Patient Inducement, Provider Priorities, and Resource Allocation in Public Mental Health Systems

Abstract

Public mental health systems are increasingly facing demands from the criminal justice system and social services agencies to provide services and support in cases in which mental illness contributes to crime, homelessness, or poverty. In this article we analyze how policies from outside public mental health systems affect resource allocation within these systems, using examples from criminal justice. These policies use two types of mechanisms: inducing patients to consume treatment (by offering rewards or imposing penalties) and inducing clinicians to provide treatment (by creating priorities). We propose a classification of these social policies based on whether they affect demand through rewards or penalties or supply through priorities. We then relate the classification to data on patients treated in public systems to evaluate the current prevalence and potential for growth in these outside demands. These inducements impose a set of nonobvious costs on other patients who are not targeted by the policies. Furthermore, they create incentives for both patients and providers to modify their behavior in order to take advantage of rewards, avoid penalties, or better compete for resources with prioritized patients. We consider some policy implications for avoiding unintended consequences of these policies.

Mental Health Treatment and Criminal Justice Outcomes

“…23 evaluating the impact of MHCs, this is very difficult to do in practice (Wolff 2002, Petrila 2003. In resource constrained mental health systems, persons with mental illness have incentives to offend in order to access treatment, an "unintended consequence" referred to by a number of observers (Sinaiko andMcGuire 2006, Wolff 2002). 23 MHC clientele differ systematically from traditional criminal caseloads.…”

“…"Mandated" or involuntary treatment can commit the client to go to care, the provider to supply care, or both. SeeSinaiko and McGuire (2006) for discussion and classification.…”

“…If this system is capacityconstrained, the cost will be manifest as other patients not getting treatment. SeeSinaiko and McGuire (2006) for…”

The Cost of Assisted Outpatient Treatment: Can It Save States Money?

“…However, if assisted outpatient treatment offsets other medical costs, such as reducing hospitalizations for state-supported clients, then policy makers may be on firmer ground in arguing in favor of funding it. In the end, assisted outpatient treatment may benefit not only the people who receive court-ordered treatment but also those who will be served in a more efficient public behavioral health care system, a system with greater capacity that produces better outcomes for a broader population in need (27).…”

Involuntary Civil Commitments After the Implementation of California's Mental Health Services Act

“…These partnerships, which focus on modified community treatment, wraparound service models, and a recovery framework, serve clients with disproportionately high levels of need (28). The goal of allocating MHSA funds to clients with high levels of need adheres to the principle of targeting resources so that they accrue the greatest societal and health benefits (29). This circumstance supports the plausibility that the expansion of treatment services (such as therapy and rehabilitation or case management) among high-risk clients may have reduced the likelihood of 5250s.…”