An econometric model of an episode of mental health care for patients with mild conditions: Implications for caregiver substitution

This article presents a model of the number of hours of mental health care, the concurrent improvement in the patient's condition, the probability the patient will receive medications, and the reasons for treatment termination. The variables related to these aspects of mental health care are analyzed separately for patients of psychiatrists, psychologists, and social workers. Estimates of the average length of treatment, the average price and income elasticities, and the average cost of treatment are obtained from the model. The major conclusions from this study are that psychiatrists do not have a benefit-cost advantage in the treatment of relatively mild conditions, and that consumer responsiveness to variations in price appear to be largely confined to the decision to seek treatment. These and other findings provide a basis for making tentative recommendations about personnel substitution and reimbursement policies in mental health.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/28831/1/0000666.pd

Need-driven dementia-compromised behavior: An alternative view of disruptive behavior

The disruptive behavior of persons with dementia is a problem of considerable clinical interest and growing scientific concern. This paper offers a view of these behaviors as expressions of unmet needs or goals and provides a comprehensive conceptual framework to guide further research and clinical practice. Empiricalfindings and clinical impressions related to wandering, vocalizations and aggression to support and illustrate the framework are presentedPeer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/66887/2/10.1177_153331759601100603.pd

Markov models and the utilization of mental health services: A study of endogenously depressed patients

Patients in the mental health care system typically make more or less irregularly spaced visits to psychiatrists, both within and between episodes of a given illness. A Markov model is constructed which can predict the utilization of psychiatric services for such patients. Unlike previous Markov models of utilization, the current model takes as its starting point a model of an actual disease, specifically, endogenous depression It is shown how one can estimate the parameters of both the model of utilization and the model of depression using data which were collected for clinical research purposes. The models provide reasonable fits to the data. Several applications of the models are worked out. In addition to predicting the utilization of mental health services, the models can be used to predict incidence, prevalence and recovery rates and to predict the changes in utilization which parallel changes in treatment regimens.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/25339/1/0000785.pd