The use of conventional antipsychotic medications for patients with schizophrenia in a Medicaid population: therapeutic and cost outcomes over 2 years.
Researchers found that California Medicaid (Medi-Cal) patients with schizophrenia who initiated therapy with conventional antipsychotics frequently exhibited suboptimal drug use patterns, such as delaying treatment, switching between alternative antipsychotic medications, and using medication inconsistently, all of which increased overall health care costs. The results suggest that interventions must be developed to reduce the rate at which patients abstain from or delay antipsychotic drug therapy, or switch between alternative antipsychotic medications over time; any successful intervention in antipsychotic drug therapy may also achieve significant offsetting savings.

Published by Value in Health in May/June 2000.  Authors: McCombs JS, Luo M, Johnstone BM, Shi L.

Association Between Prescription of Major Psychotropic Medications and Violent Reoffending
This study examined whether pharmacological treatments reduce the reoffending risk for individuals released from prison. For 22, 275 released prisoners in Sweden, researchers compared rates of violent reoffending during medicated periods with rates during nonmedicated periods. Authors conclude that rates of violent reoffending were lower during periods when individuals were dispensed antipsychotics, psychostimulants, and drugs for addictive disorders, compared with periods in which they were not dispensed these medications.

Published by the Journal of the American Medical Association in 2016.  Authors: Zheng Chang, PhD; Paul Lichtenstein, PhD, Niklas Långström, MD, Henrik Larsson, PhD, and Seena Fazel, MD.

Assessing the Economic Costs of Serious Mental Illness
This editorial focuses on the indirect costs associated with mental illness, with particular emphasis on loss of earnings due to mental illness.  The author estimates the total economic burden of serious mental illness to be $317 billion despite limitations that excluded indirect costs associated with comorbid conditions, incarceration, homelessness, and early mortality from the calculation.

Published by the American Journal of Psychiatry in June 2008. Author: Thomas R. Insel, M.D.

Scaling-up treatment of depression and anxiety: a global return on investment analysis
This study, led by the World Health Organization (WHO), conducted a cost-benefit analysis for expanded investment in treatment services for depression and anxiety across 36 countries. For the U.S., every $1 invested in expanded treatment for depression and anxiety leads to a return of $4 in better health and enhanced labor participation and productivity.

Published by Lancet Psychiatry on April 12, 2016.  Authors: Dan Chisholm, Kim Sweeny, Peter Sheehan, Bruce Rasmussen, Filip Smit, Pim Cuijpers, and Shekhar Saxena.

Mental Disorders Top The List Of The Most Costly Conditions In The United States: $201 Billion
The author analyzed spending across 10 different categories of health conditions using the most recent estimates available from the Centers for Medicaid and Medicare’s National Health Expenditure Accounts. The study found mental disorders to be the most costly medical condition is the U.S. with spending at $201 Billion in 2013, exceeding other costly conditions such as heart conditions, trauma, and cancer.

Published in the Health Affairs in Map 2016.  Author: Charles Roehrig.

The Impact of Psychological Interventions on Medical Cost Offset: A Meta-analytic Review
A review of 91 studies between 1967 and 1997 found that in the presence of active behavioral health treatment, patients with diagnosed mental health disorders reduced their overall medical costs by 17%, whereas control groups who did not get behavioral health care increased costs an average of 12.3%. About one third of the articles demonstrated that dollar savings continued to be substantial even when the cost of providing the psychological intervention was subtracted from the savings.

Published by Clinical Psychology Science and Practice in June 1999.  Authors: Jeremy A. Chiles, Michael J. Lambert, and Arlin L. Hatch.

Crisis Services:  Effectiveness, Cost Effectiveness, and Funding Strategies
This report summarizes the evidence base on the clinical effectiveness and cost-effectiveness of a wide range of crisis services. It then presents case studies of different approaches that states are using to coordinate, consolidate, and blend fund sources in order to provide robust crisis services.

Published by the Substance Abuse and Mental Health Services Administration (SAMHSA) in 2014.

Psychosocial treatments for bipolar disorder: cost-effectiveness, mediating mechanisms, and future directions.
A review of meta-analyses consistently show that disorder-specific psychotherapies [cognitive-behavioral therapy (CBT), interpersonal, family, and group] reduces rates of relapse for bipolar disorder over 1-2 years.  Psychotherapies can be cost-effective when weighed against observed reductions in recurrence, hospitalization and functional impairments.

Published by Bipolar Disorders: An International Journal of Psychiatry and Neurosciences on June 1, 2009. Authors: David J Miklowitz and Jan Scott.

Disability and depression among high utilizers of health care. A longitudinal analysis.
Results showed a marked increase in productive time when employee depression was improved. Patients with severe depression who improved reduced their disability days by 36%, and patients with moderate depression who improved reduced their disability days by 72%.

Published by Archives of General Psychiatry in February 1992. Authors: Von Korff, M., Ormel, J., Katon, W., and Lin, EH.

