The Collaborative Assessment and Management of Suicidality (CAMS) is a novel clinical approach used to identify, assess, and manage suicidal outpatients (Jobes & Drozd, 2004). The results of a retrospective study evaluating the impact of CAMS versus treatment as usual (TAU) on suicidal outpatients are presented. Patients in the CAMS treatment group (n = 25) resolved their suicidality significantly more quickly than TAU patients (n = 30). CAMS was also significantly associated with decreased medical health care utilization in the 6 months after the start of suicide-related mental health treatment. These results provide promising preliminary support for the effectiveness of CAMS and a foundation for prospective research.

The Collaborative Assessment and Management of Suicidality versus Treatment as Usual: A Retrospective Study with Suicidal Outpatients

This paper examines recent trends in the design and organization of coverage for mental health care using data from a Henry J. Kaiser Family Foundation and Health Research and Educational Trust (KFF/HRET) national employer survey. Legislation and changes in the delivery of mental health services have altered how mental health insurance is bought and sold. However, our findings reveal that mental health coverage is still typically not offered at a level equivalent to coverage for other medical conditions. We attempt to synthesize these data with prior research as a foundation for informed debates.

Design of mental health benefits: still unequal after all these years

Overview & Epidemiology of Mental Disorders in Women.- Public Health and Women's Mental Health.- Epidemiology of Mental Disorders in Girls and Female Adolescents.- Mental Conditions in Adult Women: Epidemiology and Impact.- Epidemiology of Mental Disorders in Older Women.- Physical Illness and Medical Needs of Women with Mental Disorders.- Selected Disorders.- Depression and Postpartum Disorders.- Eating Disorders.- Menopause.- Substance Abuse.- HIV/AIDS and Mental Disorders.- Services Delivery & Emerging Research.- Services in an Era of Managed Care.- Evidence-Based Medicine.- Mental Health Issues of Incarcerated Women.- Services in the Workplace.- Organizational Stress and Trauma-Informed Services.- Services in Rural Areas.- Social and Community Contexts.- Racial and Ethnic Disparities.- Parenting and Recovery for Mothers with Mental Disorders.- Navigating the Worlds of Information.

A Public Health Perspective of Women's Mental Health

OBJECTIVE: The high rate of co-occurrence of substance abuse and mental disorders renders the availability of psychiatric programs, or integrated service delivery, a vital quality-of-care issue for substance abuse clients. This article describes the availability of psychiatric programs and integrated care for clients with severe mental illness in the private substance abuse treatment sector and examines these patterns of service delivery by profit status and hospital status. METHODS: Survey data from the National Treatment Center Study, which is based on a nationally representative sample of privately funded substance abuse treatment centers, were used to identify the proportion of centers that offered psychiatric programs in 1995-1996, 1997-1998, and 2000-2001. Centers reported whether they treated clients with severe mental illness on-site or referred them to external providers. Repeated-measures general linear models were used to test for significant changes over time and to assess mean differences in ...

The availability of psychiatric programs in private substance abuse treatment centers, 1995 to 2001.

Recent initiatives to improve private insurance coverage for substance abuse and mental health in the United States have mostly focused on equalizing coverage limits to those found in general medical care. Federal law does not address cost sharing (copayments and coinsurance), which may also deter needed care or impose significant financial burdens on enrollees. This article reports on cost sharing requirements for outpatient care in a nationally representative sample of managed care plans in 1999. Levels of cost sharing are substantial, with around 40 percent of products requiring copayments of $20 or more and another 15 percent requiring coinsurance of 50 percent. Cost sharing for outpatient substance abuse treatment is very similar to that for mental health. Compared to general medical care, at least 30 percent of products impose higher cost sharing for substance abuse and mental health treatment. Future parity initiatives should be examined for how they address differences in cost sharing as well as limits.

Cost sharing for substance abuse and mental health services in managed care plans.

Mental health services experts suggest that managed care diminishes the need for arbitrary benefit limits and consumer cost-sharing. Data from 577 health plans were used to test the hypotheses that health maintenance organizations (HMOs) and carve-out plans are less likely to use benefit limits or service exclusions, have more generous limits, and have lower cost-sharing requirements than non-HMOs and non-carve-out plans. The results show that HMOs were more likely to use service exclusions and did not make less use of benefit limits. Carve-outs were less likely to use some coverage exclusions. Comparisons of the stringency of limits and cost-sharing provisions did not show consistent differences.

https://ps.psychiatryonline.org/doi/pdf/10.1176/ps.50.12.1631

Judy Shinogle

Papers

Mental Health Benefit Limits and Cost Sharing Under Managed Care: A National Survey of Employers