Mental Health

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The Decline of Mental Hospitals, 1950s

April 27, 2012 in Mental Health, Mental Illness, Nursing Home, Nursing Homes | No comments

The movement of mental health care from mental hospitals to treatment in outpatient settings and nursing homes  began in the 1950s.  Here is how it happened.

“The field of medicine where the ‘rediscovery of community’ found an immediately welcome reception was mental health services.  A movement away from mental hospitals had already begun in the mid-1950s.  The national census of mental hospitals declined from a peak of 634,000 in 1954 to 579,000 by 1963.  The predominant, though contested, explanation for the drop is that the discover and introduction of major tranquilizers (e.g., Thorazine) was the decisive event.  Patients who were previously hospitalized could now be safely treated, or at least more safely ignored, on an outpatient basis.  Another interpretation points to the adoption by Congress in 1956 of amendments to Social Security that provided greater aid to states to support the aged in nursing homes. Mental hospitals had been filled with unwanted older people suffering only from a harmless senility.  By transferring such patients from mental hospitals to nursing homes, the states could transfer part of the cost of upkeep to the federal government.  Probably both drugs and nursing homes had some effect on the decline of mental hospitalization.”

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Mental Health and Substance Abuse Spending

October 7, 2010 in Mental Health, Supply of Medical Services | 2 comments

Although somewhat outdated, this report by Mark et al. (2007) provides a glimpse at trends in mental health and substance abuse (MHSA) spending.

National expenditures for the treatment of MHSA disorders amounted to $121 billion in 2003, up from $70 billion in 1993.  The average annual rate of (5.6%) was somewhat slower than spending growth for all medical services (6.5 %).  As a result, MHSA spending as a share of all health spending fell to 7.5 percent of the $1.6 trillion spent on all health services in 2003, from 8.2 percent in 1993.

From 1993 to 1998, a period of rapid expansion of managed care, the growth rate for MHSA expenditures was only 3.4% compared to 5.4% for all health services.  From 1998 to 2003 MHSA spending grew by 7.9 percent similar to the 7.7 percent for all health.

Of all MHSA spending, $100 billion was for mental health and $21 billion was for substance abuse.  The pie chart below gives the breakdown of payers for MHSA spending in 2003.

The next chart shows the distribution of MHSA expenditures by provider in the same year.

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Do for-profit hospitals reduce safety net services?

July 14, 2009 in Managed Care | 1 comment

Social safety net services are necessary, but often unprofitable for hospitals. Is the expansion of HMOs and for-profit hospitals jeopardizing these safety net servies? This is the question researcher Yu-Chu Shen investigates.

To test this hypothesis, Shen examines how changes in the market share of HMOs and for-profit HMOs affects probability of shutting down following safety net services: emergency department, HIV/AIDS services, inpatient substance abuse services, and outpatient substance abuse services. “Safety net services rely more on public finance than other types of hospital services. For example, almost two- thirds of revenue for substance abuse treatments comes from public sector…and less than 40% of emergency department revenue comes from private health insurance.”

HMO penetration is calculated using Laurence Baker‘s data. A proportional hazard specification models the probability each of the 4 safety net services shuts down as a function of whether the hospital is in a market with a high level of managed care and whether or not the hospital is for-profit.

The author finds that HMO penetration in a local market has no effect on the probability safety net services are offered. However, the probability of “shutting down safety net services do differ by levels of for-profit HMO share. In particular, in the current environment (post-2000), a higher for-profit HMO presence is associated with a higher risk of shutting down all safety net services examined in this study except for HIV/AIDS services.”

  • Yu-Chu Shen (2009) “Do HMO and its for-profit expansion jeopardize the survival of hospital safety net services?” Health Economics, 18(3):305-320.

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Canadian Mental Health Care

July 1, 2009 in Uncategorized | 4 comments

In this blog, I have frequently discussed the merits of Canadian and American health care systems (see Health Care Grudge Match).  One thing most people can agree with is that mental health care is subpar in both countries.  

The Vancouver Sun reports of a man committing suicide by jumping off the Granville Street Bridge.  
[In British Columbia]…family members of persons with severe mental health problems complain about the difficulty of getting loved ones committed. They cite restrictive confidentiality rules that isolate the family member in need, or the difficulty of getting doctors to agree to a commital or the system’s unwillingness to commit a patient until it is too late.

“In the 20-month period from December, 2006 through to Mr. Kwapiszewski’s suicide in 2008, Ms. Haboosheh — either directly or through her husband, Mr. Kwapiszewski’s GP, a lawyer, and a North Shore mental health worker — contacted Vancouver mental health services 16 times, desperately trying to get them to intervene as her brother showed more and more troubling behavioural symptoms. Three letters were also filed as part of, or in conjunction with, those contacts, and some meetings were also involved. Ms. Haboosheh also called the Vancouver Police Department on three different occasions to report him missing. Of the 16 calls and other contacts, 10 were with Mental Health Emergency Services and six with the Midtown Mental Health Team. They consistently, however, declined to commit Mr. Kwapiszewski for treatment, insisting he was non-committable. There was no mistaking his deterioration, however.”

There are fewer quantitative tests associated with mental health evaluations.  Also, there is also more of a stigma associated with mental compared to physician illness.  For both of these reasons, mental health problems too frequently take a back seat to physical health illnesses.

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