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Articles   |    
The Cost of Assisted Outpatient Treatment: Can It Save States Money?
Jeffrey W. Swanson, Ph.D.; Richard A. Van Dorn, Ph.D.; Marvin S. Swartz, M.D.; Pamela Clark Robbins, B.A.; Henry J. Steadman, Ph.D.; Thomas G. McGuire, Ph.D.; John Monahan, Ph.D.
Am J Psychiatry 2013;170:1423-1432. doi:10.1176/appi.ajp.2013.12091152
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Dr. Swanson has received research support from Eli Lilly, the National Science Foundation, the Robert Wood Johnson Foundation Program on Public Health Law Research, the Stanley Medical Research Foundation, and the U.S. Department of Education National Institute on Disability and Rehabilitation Research; he has received speaking fees from the University of North Carolina-Chapel Hill with support from Pfizer; and he has received consulting fees from Novartis. All other authors report no financial relationships with commercial interests.

Supported by the John D. and Catherine T. MacArthur Foundation Research Network on Mandated Community Treatment and by the New York State Office of Mental Health.

From the Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, N.C.; Research Triangle Institute, Durham; Policy Research Associates, Delmar, N.Y.; Department of Health Care Policy, Harvard Medical School, Boston; and University of Virginia School of Law, Charlottesville.

Address correspondence to Dr. Swanson (jeffrey.swanson@duke.edu).

Copyright © 2013 by the American Psychiatric Association

Received September 03, 2012; Revised January 22, 2013; Accepted March 25, 2013.

An erratum to this article has been published | view the erratum
Abstract

Objective  The authors assessed a state’s net costs for assisted outpatient treatment, a controversial court-ordered program of community-based mental health services designed to improve outcomes for persons with serious mental illness and a history of repeated hospitalizations attributable to nonadherence with outpatient treatment.

Method  A comprehensive cost analysis was conducted using 36 months of observational data for 634 assisted outpatient treatment participants and 255 voluntary recipients of intensive community-based treatment in New York City and in five counties elsewhere in New York State. Administrative, budgetary, and service claims data were used to calculate and summarize costs for program administration, legal and court services, mental health and other medical treatment, and criminal justice involvement. Adjusted effects of assisted outpatient treatment and voluntary intensive services on total service costs were examined using multivariate time-series regression analysis.

Results  In the New York City sample, net costs declined 43% in the first year after assisted outpatient treatment began and an additional 13% in the second year. In the five-county sample, costs declined 49% in the first year and an additional 27% in the second year. Psychotropic drug costs increased during the first year after initiation of assisted outpatient treatment, by 40% and 44% in the city and five-county samples, respectively. Regression analyses revealed significant declines in costs associated with both assisted outpatient treatment and voluntary participation in intensive services, although the cost declines associated with assisted outpatient treatment were about twice as large as those seen for voluntary services.

Conclusions  Assisted outpatient treatment requires a substantial investment of state resources but can reduce overall service costs for persons with serious mental illness. For those who do not qualify for assisted outpatient treatment, voluntary participation in intensive community-based services may also reduce overall service costs over time, depending on characteristics of the target population and local service system.

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FIGURE 1. Summary Costs by Category, Assisted Outpatient Treatment (AOT) Period, and Sample
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TABLE 1.Demographic and Clinical Characteristics of Assisted Outpatient Treatment Participants in New York City and Five New York Counties
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TABLE 2.Prevalence of Service Utilization by Assisted Outpatient Treatment (AOT) Period and Sample
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TABLE 3.Average Costs for Services Before and After Hospital Discharge Initiating Assisted Outpatient Treatment (AOT), By Samplea
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a Costs are per-person averages for subgroups with any utilization in each category of service and do not sum to the total costs for the sample.

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TABLE 4.Regression-Adjusted Effects of Assisted Outpatient Treatment (AOT) and Non-AOT Intensive Services on Mental Health and Total State Costs (By Sample)a
Table Footer Note

a Models are adjusted for study month, participants’ demographic characteristics (age, sex, and race/ethnicity), psychiatric diagnosis, and county of residence.

Table Footer Note

* p<0.05. **p<0.01. ***p<0.001.

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