This Month's Highlights

Two reports from a research group based at Dartmouth College focus on smoking among people with severe mental illness, and one offers some promising findings for those who want to quit. Rates of cigarette smoking in this group are reported to range from 50% to 85%, compared with about 20% in the general population. Although researchers have explored reasons for the high rates, relatively few studies have looked at characteristics of smokers in this group who have quit or tried to quit. Joelle C. Ferron, M.S.W., Ph.D., and colleagues analyzed data from a longitudinal study of clients with severe mental illness. The authors hypothesized that several demographic and clinical characteristics would be associated with clients' attempts to quit. Among the 174 participants at baseline, 89% were smokers. Over 11 years of annual follow-ups, 75% reported at least one attempt to quit, and many reported numerous attempts. Characteristics associated with quit attempts included being male and having a high school education, higher scores on the activation scale of the BPRS, and more daily activities. No participant reported receiving nicotine replacement therapy or bupropion, and at the study's end only 17% were not smoking (page 353). In the second report, Mary F. Brunette, M.D., and coauthors describe results from an initial trial of a Web-based interactive decision support system that is tailored for use by people with cognitive deficits and is designed to stimulate motivation to quit smoking by using evidence-based treatments. In a convenience sample of 41 smokers with severe mental illness, the authors found that those who used the online system were significantly more likely to show behavioral motivation to quit, such as meeting with a clinician to discuss cessation and initiating nicotine replacement therapy or bupropion (page 360).

When the federal Mental Health Parity and Addiction Equity Act went into effect in January 2010, researchers and policy makers began to monitor its implementation. In January 2007 New York State got a head start on parity with Timothy's Law, and an evaluation study conducted two years later raises some red flags for national parity monitors. Vera Oziransky, M.P.H., and colleagues interviewed 54 employed persons in New York—32 adults with mental illness and 22 parents of children with mental illness—about their knowledge of their insurance benefits under Timothy's Law. The authors found that most were unaware of their extended benefits. Many employees reported receiving incomplete or incorrect information from health plans. Many complained about the lack of high-quality in-network mental health providers. The findings highlight several critical areas for monitoring in the national parity roll-out, especially health plans' communications and outreach efforts to educate consumers so that the 113 million Americans affected by federal parity understand their benefits (page 344). In a Taking Issue commentary on this study, Laura Van Tosh notes that “Effective information sharing should be the hallmark of today's health care reform, ensuring that reform begins on a level playing field” (page 341).

From 2000 to 2007 the number of veterans who used Department of Veterans Affairs (VA) health care services grew 40.2%, from 3.65 million to 5.12 million (4.9% per year). Overall health spending increased 5.7% per year, but total health spending per veteran increased only .7% per year, from $6,134 to $6,459, according to an analysis by Todd H. Wagner, Ph.D., and colleagues. The authors found that VA spending on behavioral health care (treatment for mental and substance use disorders) did not keep pace with overall health spending. This was most notable in spending per veteran, which decreased at a rate of 2.0% per year over the same period, from $668 in 2000 to $578 in 2007. The largest decrease was on per-veteran spending for substance use disorder treatment, which showed a 5.5% annual decrease, from $106 to $72. However, spending on psychotropic medications increased 5.9% per year, from $98 in 2000 to $147 in 2007 (page 389).