A Systematic Review of the Impact of Public Mental Health Benefit Changes on Patients with a Serious Mental Illness

Abstract

Specific Aims: The specific aim of this study was to assess the impact of public mental health benefit changes on patients with a serious mental illness. Methods: A comprehensive literature search was conducted using several databases. Articles that were included in the analysis met the following inclusion criteria: 1) Study conducted in the United States 2) Study population composed of adults (≥18) with a diagnosis indicative of a serious mental illness (psychotic disorders, bipolar disorders, major depressive disorder, anxiety disorders, dysthymic disorder, or a personality disorder) 3) Study evaluated a change or discontinuation of mental health services, 4) Study reported outcomes. Main Results: Of the 117 studies originally identified, 27 met all the inclusion criteria. Data was then extracted from each study regarding the design of the study, patient demographics, and impact of the various outcomes. Five studies looked at the implementation of prior authorizations required for psychiatric medications, which all showed increased rates of treatment discontinuation. Two of these five studies also looked at the impact on emergency department (ED) visits and hospitalizations with both studies showing increased ED visits, but no effect on hospitalizations. Three studies looked at the implementation of Medicare Part D, which all showed increased rates of medication access problems and increased rates of ED visits. Other studies that examined medication access issues found increased rates of suicide ideation or behavior, increased rates of treatment discontinuation, and increased rates of ED visits. Conclusions: Given the amount of variability among the studies, it is difficult to determine the impact specific benefit changes have on patients diagnosed with a serious mental illness. In order to draw conclusions regarding specific benefit changes, more studies looking at similar outcomes need to be conducted. This is critical as the studies examined, in general, showed negative outcomes for patients with a serious mental illness when mental health benefit changes were implemented.