this month.pdf

This Month’s Highlights

An Intervention for Depressed Older Workers

Middle-aged and older workers with depression were moreproductive at work after they completed a phone-based in-tervention that focused on restoring their work functioning.The multisite trial, conducted by Debra Lerner, M.S., Ph.D.,and colleagues, randomly assigned workers age 45 and olderwho screened positive for depression and lost work pro-ductivity to the work-focused intervention (WFI) or to usualcare (referral to a health care provider or an employee as-sistance plan). EachWFI participant was allocated up to eight50-minute telephone sessions every two weeks with a spe-cially trained clinician. TheWFI helped employees to developstrategies for coping with thoughts, feelings, and behaviorsthat interfered with work and to make changes in workroutines or conditions to improve their effectiveness. Fourmonths after the intervention, the researchers found that daysabsent from work had declined by 53% in the WFI group,compared with 13% in usual care. Depression symptoms im-proved significantly amongWFI participants, compared withthose in usual care. A cost analysis found substantial savingsfor employers owing to WFI participants’ greater produc-tivity (page 570). In a Taking Issue commentary, PaulSummergrad, M.D., Immediate Past President of APA, notesthat telephone and Web-based interventions, such as theWFI, can increase access to mental health care, especially insettings where services are limited (page 561).

Parity on State Exchanges? What Consumers See

Some health plans offered on the health exchanges establishedby the Affordable Care Act (ACA) appear to be out of com-pliance with federal parity law, according to a study reportedin this month’s Economic Grand Rounds column. Kelsey N.Berry and colleagues sought to duplicate the experience ofconsumers shopping for health care coverage on two state-runexchanges during the first open enrollment period (October2013–March 2014). To do so, they accessed online benefitssummary documents available to potential enrollees for allinsurance products, and they documented instances of ap-parent inconsistency with requirements of theMental HealthParity and Addiction Equity Act of 2008. Some of the incon-sistencies may reflect actual noncompliance. But more subtleinconsistencies may represent efforts at the “point of sale”to dissuade consumers from enrolling in a health plan. Theauthors concluded that their findings underline the needfor close monitoring of health plans for parity compliance(page 565).

Updated Estimates of Unmet Need for Treatment

Future evaluations of the ACA’s impact will require goodbaseline data for comparison. Before implementation of theACA, what proportion of people with mental illnesses re-ceived treatment, and how extensive was perceived unmetneed for care? To provide such data, Elizabeth ReisingerWalker, Ph.D., M.P.H., and a research team from EmoryUniversity analyzed data from the National Survey on DrugUse and Health for more than 12,000 adults with mentalillness. The researchers found that many of these adultsdid not receive anymental health care in the past year: 62%of those with any mental illness and 41% of those with aserious mental illness. The strongest correlate for receiptof care was insurance status. Among those without in-surance, 75%with anymental illness and 56% of those withserious mental illness did not receive treatment. Amongthose who reported unmet need, the cost of treatment wasthe most frequently cited structural barrier (cited by 51%),and the belief that problems could be handled withouttreatment was the most common attitudinal barrier (23%).The ACA and national parity regulations can help reducecosts, the authors conclude, but efforts to broaden accessmust also address attitudinal barriers, such as stigma andmisconceptions about the effectiveness of treatments (page578).

Briefly Noted

• Performance and quality measures are of critical impor-tance under new systems of care promoted by the ACA. Anonline search of the state Medicaid sites before ACA im-plementation highlighted a need for additional nationallyendorsed measures, especially in the areas of substanceabuse, treatment outcome, and crisis services (page 585).

• At Home/Chez Soi, a research demonstration project in fiveCanadian cities, randomly assigned individuals with mentalillness to Housing First or usual treatment. At 18-monthfollow-up interviews, Housing First participants were twiceas likely as those in the comparison group to report positivelife changes (page 592).

• Peer respite programs, which are increasingly being imple-mented across the United States to relieve overburdenedmental health systems, are voluntary, short-term residentialprograms for individuals experiencing or at risk of crisis. Thismonth’s Open Forum outlines a research agenda for estab-lishing the effectiveness of these programs (page 638).

Psychiatric Services 66:6, June 2015 ps.psychiatryonline.org 563

HIGHLIGHTS