Antipsychotic Drug Use: Managing Cardiometabolic and Cost Effects

Across the US, 30%, or approximately one third of people meet the criteria for at least one mental illness.1 Of those with severe mental illness (SMI), namely schizophrenia and bipolar disorder, the mortality rate is more than twofold compared to the general population.2 The cardiovascular risk factors that contribute to cardiovascular related deaths, including metabolic disease and type II diabetes, are not only modifiable, but staggeringly higher for those with SMI.3 Though antipsychotic drug prescription is the standard protocol for SMI treatment, such drug effects on cardiovascular risk factors and related deaths exacerbate the much higher mortality rate for the severely mentally ill population. Due to both the prevalence of SMI and the physical comorbidities that it entails, analysis of healthcare costs associated with this population are an essential part of general health and policy improvement for the U.S. Therefore, a breakdown of the healthcare costs of this population requires not only acknowledgment of the modes of treatment for mental illness specifically, but also the identification and cost-analysis of the commonly associated physical comorbidities. This is especially important considering SMI is almost always considered chronic, and many SMI patients qualify for either Medicare, Medicaid, or both. Certain gaps in coverage can lead to lack of preventive care, exacerbating the cost burden. From a clinician’s perspective, assessing relevant scientific studies and reviews to change the relationship between primary care and psychiatry is necessary to dampen the high mortality rate of the SMI population. From a policy-maker’s perspective, analyzing the cause and effect balance between managing costs of care directed at the SMI itself against the adjunct costs from physical comorbidity calls for a change in the structure of therapeutic care and how the SMI population accesses primary care. The Collaborative Care model is a health care model that unifies psychiatric, behavioral, and primary care to support the mental, behavioral, and physical health of patients. By supporting holistic healthcare, the high cost of care for the SMI population will be diminished. The model includes four parts: patient-centered care, populationbased care, measurement-based treatment to target, and evidence-based care. Swapping oral antipsychotics with injectable versions will be especially cost-effective by improving adherence rates, and thus, reducing institutionalization and other hospitalizations. By enforcing the Collaborative Care model through community health center interventions, clinicians and policy makers will be able to work together to effectively leverage the health of the SMI population while eroding the high health care expenditure that this population currently imposes on states

Non-specialist health worker interventions for mental health care in low- and middle- income countries.

This is the protocol for a review and there is no abstract. The objectives are as follows: OVERALL OBJECTIVE: In order to assess the impact of delivery by non-specialist health workers (NSHWs) and other professionals with health roles (OPHRs) on the effectiveness of mental healthcare interventions in low- and middle- income countries (LMICs), we will specifically analyse the effectiveness of NSHWs and OPHRS in delivering acute mental health interventions; as well as the effectiveness of NSHWs and OPHRs in delivering long term follow-up and rehabilitation for people with mental disorders; and the effect of the detection of mental disorders by NSHWs and OPHRs on patient and health delivery outcomes. For each of these objectives we will examine the current evidence for the impact of delivery by NSHWs and OPHRs on the resource use and costs associated with mental healthcare provision in LMICs

Recovery:an international perspective

SUMMARY. Aims To review developments in recovery-focussed mental health services internationally. Methods Two forms of recovery which have been used in the literature are considered, and international examples of recovery-focussed initiatives reviews. A litmus test for a recovery-focussed service is proposed. Results Clinical recovery has emerged from professional literature, focuses on sustained remission and restoration of functioning, is invariant across individuals, and has been used to establish rates of recovery. Personal recovery has emerged from consumer narratives, focuses on living a satisfying, hopeful and contributing life even with limitations caused by the illness, varies across individuals, and the empirical evidence base relates to stages of change more than overall prevalence rates. Clinical and personal recovery are different. Two innovative, generalisable and empirically investigated examples are given of implementing a focus on personal recovery: the Collaborative Recovery Model in Australia, and Trialogues in German-speaking Europe. The role of medication is an indicator: services in which all service users are prescribed medication, in which the term compliance is used, in which the reasoning bias is present of attributing improvement to medication and deterioration to the person, and in which contact with and discussion about the service user revolves around medication issues, are not personal recovery-focussed services. Conclusions The term Recovery has been used in different ways, so conceptual clarity is important. Developing a focus on personal recovery is more than a cosmetic change it will entailfundamental shifts in the values of mental health services