Monday, March 13, 2006

Services can fail when treatment law is weak

An intensive outpatient program that is being discontinued, "changed my life" according to an Albuquerque woman who had been hospitalized for mental illness and suicidal thoughts.

All outpatient programs in New Mexico are voluntary because the state is one of eight that does not have assisted outpatient treatment. So it should not be a complete surprise "that many patients weren't showing up for the nine required hours per week,” according to Dr. John Lauriello, executive medical director at the UNM Psychiatric Center.

If they didn't show up for a full nine hours, insurers wouldn't reimburse UNM for the service.

Opponents said "mandated treatment wouldn't work in New Mexico, due to a lack of services." But, this is a case where services didn't work, in part, because New Mexico does not have AOT.

It is important to have as many options as possible to increase treatment compliance, including AOT, particularly in communities that have a dearth of services. Nonadherence to treatment has significant fiscal (and clinical) implications.

For example, medication nonadherence is a significant factor in hospital readmissions. A study of Medicaid recipients with schizophrenia in California revealed that “individuals who were [medication] nonadherent were two and one-half times more likely to be hospitalized than those who were adherent.” The same study found that those who are non-adherent incur 43 percent more in service costs than those who adhere to medication.

AOT can help reduce such costs by improving medication compliance. Under AOT in New York the number of individuals exhibiting good adherence to medication increased by 103 percent and good service engagement increased by 51 percent.

Last week NAMI gave a D+ grade to the state that spends the most per capita on services – this could be because Pennsylvania is a state that has an overly restrictive AOT law that is rarely used, making services ineffective and inefficient – like New Mexico.

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