An analysis of Medicaid data released today from five states indicates that psychiatric and substance abuse services may be missing their mark if they are limited to community settings, such as community clinics and therapists offices.

Although most intervention policies for co-occurring substance abuse and mental disorders are community-based, a significant number of people with co-occurring disorders never appear in these settings, said study co-author Robin E. Clark, Director of Research, Center for Health Policy and Research, University of Massachusetts Medical School. Substance abuse actually lowers the odds of being treated in a community setting.

The study, funded by the Robert Wood Johnson Foundations Substance Abuse Policy Research Program (SAPRP), shows that when Medicaid beneficiaries have co-occurring disorders, their odds of inpatient and emergency department use and hospital-based psychiatric treatment go up and use of community services goes down, as compared to beneficiaries with just one disorder.

This pattern was clear both for persons with severe and less severe mental disorders. The study was published in the July 2007 issue of Psychiatric Services.

This is occurring despite the fact that primary care studies indicate that continuity of treatment is weaker and costs are higher in hospital settings and data suggest that people treated in these settings have higher rates of inpatient treatment, the authors say.

We need to provide treatment to people wherever they appear in the treatment system instead of increasing treatment in one settingsuch as the community-based settingand hoping they come there, said Clark.

Psychiatric disorders and substance abuse are major problems for the Medicaid population. Diagnosed psychiatric and substance use disorders are from fifty percent to one hundred percent more prevalent among Medicaid beneficiaries than in the general popula
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