Study Clarifies Public Health Value of Large-Scale Mental Health Recovery Efforts
• Science Update
Making evidence-based mental health services accessible to everyone in a disaster-stricken area would have substantial public health benefits, according to a statistical model developed by NIMH-funded researchers. Rough estimates of cost show such comprehensive care would be within the range of other accepted medical practices. However, given the considerable costs and resources required, further studies are needed to determine whether such broader efforts are advisable and, if so, to what degree. The study was published in the August 2009 issue of the Archives of General Psychiatry.
Research on survivors of Hurricanes Katrina and Rita show that this population continues to face many persistent mental health issues. These issues may at times be worsened by lack of availability or access to proper mental health care services. To help inform future disaster plans, a group of researchers led by Kenneth B. Wells, M.D., MPH, of RAND Corporation and UCLA Semel Institute, Health Services Research Center, developed a model to estimate the costs and outcomes of providing enhanced, evidence-based mental health care in a post-disaster setting.
Starting with a population of around 11 million in the hurricane-affected areas (based on U.S. Census & Area Resources File1 data), the researchers focused on medium-term mental health response, which starts around seven months post-disaster. They chose this period because fewer strategies have been developed for medium-term response, compared with the immediate post-disaster response (zero to six months), which mainly involves humanitarian efforts such as life-saving care and crisis counseling. Wells and colleagues modeled service use through 24 months post-disaster and measured outcomes up to 30 months out.
Results of the Study
According to their model, providing comprehensive mental health care coverage would cost around $1,133 per person—or about $12.5 billion for the entire disaster-affected population—over the period between months seven and 24 post-disaster. Nearly half this amount would be spent in months seven through 12 due to screening and an initial surge in need. The researchers estimated that, overall, this spending would reduce the total number of episodes of mental illness associated with the disaster in the affected population by 35 percent, compared with providing no mental health treatment.
Reducing either the level of service coverage or available treatments would reduce both costs and benefits. Though formal cost-effectiveness analysis was beyond the study’s scope, according to the researchers, the estimated gains from preventing psychiatric episodes would be within the cost range of generally accepted medical practices, comparable to the cost benefits of screening people for high blood pressure.
The researchers noted that some questions remain on the exact definition of evidence-based care and how it applies to disaster response. Also, though the model was designed to apply to many contexts, estimates for other disasters may require different assumptions and have different results.
The researchers intend the model to serve as a starting point for policy discussions to improve services for people with persistent mental illness following the Gulf storms, and to plan coordinated strategies for future disasters.
Current research shows that the demand and clinical need for mental health services exceeds availability for many parts of the country, even in the absence of a disaster situation. Wells and colleagues suggest that effective and efficient disaster plans may need to include establishing a national “reserve” of mental health care providers trained in evidence-based treatments, and linked to a logistical infrastructure for service delivery, including in-person and tele-health options. Policies on licensure, which are governed at the state level, may need to be revised to allow providers from outside a disaster area to provide care. Communities may also want to consider ways to develop local resources through re-training or redeployment of professional and non-professional social service providers.
Further research is needed to determine the best practices for in-patient services following a disaster, as well as to examine issues in sustaining disaster response plans over an extended period of time. The interactions between a survivor’s mental health, physical health, social, and economic needs that may affect recovery also require further study.
Also participating in the study were Michael Schoenbaum, Ph.D., NIMH Division of Services and Intervention Research (RAND Corporation at time of study); Brittany Butler, RAND Corporation (UCLA Semel Institute at time of study); Sheryl Kataoka, M.D., MSHS, UCLA Semel Institute, Health Services Research Center; Grayson Norquist, M.D., MSHS, University of Mississippi, Department of Psychiatry; Benjamin Springgate, M.D., UCLA, Robert Wood Johnson Foundation Clinical Scholars Program Rapid Evaluation and Action for Community Health in New Orleans, Louisiana (REACH-NOLA); Greer Sullivan, M.D., MSHS, RAND Corporation (Little Rock VA & University of Arkansas, Department of Psychiatry at time of study); Naihua Duan, Ph.D.,Columbia University (UCLA Semel Institute, Health Services Research Center at time of study); Ronald C. Kessler, Ph.D., Harvard Medical School, Department of Healthcare Policy.
Schoenbaum M, Butler B, Kataoka S, Norquist G, Springgate B, Sullivan G, Duan N, Kessler RC, Wells K. Promoting Mental Health Recovery After Hurricanes Katrina and Rita: What Can Be Done at What Cost . Arch Gen Psychiatry. 2009 Aug;66(8):906-914.
PubMed PMID: 19652130.
1As stated on the Health Resources and Services Administration (HRSA) Web site, the Area Resource File is “a health resource information system that enables policymakers, researchers, planners and others to analyze the current state of health care access at the county level.” The ARF is funded by HRSA and other Federal agencies. For more information, see http://bhpr.hrsa.gov/healthworkforce/data/arf.htm.