Support Community-Based Mental Health Treatment to Lower Hospitalization Costs in the United States
This fact sheet was made leveraging BHECON’s State Chartbooks produced by the USC Schaeffer Center for Health Economics & Policy. This advocacy tool overviews the economic impact of avoidable psychiatric hospitalizations and provides a case example of what happens when an individual with schizophrenia is hospitalized. An editable version exists for your own use.

Created in 2017 by the National Council for Behavioral Health

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.

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.

Emergency Department Length-Of-Stay For Psychiatric Visits Was Significantly Longer Than For Nonpsychiatric Visits, 2002–11
Using a retrospective analysis of national emergency department (ED) visit data in the period 2002–11, authors found that psychiatric patients who visited the ED experienced a significantly longer length of stay than non-psychiatric patients and were transferred to another facility at six times the rate of non-psychiatric patients. These findings suggest deficiencies in ED capacity for psychiatric care, which may necessitate improvements in both emergency department processes and alternative models of care.

Published in the Health Affairs in September 2016.  Authors: Jane M. Zhu, Astha Singhal, and Renee Y. Hsia.

A Comprehensive Review of Extant Research on Crisis Intervention Team (CIT) Programs
A review of available research on CIT supports the idea that the CIT model may be an effective component in connecting individuals with mental illnesses who come to the attention of police officers with appropriate psychiatric services, and may result in fewer arrests and associated criminal justice costs.

Published by The Journal of the American Academy of Psychiatry and the Law in March 2008. Authors: Michael T. Compton, MD, MPH, Masuma Bahora, MPH, Amy C. Watson, PhD and Janet R. Oliva, PhD.

Sustaining recovery through the night: Impact of a peer-run warm line (Dalgin, R. S., Maline, S., & Driscoll, P., 2011).
In a four year survey of 480 warm line callers, authors found respondents had a reduction in the use of crisis services and feelings of isolation. The results indicate that peer-run warm lines can fill an important void in the lives of individuals living with mental illnesses.

Published by Psychiatric Rehabilitation Journal in 2011. Authors: Dalgin RS, Maline S, and Driscoll P.

The psychiatric emergency service holding area: effect on utilization of inpatient resources.
This study compared the rates of hospitalization from two psychiatric emergency services which were similar except that one service had an extended evaluation unit, or holding area, allowing up to 24 hours of evaluation. The rate of hospitalization from the service with the extended evaluation unit was 36% and the rate from the other service was 52%; the availability of the extended evaluation unit made it possible for many patients to avoid rather than merely postpone admission to the hospital.

Published by the American Journal of Psychiatry in March 1989.  Authors: Gillig PM, Hillard JR, Bell J, Combs HE, Martin C, and Deddens JA.

Utilization and Outcome in an Overnight Psychiatric Observation Program at a Veterans Affairs Medical Center
An observational study by Francis and colleagues (2000) examined the effectiveness of an overnight observation program at a Veterans Affairs medical center. Finding suggest that overnight observation programs may provide a cost-effective alternative to traditional inpatient treatment for some individuals with psychiatric disorders.

Published online by Psychiatric Services in January 2000.  Authors: Elie Francis, M.D., William Marchand, M.D., Marlene Hart, M.D., M.P.H., Ann Carter, M.N., A.R.N.P., John Schinka, Ph.D., Alan Feldman, M.D., and Patricia Ordorica, M.D..

The impact of mobile crisis services on the use of community-based mental health services.
Researchers compared differences in use of post-crisis mental health services and timing between a community-based intervention mobile-crisis services cohort and a matched hospital-based cohort.  A mobile crisis intervention consumer was 17% more likely to receive community-based mental health services within 90 days after the crisis event, and, when examining individuals with no prior service use, this figure jumped to 48%.

Published by Research on Social Work Practice in 2002.  Authors: Dyches, H., Biegel, D. E., Johnsen, J. A., Guo, S., and Min, M.O.

Crisis stabilization claims analysis: Technical report, assessing the impact of crisis stabilization on utilization of healthcare services
In this study, authors used claims data to calculate a return on investment of mental health crisis stabilization programs in the east metropolitan area of the Minnesota Twin Cities.  Researchers calculated that the net benefit for mental health crisis stabilization services was approximately $0.3 million, with a return of $2.16 dollars for every dollar invested.

Published by Wilder Research in April 2013.  Prepared by: Amy Leite Bennett and Jose Diaz

Evaluation of a mobile crisis program: effectiveness, efficiency, and consumer satisfaction. Psychiatric Services
Findings indicate that mobile crisis programs can decrease hospitalization rates for persons in crisis and can provide cost-effective psychiatric emergency services that are favorably perceived by consumers and police officers.

