Mental Health Self-Directed Care Financing: Efficacy in Improving Outcomes and Controlling Costs for Adults With Serious Mental Illness

Cook, Judith Α.; Shore, Samuel E.; Burke-Miller, Jane K.; Jonikas, Jessica A.; Hamilton, Marie M.; Ruckdeschel, Brandy; Norris, Walter; Markowitz, Anna Frost; Ferrara, Matthew L.; Bhaumik, Dulal K.

doi:10.1176/appi.ps.201800337

Cited by 16 publications

(23 citation statements)

References 38 publications

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“…Eight studies [only two with quantitative data, ( 30 , 31 )] contained validated measures (e.g., Health of the Nation Outcome Scales, Brief Psychiatric Rating Scale, Global Assessment of Functioning, and World Health Organization’s International Classification of Functioning, Disability, and Health).…”

Section: Resultsmentioning

confidence: 99%

“…The involvement of patients in the process of managing their care led to significant outcomes in terms of health status improvement, personalization of interventions, user satisfaction, increase in autonomy, self-esteem, competence, coping mastery, autonomy support, choice and control, control over service choices, and cost savings ( 30 , 31 , 36 , 37 , 40 – 42 ). Also, personalization can have positive outcomes for carers regarding their control over their daily lives, quality of life, health, and wellbeing ( 43 ).…”

Section: Resultsmentioning

confidence: 99%

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Benefits and challenges of a personal budget for people with mental health conditions or intellectual disability: A systematic review

et al. 2022

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Personal budgets (PBs) may improve the lives of people with mental health conditions and people with intellectual disability (ID). However, a clear definition of PB, benefits, and challenges is still faded. This work aims to systematically review evidence on PB use in mental health and ID contexts, from both a qualitative and quantitative perspective, and summarize the recent research on interventions, outcomes, and cost-effectiveness of PBs in beneficiaries with mental health conditions and/or ID. The present systematic review is an update of the existing literature analyzed since 2013. We performed a systematic search strategy of articles using the bibliographic databases PubMed and PsycINFO. Six blinded authors screened the works for inclusion/exclusion criteria, and two blinded authors extracted the data. We performed a formal narrative synthesis of the findings from the selected works. A total of 9,800 publications were screened, and 29 were included. Improvement in responsibility and awareness, quality of life, independent living, paid work, clinical, psychological, and social domains, and everyday aspects of the users’ and their carers’ life have been observed in people with mental health conditions and/or ID. However, the PBs need to be less stressful and burdensome in their management for users, carers, and professionals. In addition, more quantitative research is needed to inform PBs’ policymakers.Systematic Review Registration[www.crd.york.ac.uk/prospero/], identifier [CRD42020172607].

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Benefits and challenges of a personal budget for people with mental health conditions or intellectual disability: A systematic review

et al. 2022

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“…Another approach seeks to maximize participant choice in finding housing, by providing individuals with an annual housing and services allotment that they can spend anywhere within a proscribed set of guidelines. Known variously as “self-directed care” or “self-directed services,” research findings suggest that it has superior client outcomes and greater satisfaction with mental health care, compared to services as usual (57).…”

Section: Discussionmentioning

confidence: 99%

From Residential Care to Supportive Housing for People With Psychiatric Disabilities: Past, Present, and Future

Farkas

Coe

2019

Front. Psychiatry

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For centuries, treatment and accommodation for people with significant mental health conditions in many countries, including the United States, have been viewed as necessarily inseparable elements, first in asylums and then, with deinstitutionalization, in community care models. The advent of psychiatric rehabilitation and later, recovery, helped to shift the paradigm of mental health services and the role of housing, to one focused on promoting the ability of individuals to achieve not only a life located in the community, but one that reflects a meaningful life as part of a community. In this context, supportive housing emerged as a model based on integrated, permanent, affordable housing, selected by the person, with flexible supports that are functionally separate, but available as needed and wanted. This model of housing has been predominant in American mental health services for over 20 years, and evidence now exists for its outcomes in terms of housing stability, symptom reduction, and psychosocial variables. Current challenges, both at the societal and the individual level, confront the sustainability of supportive housing, with some efforts being made by housing groups to address these challenges. This article reviews the evolution of supportive housing and its basic tenets, identifying the challenges and some efforts to address them. In addition, the article discusses the current social and economic climate, which appears to be shaping opposing trends, and makes a call to action, to mitigate the possible risks to the future of this value-based housing approach.

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“…However, evaluations of DPs and other cash-for-care schemes have demonstrated mixed results. While some studies have found improved access, satisfaction with care, and reduced or stable system costs associated with DPs (Alakeson 2010;Cook et al 2019), others have found no change in health outcomes between those who receive DPs and those whose budgets are managed by a third party (Woolham et al 2017). Furthermore, some authors have commented that there is insufficient evidence that choice over services is the mechanism by which care experiences are improved and are critical of the legal and administrative burden that increased choice can have on service users (Murphy and Kelly 2019).…”

Section: Brief Description Of the Health Policy Reformmentioning

confidence: 99%

Advancing Direct Payment Reforms in Ontario and Scotland

Carbone

Allin

2020

HRO-ORS

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Over the last several decades, there has been an increased interest in cash-for-care programs internationally. Important among these reforms has been the emergence of direct payments (DPs), which are cash payments given directly to individuals so that they can purchase their own community care services. In the mid-1990s, both Ontario and Scotland implemented early direct payment programs with the explicit goals of providing greater choice and control over social services to adults with disabilities. Since then, however, the programs have diverged considerably. In Scotland, negative public perceptions resulted in DPs conversion into a program option embedded within the Self-Directed Support program. In Ontario, DPs have never been required by law and have instead expanded through multiple distinct programs funded through different government ministries. This paper compares the evolution of DPs in these two jurisdictions in order to better understand the actors and mechanisms that contributed to this divergence. Using the 3-I framework, we explore the ideas, interests and institutions that have shaped these reforms into their current structures. Our analysis offers several insights for other jurisdictions considering expanding direct payment reforms. These include recognizing: 1) policy conversion as a tool for managing negative perceptions of a reform, 2) policy levers for encouraging compliance among administering authorities, 3) divisions between health and social care as limiting possible expansion of the reform, and 4) program evaluations as justification for the reform's expansion.Advancing Direct Payment Reforms in Ontario and Scotland Carbone & Allin leviers politiques pour améliorer l'adhésion des autorités administrative, 3) les limites potentiellement apportées à la réforme par la séparation entre le sanitaire et le social et 4) les évaluations de programmes comme une justification de l'expansion de la réforme. Key Messages• Similar direct payment schemes emerged in Ontario and Scotland in the mid-1990s; however, the reforms have since diverged considerably.• Divisions between health and social care may serve to limit the potential expansion of direct payment programs which bridge these sectors.

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Mental Health Self-Directed Care Financing: Efficacy in Improving Outcomes and Controlling Costs for Adults With Serious Mental Illness

Cited by 16 publications

References 38 publications

Benefits and challenges of a personal budget for people with mental health conditions or intellectual disability: A systematic review

Benefits and challenges of a personal budget for people with mental health conditions or intellectual disability: A systematic review

From Residential Care to Supportive Housing for People With Psychiatric Disabilities: Past, Present, and Future

Advancing Direct Payment Reforms in Ontario and Scotland

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