Search is on to contain mental-health care costs

Sylvia Porter

April 08, 1991|By Sylvia Porter | Sylvia Porter,1991 Los Angeles Times Syndicate Times Mirror Square Los Angeles, Calif. 90053

You may never need mental health care, yet the odds are that in your lifetime you or someone close to you will. So, it's good news that care is becoming more available and less costly.

In what amounts to a revolution, people with problems ranging from chemical dependency to schizophrenia are being treated with greater understanding and better care. It's happening because of money -- and the lack of it.

Almost two million Americans were hospitalized for mental health problems last year, according to the National Institute of Mental Health. How costly is the problem? The bill for all mental health care services is almost $250 billion annually and is increasing 20-30 percent each year -- or, in some groups, even more. Such costs typically account for almost one-third of all health care dollars spent.

It is this price tag that started a search for better ways. Even employee plans that limit mental health benefits have been ineffective in controlling costs. Congress in 1988 directed the National Institutes of Health (NIH) to develop a model plan for federal employees. But even before the NIH makes its report, prototype plans are emerging.

The solution lies in new ways of administering mental health employee benefit programs, says John Randazzo, vice president Community Psychiatric Centers' Managed Care Division, a national network of psychiatric hospitals based in Los Angeles. For instance, he says, his company's new CPC Care program provides in-hospital psychiatric treatment at a fixed rate, regardless of the length of stay. The program is available through HMOs and managed care companies.

Programs like CPC Care assist in the control of costs by introducing an element of predictability to mental health care, according to Dr. John Tillotson, a consultant to mental health care companies and psychiatric hospitals.

"What varies widely is individual length of stay," says Dr. Tillotson. "By adopting a fixed cost per admission, psychiatric hospitals like CPC are able to provide their clients with predictable costs for mental health care. This is important because predictable costs enable companies to project more accurately their mental health care costs for the coming years."

Many psychiatric hospitals have developed alternatives to full-time hospitalization, Randazzo reports. One alternative, Day Treatment or Partial Hospitalization, involves a broad range of patient services for a price that's less than half of residential treatment programs.

"Patients typically arrive at 8 a.m. and spend the day in group, individual and occupational therapy and programs that involve their families in the treatment process. Throughout the day, they're in a safe, controlled environment with constant access to professional help."

Day Treatment programs also eliminate what some believe to be the stigma of psychiatric hospitalization. "Some patients call it 'coming to work,' " Randazzo says. "They leave home in the morning and return in the evening, and their neighbors are none the wiser about where they've been."

Destigmatizing psychiatric treatment through the use of Day Treatment programs is important, Dr. Tillotson points out. "It provides a non-threatening vehicle for people who need help to get help. That it costs less than inpatient care and is often less emotionally damaging to the patient -- especially adolescents -- makes it a powerful tool in mental health care treatment.

"Mental health providers are having to treat more patients while at the same time the payers for that treatment -- insurance companies, employers, government agencies and individuals -- are insisting that costs be controlled," Dr. Tillotson said. "The solution begins with recognizing that some employees have serious emotional and substance abuse problems that have a direct effect on morale and productivity in the workplace. Preventive programs, which may include counseling, are a start."

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