Published by the Psychiatric Services in September 2000.  Author: Scott RL.

The cost effectiveness of crisis intervention: Admission diversion savings can offset the high cost of service.
Authors found that mobile crisis intervention services can reduce costs from inpatient hospitalization by approximately 79 percent in a six-month follow-up period after the crisis episode. Authors conclude that crisis intervention allows some patients who would otherwise have been hospitalized to remain in the community and that savings thus realized greatly exceed the expense of crisis intervention.

Published by The Journal of Nervous and Mental Disease in December 1993.  Authors: Bengelsdorf H, Church JO, Kaye RA, Orlowski B, and Alden DC.

Global Epidemiology of Mental Disorders: What Are We Missing?
This systemic review looks at global data available for mental disorders in order to identify areas for further study. This resource is helpful to determine how prevalence is reported at a national level around the world, and the significant amount of data that is missing related to mental health diagnoses, associated remission rates and mortality.

Published by PLOS One on June 24, 2013. Authors: Patton, G., Scott, K.M., Degenhardt, L., Whiteford, H.

A state-by-state breakdown of 80 rural hospital closures
This article lists all of the rural hospitals that have closed since 2010 by state. The post is accurate as of December 2016 and highlights the 80 rural facilities that no longer provide inpatient care.

Published by Becker’s Hospital Review by North Carolina Rural Health Research Program on December 13, 2016. Author: Ellison, A.

Prevention of Substance Abuse and Mental Illness
This website looks at the importance of prevention and early intervention in mental illnesses and how coordinated care plays a critical role.

Published by SAMHSA and updated September 2017.

Access to Care Among Adults Aged 18–64 With Serious Psychological Distress: Early Release of Estimates From the National Health Interview Survey, 2012–September 2015
This report looks at the change in rates of insured adults with severe psychological distress between 2012 and 2015 and provides detailed data on use of mental health services and impacts of costs of care.

Published by CDC’s National Health Interview Survey Early Release Program in May of 2016. Authors: Cohen, R., Zammitti, E.

State Estimates of Adult Mental Illness from the 2011 and 2012 National Surveys on Drug Use and Health
This 2014 report compiles information from the National Surveys on Drug Use and Health to provide prevalence data on Serious Mental Illness and Any Mental Illness in the United States.

Published by SAMHSA on February 28, 2014.

Receipt of Services for Behavioral Health Problems: Results from the 2014 National Survey on Drug Use and Health
This report breaks down data from the National Survey on Drug Use and Health to focus on the receipt of services for behavioral health, including substance use disorders. The report also explores data on perceived need for SUD treatment as well as barriers to both SUD and mental health treatment.

Published by SAMHSA in September 2015. Authors: Han, B., Hedden, S., Lipari, R., RTI International, Copello, E., Kroutil, L.

Supplemental Nutrition Assistance Program (SNAP): Able-Bodied Adults Without Dependents (ABAWDs)
This website provides an overview of the definition “Able-Bodied Adults Without Dependents” (ABAWD) in the context of receiving SNAP benefits.

Published and maintained by U.S. Department of Agriculture.

Mental Health Facts: Children & Teens
This fact sheet provides clear data on the percentage of children and teens who have serious mental illness and the impact and risk of suicide. This fact sheet can be a helpful handout for parents as it provides high-level warning signs and recommendations.

Published by NAMI.

82 Rural Hospital Closures: January 2010 – Present
This interactive map provides detailed information on rural hospital closures from January 2010 to present. Links are also available to other projects by the North Carolina Rural Health Research Programs including and in-depth look at rural health in Appalachia and a multi-year review of the Medicare Rural Hospital Flexibility Program. Links to a full listing of U.S. hospitals and rural hospitals are also available.

This website is managed by the North Carolina Rural Health Research Program through the University of North Carolina’s Cecil G. Sheps Center for Health Services Research.

Surveillance Success Stories California Department of Corrections and Rehabilitation
This report by the California Department of Corrections and Rehabilitation (CDCR) overviews how a need for data was identified related to inmates who self-harmed or attempted suicide, how CDCR adapted to collect necessary self-harm and suicide risk information and the programs that will be put into place to address new identified risk factors among inmates. Notable fact: in 2016, only 19 percent of deaths by suicide occurred with inmates who were not receiving mental health services.

Published by Suicide Prevention Resource Center in 2017. Author: Canning, R.

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.