial?
Article in the September Canadian Journal of Psychiatry - "The use of community treatment orders and other forms of mandatory outpatient treatment has been controversial. The debate on the appropriateness of compulsory treatment in the community addresses a volatile mix of clinical, social policy, legal, and philosophical issues. This paper describes the major sources of contention, outlines the position of the protagonists, and where possible, attempts to answer some of the questions raised and identify common ground."  
  

Involuntary Outpatient Commitment, Community Treatment Orders, and Assisted Outpatient Treatment: What’s in the Data?
Article in the September Canadian Journal of Psychiatry - "Involuntary outpatient commitment (OPC) is a legal intervention designed to benefit persons with serious mental illness (SMI) who need ongoing psychiatric care and support to prevent relapse, hospital readmissions, homelessness, or incarceration but have difficulty following through with community-based treatment. Virtually all states in the US permit some form of OPC. Forty states and the District of Columbia have explicit OPC statutes, while several states are currently considering enacting or modifying existing OPC legislation (1–4). OPC has been enacted or is being considered in several other countries, including Israel, Canada, the UK, Australia, and New Zealand (5–11). OPC is also referred to as assisted outpatient treatment, community treatment orders (CTOs), and mandated outpatient treatment. In this paper, we refer to it generically as OPC. We discuss the empirical evidence for the effects of OPC on treatment outcomes. "  
  

Hospitalization in the First Year of Treatment for Schizophrenia
Article in the September Canadian Journal of Psychiatry - "Over the past decade, interest has increased in designing services to optimize care during the early stages of psychotic disorders. In designing these services, it will be important to study such service indicators as hospitalization rates and to investigate factors that may influence these indicators. The province of Nova Scotia is an advantageous setting in which to carry out such studies. Available administrative databases contain all inpatient admissions and outpatient psychiatric contacts. As do all Canadian provinces and territories, Nova Scotia provides universal access to health care. A prototype Early Psychosis Program, designed to enhance prompt assessment and optimize treatment, has been operating in the province since late 1995. The program has focused on education about the signs and symptoms of early psychosis while also providing expert clinical care for a self-selected convenience sample of first-episode patients. This study measured hospitalization rates during the first year of treatment for schizophrenia in Nova Scotia and identified factors that might influence those rates."  
  

Medicare Demonstration PPOs
A September GAO report to the House Finance Committeein Adobe Acrobat format - "Preferred provider organizations (PPO) are more prevalent than other types of health plans in the private market, but, in 2003, only six PPOs contracted to serve Medicare beneficiaries in Medicare+Choice (M+C), Medicare’s private health plan option. In recent years, the Centers for Medicare & Medicaid Services (CMS), the agency that administers Medicare, initiated two demonstrations that include a total of 34 PPOs. GAO (1) described how CMS used its statutory authority to conduct the two demonstrations, (2) assessed the extent to which demonstration PPOs expanded access to Medicare health plans and attracted enrollees in 2003, (3) compared CMS’s estimates of out-of-pocket costs beneficiaries incurred in demonstration PPOs with those of other types of coverage, including fee-for-service (FFS) Medicare, M+C plans, and Medigap policies in 2003, and (4) determined the effects of demonstration PPOs on Medicare spending."  
  

Safe and Effective Approaches to Lowering State Prescription Drug Costs: Best Practices Among State Medicaid Drug Programs
A September CMS/HHS report in Adobe Acrobat format - "As a result of increasing prescription drug costs, State Medicaid programs have implemented a variety of cost-containment mechanisms in their drug programs over the past few years. These mechanisms have allowed states to reduce their pharmacy expenditures and maintain beneficiary access to a vital part of their overall healthcare. This paper describes some of these cost-containment mechanisms and highlights several states that have achieved reduced costs with each technique. In general, states have not yet taken advantage of all of these approaches. CMS can provide consultation and support to assist states in using these and other methods to lower their drug costs without compromising quality of care."  
  

Psychosocial Screening, Parenting Education Can Reduce Youth Violence
A new CME unit at Medscape - "Psychosocial screening with parenting education can reduce youth violence, according to the results of a randomized trial published in the October issue of Pediatrics..." "med"  
  

Preferred lists for drugs such as Prozac? (Virginia)
October 7 Richmond Times-Dispatch story - "State Medicaid officials yesterday moved closer to making antidepressants such as Prozac and Zoloft subject to tighter prescribing procedures - but just how strict is yet to be determined. In an effort to control costs, the state agency has created lists of preferred drugs that doctors select from when prescribing drugs for Medicaid patients. That way, the state can negotiate better prices on the preferred drugs. At the urging of mental-health advocates, antidepressants and anti-anxiety drugs had been excluded from that process - until yesterday. Despite testimony from advocates that psychotropic drugs should be given special consideration, the Medicaid agency's Pharmacy and Therapeutics Committee yesterday voted to consider preferred drug lists in those categories..."  
  

