This Month’s Highlights

Two studies this month examine whether diversion to mental health courts (MHCs) and treatment lead to fewer arrests and improved treatment outcomes for people with serious mental illness. Virginia Aldigé Hiday, Ph.D., and colleagues assessed whether an MHC program reduced arrests over a longer term than is typically measured: up to two years after program exit. They compared arrests for 408 MHC participants in two groups—program completers and noncompleters—and 687 MHC-eligible defendants whose cases were handled in traditional courts. All three groups had reduced recidivism over two years, but the reduction was greatest among MHC completers. The worst outcomes were seen for noncompleters (page 378). Woojae Han, M.S.W., Q.M.H.P., and Allison D. Redlich, Ph.D., focused on the role of treatment in these positive recidivism outcomes. They compared treatment adherence, motivation, and use for 357 MHC participants who received community treatment and 384 individuals with serious mental illness in traditional courts. The MHC group had greater treatment motivation and use over six months, compared with the non-MHC group. Greater medication compliance and treatment use in the MHC group were associated with a significant decrease in arrests, whereas no treatment- arrest associations were seen for the non-MHC group (page 384). In a Taking Issue commentary, Marvin S. Swartz, M.D., and Allison G. Robertson, Ph.D., M.P.H., discuss how MHCs appear to enhance the benefits of treatment. However, they also point out how little in the way of treatment the MHC participants actually received (page 363).

The quality of health care provided by the U.S. Department of Veterans Affairs (VA) has been criticized in congressional hearings and media reports. To examine how the VA’s care for persons with behavioral health disorders stands up against care provided in the private sector, Katherine E. Watkins, M.D., M.S.H.S., and colleagues analyzed administrative and claims data for two large samples—836,519 veterans and 545,484 individuals in employer-sponsored health plans. Seven widely used performance indicators were used to assess care processes. On all seven measures, VA performance was superior to that of the private sector by more than 30%. For example, among individuals with schizophrenia or major depression, veterans were more than twice as likely as those in private plans to receive appropriate initial medication treatment, and veterans with depression were more than twice as likely to receive appropriate long-term treatment. The authors attribute the findings partly to new structures put in place by the VA to support and encourage high-quality care (page 391).

The morbidity and mortality associated with misuse of prescription opioid analgesics have been referred to as an epidemic. To determine the extent to which concentrated distribution (prescription and use) predicts opioid misuse, Hyunjee Kim, Ph.D., and colleagues analyzed 2013 claims data from the Medicaid program in Oregon—a state where death and hospitalization rates from prescription opioid overdose increased more than fivefold between 2000 and 2011. The researchers found that prescriptions and use were heavily concentrated among the top 10% of prescribers and users. High-volume prescribers accounted for 81% and high-volume users accounted for 83% of all opioids prescribed. Policies targeting this pattern may prove more beneficial than broad-based policies to reduce misuse, the authors concluded (page 397). Even though experts consider prescription opioid misuse to be a public health crisis that warrants a treatment response, the news media is more likely to frame it as a criminal justice issue. These were the findings of Emma E. McGinty, Ph.D., M.S., and colleagues, who assessed the content of news coverage from 1998 to 2012 in a large sample of print and television news sources. The most frequently mentioned cause of the problem was illegal drug dealing, and the most frequently mentioned solutions involved arrest and prosecution. Prevention- and treatment-oriented solutions were mentioned in less than 5% of the stories in which solutions were addressed. The findings underscore the need for a concerted effort to reframe opioid analgesic abuse as a treatable condition, the authors concluded (page 405).

In an analysis of data from a large implementation of the collaborative care model in Washington State, Yuhua Bao, Ph.D., and colleagues found that two of the model’s process-of-care tasks were significantly associated with improved depression outcomes: at least one care manager follow-up contact within four weeks of initial contact and at least one psychiatric consultation between weeks 8 and 12 for patients not responding to treatment by week 8 (page 418).