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Psychiatr Rehabil J. 2019 May 9. doi: 10.1037/prj0000374. [Epub ahead of print]

Service costs and mental health self-direction: Findings from consumer recovery investment fund self-directed care.

Author information

1
Human Services Research Institute.
2
Live and Learn, Inc.
3
Department of Social and Behavioral Sciences.

Abstract

OBJECTIVE:

Mental health self-direction, also known as self-directed care, involves an individual budget controlled by the participant with support from a specially trained recovery coach. The model under study here, implemented in a Medicaid behavioral health managed care context, allowed individuals to intentionally reduce mental health service use and apply cost savings as "Freedom Funds" to purchase a range of goods and services that are not typically considered mental health services to support recovery. This pre-post study examined mental health service utilization and cost before and after participating in self-direction.

METHODS:

The study involved Medicaid claims data for 45 self-directing participants over a 3-year period. Bivariate statistics were computed to identify meaningful pre-post differences in service utilization and standardized monthly costs.

RESULTS:

Median standardized monthly mental health clinical outpatient costs were significantly lower after self-direction participation compared to before. Participants spent a mean of $182 per month in Freedom Funds to purchase a range of nonclinical goods and services to work toward recovery goals. Total service costs-including Freedom Funds used during self-direction-did not differ significantly before and after program participation.

CONCLUSIONS AND IMPLICATIONS FOR PRACTICE:

Findings from this modest pre-post examination of self-direction suggest that mental health self-direction can result in more person-driven, individualized services without increasing costs. More research is needed to examine the cost-effectiveness of self-direction and to understand how program design and implementation factors influence the relationship between self-direction and service costs. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

PMID:
31070443
DOI:
10.1037/prj0000374

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