The Economic Burden of Schizophrenia in the United States in 2013
The study concludes that schizophrenia is associated with a significant economic burden and estimates the specific costs of schizophrenia to be $155.7 billion for the year 2013.  Costs include direct health care costs ($37.7 billion), as well as indirect ($117.3 billion) and non-health care ($9.3 billion) costs, which are strong contributors, suggesting that therapies for schizophrenia should aim at improving not only symptom control but also cognition and functional performance, which are associated with substantial non-health care and indirect costs.

Published by the Journal of Clinical Psychiatry in June 2016.  Authors: Cloutier M, Aigbogun MS, Guerin A, Nitulescu R, Ramanakumar AV, Kamat SA, DeLucia M, Duffy R, Legacy SN, Henderson C, Francois C, and Wu E.

Cost and Cost-effectiveness of Hospital vs Residential Crisis Care for Patients Who Have Serious Mental Illness
This study examined the cost and cost-effectiveness of a residential crisis program compared with treatment received in a general hospital psychiatric unit for voluntary patients who have serious mental illness and concluded that residential crisis programs may be a cost-effective approach to providing acute care to this patient population. Authors suggest that where resources are scarce, access to needed acute care might be extended using a mix of hospital, community-based residential crisis, and community support services.

Published in the Archive of General Psychiatry in 2002.  Authors: Wayne S. Fenton, MD; Jeffrey S. Hoch, PhD; James M. Herrell, PhD, MPH; Loren Mosher, MD; Lisa Dixon, MD, MPH.

Costs Of Depression from Claims Data For Medicare Recipients In A Population-Based Sample.
Medicare recipients with a history of depression identified in CMS medical claims data had significantly higher medical costs than recipients with no history of depression.  The findings show that depressive disorder involves substantial medical care costs.

Published in the Journal of Health and Human Services Administration in Summer 2016.  Authors: Alexandre PK, Hwang S, Roth KB, Gallo JJ, Eaton WW.

Costs and Resource Utilization Among Medicaid Patients with Schizophrenia Treated with Paliperidone Palmitate or Oral Atypical Antipsychotics
Study concluded that treatment with long-acting injectable (LAI) antipsychotics, such as Paliperidone Palmitate (PP), may reduce inpatient and outpatient healthcare services utilization and associated costs. These findings also suggest that patients with schizophrenia taking once-monthly PP may stand a lower risk of hospitalization than patients on oral antipsychotic therapy (OAT).

Published by Drugs- Real World Outcomes in 2015.  Authors: Jacqueline A. Pesa, Erik Muser, Leslie B. Montejano, David M. Smith, Oren I. Meyers.

Review and analysis of hospitalization costs associated with antipsychotic nonadherence in the treatment of schizophrenia in the United States.
Looking across seven studies on the medication adherence of patients with schizophrenia, authors found poor adherence to antipsychotic medications was consistently associated with higher risk of relapse and rehospitalization and higher hospitalization costs. To reduce the cost of hospitalizations among schizophrenia patients, authors recommend that efforts to increase medication adherence should be undertaken.

Published by Current Medical Research and Opinion in October 2007.  Authors: Sun SX, Liu GG, Christensen DB, Fu AZ.

Cost-effectiveness of Supported Housing for Homeless Persons With Mental Illness.
This article provides data on the cost-effectiveness of integrating clinical and housing services as an intervention with homeless veterans who have psychiatric, substance use, or comorbid disorders.

Published in Arch Gen Psychiatry in September 2003. Author: Rosenheck, R., Kasprow, W., Frisman, L.

A mentally healthy workforce – it’s good for business.
This program guide gives tools to conduct a mental health evaluation of a targeted workforce and how to change culture in an organization to improve mental health. This guide also gives details on the cost-saving benefits of a mentally healthy workforce.

Published by Partnership for Workplace Mental Health in 2006.

Few Winners, Many Losers: Evaluating the Impact of Key Provisions of Maine’s New Health Insurance Law To Date
This white paper reviews the impact of key provisions to Maine’s healthcare law including reinsurance tax, changes to factors used to set rates, and rate increases, among other provisions.

Published by Consumers for Affordable Health Care on September 4, 2012. Author: Ditre, J.

The Effects of Antidepressant Step Therapy Protocols on Pharmaceutical and Medical Utilization and Expenditures
This study takes a look at data from 2003-2006 claims databases to determine the cost effectiveness of step therapy for antidepressants. The key finding is that step therapy may have unintended effects of decreasing antidepressant use and increasing hospitalization costs.

Published in The American Journal of Psychiatry on October 1, 2010. Authors: Mark, T., Gibson, T., McGuigan, K., Chu, B.

State-specific public health data and information
This interactive data map displays state and U.S. territory-specific public health data and information. This includes data on uninsured rates of individuals with serious mental illness or substance use disorders available by state.

Data made available by the Trust for America’s Health.

29 CFR 825.114 – Inpatient care.
This link highlights the legal language of the Family Medical Leave Act that identifies that inpatient care is included in the act’s conditions to be able to take up to 12 weeks off without penalty to their job.

Published by Cornell Law School.

