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The cost of assisted outpatient treatment: can it save states money?

Publication ,  Journal Article
Swanson, JW; Van Dorn, RA; Swartz, MS; Robbins, PC; Steadman, HJ; McGuire, TG; Monahan, J
Published in: Am J Psychiatry
December 2013

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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Published In

Am J Psychiatry

DOI

EISSN

1535-7228

Publication Date

December 2013

Volume

170

Issue

12

Start / End Page

1423 / 1432

Location

United States

Related Subject Headings

  • Psychiatry
  • New York City
  • New York
  • Mental Disorders
  • Male
  • Humans
  • Health Care Costs
  • Female
  • Drug Costs
  • Community Mental Health Services
 

Citation

APA
Chicago
ICMJE
MLA
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Swanson, J. W., Van Dorn, R. A., Swartz, M. S., Robbins, P. C., Steadman, H. J., McGuire, T. G., & Monahan, J. (2013). The cost of assisted outpatient treatment: can it save states money? Am J Psychiatry, 170(12), 1423–1432. https://doi.org/10.1176/appi.ajp.2013.12091152
Swanson, Jeffrey W., Richard A. Van Dorn, Marvin S. Swartz, Pamela Clark Robbins, Henry J. Steadman, Thomas G. McGuire, and John Monahan. “The cost of assisted outpatient treatment: can it save states money?Am J Psychiatry 170, no. 12 (December 2013): 1423–32. https://doi.org/10.1176/appi.ajp.2013.12091152.
Swanson JW, Van Dorn RA, Swartz MS, Robbins PC, Steadman HJ, McGuire TG, et al. The cost of assisted outpatient treatment: can it save states money? Am J Psychiatry. 2013 Dec;170(12):1423–32.
Swanson, Jeffrey W., et al. “The cost of assisted outpatient treatment: can it save states money?Am J Psychiatry, vol. 170, no. 12, Dec. 2013, pp. 1423–32. Pubmed, doi:10.1176/appi.ajp.2013.12091152.
Swanson JW, Van Dorn RA, Swartz MS, Robbins PC, Steadman HJ, McGuire TG, Monahan J. The cost of assisted outpatient treatment: can it save states money? Am J Psychiatry. 2013 Dec;170(12):1423–1432.
Journal cover image

Published In

Am J Psychiatry

DOI

EISSN

1535-7228

Publication Date

December 2013

Volume

170

Issue

12

Start / End Page

1423 / 1432

Location

United States

Related Subject Headings

  • Psychiatry
  • New York City
  • New York
  • Mental Disorders
  • Male
  • Humans
  • Health Care Costs
  • Female
  • Drug Costs
  • Community Mental Health Services