States Find Creative Uses For Treatment Grants
Psychiatric News story - "People seeking help for drug and alcohol abuse and dependence in a number of states will benefit from a federal treatment initiative that provides vouchers to pay for individualized care. Fourteen states and one tribal community are the recipients of a total of $100 million in Access to Recovery grants for people seeking treatment for drug and alcohol problems. Access to Recovery is a three-year federal treatment initiative proposed by President George W. Bush in his 2003 State of the Union address. The program is administered by the Substance Abuse and Mental Health Services Administration and is designed to help people with substance abuse and dependence to find treatment in their communities." See also the overview of the Access to Recovery faith-based initiative (Adobe Acrobat format).  
  

Research Designs Need Not Exclude Suicide Risk
Psychiatric News story - "In routine clinical trials of new medications, patients with a history of suicidal behavior are typically excluded, so that the specific effect of drugs on suicidality is not known. Research on interventions for suicidal behavior is dogged by ethical problems: how to design a study that rigorously tests the effectiveness of treatment, but that adequately protects subjects at high risk of killing themselves. Yet it is possible to design a randomized, controlled trial that minimizes the risk of morbidity and mortality for suicidal patients while providing valuable data on effectiveness of interventions, according to Maria A. Oquendo, M.D., and colleagues, in a report in the August American Journal of Psychiatry."  
  

'Switching' Risks Minimal In Bipolar Treatment
Psychiatric News story - "Antidepressants can be both safe and effective in the treatment of bipolar depression, without risk of "switching" patients to mania. Antidepressants are effective in the treatment of bipolar depression and are safe when used for short-term treatment. That is the conclusion of new research whose findings do not support a risk of "switching" patients to mania. A wide-ranging review of data from randomized controlled trials of antidepressants in bipolar patients also found that selective serotonin reuptake inhibitors (SSRIs) and monoamine oxidase inhibitors (MAOIs) are more prudent choices for first-line therapy than tricyclics. The data were reported in the September American Journal of Psychiatry..."  
  

Many in Assisted Living Have Mental Health Problems
HealthDayNews story at Yahoo - "Rates of mental health problems among elderly assisted living residents are higher than expected, says an Indiana University study in the October issue of the Journal of the American Geriatrics Society. Two-thirds of the 2,100 assisted living residents in the study showed signs of mental health problems. Half of them had dementia and a quarter of them showed signs of depression. More than half took psychotropic medications such as antipsychotics, sedatives or antidepressants..."  
  

Mental health dispute lands back in court today (Arizona)
October 8 Arizona Republic story - "State health officials and mental-health attorneys are divided over the best way to provide better care to the Valley's seriously mentally ill on the heels of a critical performance audit of the system. The parties are being called into court today to hammer out a joint plan for improvements following the August audit that found that despite getting $230 million in extra funding, the system had reversed course and was worse off in some areas than it was four years ago." See also the follow up story the next day, Judge orders fast action on mental-health system - "Repeatedly chastising the state for poor monitoring, a Maricopa County Superior Court judge on Friday ordered it to come up with a plan to fix the Valley's mental-health system by mid-December. Judge Pro Tem Bernard Dougherty told the state to return in two months with a detailed report on how it will comply with court orders under the Arnold vs. Sarn case, which is more than two decades old."  
  

Backers say mental health levy to keep programs alive (Ohio)
Toledo Blade story - "The Lucas County Mental Health Board helps fund mental health care for thousands of county residents, but now the board says it needs some help of its own. 'We're just trying to stay above water,' Jackie Martin, the board's executive director, said of her organization's struggle to keep up with increasing demand. Four years ago, the board funded services for 11,729 clients. But a poor economy and a growing number of residents without health insurance have sparked a 27 percent increase in those getting help, with 14,881 people getting some aid from the board. That aid includes help with medication expenses and providing housing, counseling, and emergency services. The board seeks a 10-year, 0.5-mill replacement levy on the Nov. 2 ballot, bringing in $4.4 million annually, a net increase of $1.9 million over the existing levy."  
  

Mental health advocates hope for respite in Prop. 63 (California)
Times-Standard story - "Humboldt County Mental Health Director Lance Morton said he's worked in various counties' mental health programs for 27 years, and has seen his budget shrink for 20 of those years. Morton and local families of mentally ill people are hoping that Proposition 63 will turn a bit of that around. The proposition would impose an additional income tax of 1 percent on taxable income above $1 million beginning Jan. 1 and put the money into a fund for counties' mental health services..."  
  

Mental health care: need and value
Roanoke Times editorial - "Sometimes, the evidence in support of improved access to mental health care is like mental illness itself: starkly real, devastating in effect and largely unseen or disregarded by the unaffected majority. The evidence mounts all the same. With it grows the need for funding from state and federal governments, health insurers, charitable foundations and private citizens. Though mental illness can afflict anyone, the most compelling recent warning addressed a specific group. According to the secretary of veterans affairs, the brutal guerrilla war in Iraq will cause many U.S. troops long-term mental health problems..."  
  

Patient experience website breaks mental health taboo (UK)
E-Health Insider story - "Dipex, a charity that runs a number of support websites that contains personal testimonies from people who have suffered from illness, has launched a new module on mental health. ... The website is different to other health information services in that it focuses on patient experience from initial diagnosis, through treatment to cure or acceptance, and features questions that patients themselves ask. It also claims to be of benefit to families, carers and clinicians too." See also the Dipex site on depression.