Mental Illness and the Workplace
This fact sheet highlights the impact to productivity and the costs associated with untreated mental illness in the workplace. Cost-effectiveness of treating mental illness is shown in contrast to costs associated with no treatment.

Published by NAMI in January 2010.

Access to Health Care and Criminal Behavior: Short-Run Evidence from the ACA Medicaid Expansions
This data review looks at the impact of the Affordable Care Act’s Medicaid Expansion and causal relationships between insurance coverage and criminal behavior. Per the statistical analysis, Medicaid expansions have contributed to a decrease in crime by 3 percent, which is estimated to be an annual savings of $13 billion dollars.

Published November 2017. Author: Vogler, J.

A Payer-Guided Approach to Widespread Diffusion of Behavioral Health Homes in Real-World Settings
This research study follows an innovative behavioral health home for three years that implemented two distinct treatment approaches, patient-driven and provider-driven, to improve client outcomes. The results showed increased patient activation in care, increased engagement with primary care, and better perceived mental health status.

Published by Health Affairs in February 2018. Authors: Schuster, J., Nikolajski, C., Kogan, J., Kang, C., Schake, P., Carney, T., Morton, S., & Reynolds, C.

Potential economic impact of integrated medical-behavioral healthcare: Updated projections for 2017
This report, updated for 2017, reviews healthcare costs and utilization data to project spending estimates for individuals living with chronic medical and comorbid behavioral health conditions. Treatment costs for patients with comorbid medical and mental health/substance use disorder are on average two to three times higher than costs for chronic medical conditions alone.

Published by Milliman in January 2018. Authors: Melek, S., Norris, D., Paulus, J., Matthews, K., Weaver, A. & Davenport, S.

Scaling-up treatment of depression and anxiety: a global return on investment analysis
This article proposes and estimates the financial impact of properly scaling mental health treatment for depression and anxiety disorders. By predicting a modest improvement of ability to work and productivity with increased treatment availability, these researchers determined that an investment of $147 billion over the course of 14 years would yield an economic increase of healthy working years in the value of $310 billion.

Published by The Lancet Psychiatry in April 2016. Authors: Chisholm, D., Sweeny, K., Sheehan, P., Rasmussen, B., Smit, F., Cuijpers, P. & Saxena, S.

Return on Investment for Behavioral Healthcare: Making the Case
This PowerPoint presentation provides data and estimates relating to the return on investment of funding behavioral health treatment. It leverages a case study of the impact of Medicaid formulary restrictions to show unintended negative patient outcomes, and increased Medicaid drug and criminal justice costs.

Created by the USC Schaeffer Center Leonard D. Schaeffer Center for Health Policy & Economics in April 2018. Author: Seabury, S.

Association of Cost Sharing With Mental Health Care Use, Involuntary Commitment, and Acute Care
This study of 1,448,541 treatment records in the Netherlands found that a national reform that increased cost sharing led to reduced use of mental health care for severe and mild disorders, especially in low-income neighborhoods. Overall, this reduced use created net savings, but for patients with psychotic disorder or bipolar disorder, the reform was associated with costly increases in involuntary commitment and acute mental health care. Higher cost sharing for seriously ill patients create substantial downstream costs.

Published by Jama Psychiatry in September 2017. Authors: Ravesteijn, B., Schachar, E., Beekman, A., et al.

New Evidence That Access to Health Care Reduces Crime
This detailed blog entry highlights new research that shows that offering broad access to mental health and addiction treatment is not only compassionate, but also a cost-effective way to reduce crime rates. Reduced crime rates mean reduced incarcerations and cost savings to criminal justice institutions and states.

Published by the Brookings Institute in January 2018. Author: Doleac, J.

Reducing Health Care Costs Through Early Intervention On Mental Illnesses
This research review article looks at high-cost mental health patients and high-cost physical health patients to compare and contrast their needs. Data shows there are significantly more high-cost mental health patients under the age of 60, and presents early identification and intervention as a lifetime cost-saving measure.

Published by Health Affairs Blog in January 2016. Authors: Gionfriddo, P., Nguyen, T. & Counts, N.

Medical Cost Offsets Associated With Mental Health Care: A Brief Review
This research and analysis brief overviews how even 15 years ago it was possible to prove that mental health treatment can reduce overall medical costs for certain populations. Specifically, this brief found that in Hawaii use of managed mental health treatment was associated with a 20% decline in medical costs for the 227 clients who received it.

Published by the Washington State Department of Social and Health Services in December 2002. Authors: Anderson, N. & Estee, S.

Screening for and Treating Postpartum Depression and Psychosis: A Cost-Effectiveness Analysis
This article looks specifically at the costs associated for screening women for postpartum depression and psychosis and found that associated costs with screening ($943 per woman) can net a $13,857 cost effectiveness per quality adjusted life-year gained and $10,182 per remission achieved. Screening for and treating postpartum depression is a cost-effective intervention and should be considered as part of usual postnatal care.

Published by Maternal and Child Health Journal in April 2017. Authors: Wilkinson, A., Anderson, S. & Wheeler, S.B.