(February 19, 2019) In 2017, the Treatment Advocacy Center’s ground-breaking report, A Crisis in Search of Data: The Revolving Door of Serious Mental Illness in Super Utilization highlighted the largely uncharted role of serious mental illness in “super utilization”. The term super utilization, or high utilization, refers to the disproportionate use of high-cost public services such those provided by the health and criminal justice systems.
Although it has been widely recognized that a relatively small number of people make frequent use of public services at an enormous expense, the role of serious mental illness as a driving force behind this dynamic was overlooked and underreported.
Because examining neglected topics surrounding individuals with the most severe mental illness is the focus of our mission, the Office of Research and Public Affairs set out to narrow this information gap. We partnered with the College of Public Health at Kent State University in Ohio to conduct a systematic review of academic studies on the role and cost of serious mental illness in super utilization within healthcare, criminal justice and homeless service systems. To do so, we considered academic and “gray literature” from the United States, including state and federal government reports, think tank studies, news articles, and other non-academic sources.
Researchers at Kent State University, including Rachel Nolan, PhD, MPH, and Jeffrey Hallam, PhD, published the findings of their review in Health Behavior and Policy Review last month. The Kent State review represents an analysis of only peer-reviewed academic literature and includes international sources.
Dr. Nolan and her co-authors found that the current international research fails to quantify the economic costs of high utilizers diagnosed with a serious mental illness. However, for what evidence does exist, the most prevalent and costly diagnosis among high utilizers is schizophrenia, according to their analysis.
A more in-depth look into the data
A closer inspection reveals other interesting findings associated with serious mental illness and high utilization:
· For individuals with serious mental illness, homelessness significantly increases the degree to which they utilize public services, especially acute healthcare services.
· When compared to other mental health conditions, serious mental illness results in three times greater odds of being a high utilizer of healthcare services, especially inpatient health care.
Both the academic review and Treatment Advocacy Center report come to the same conclusion: better data collection is needed to understand the role of serious mental illness in super utilization and its associated economic costs. Until this occurs, evaluations and comparisons of interventions aimed at reducing the economic and societal costs of cycling through our nation’s safety net are unlikely to produce meaningful results.
· Nolan, R. D. et al. (2019, January). International systematic review on high utilizers diagnosed with severe mental illness. Health Behavior and Policy Review.
Elizabeth Sinclair
Director of Research
Treatment Advocacy Center