The cost-effectiveness of early care by dedicated teams for chronic mental health conditions: results from the Oxford-CLAHRC on Early Intervention Psychosis services in England

Purpose An academic review assessed the evidence for various interventions in helping people with disabilities and health conditions return to work. Design/methodology/approach The authors sifted through academic research, searching for answers to the following two questions: 1. “What is the available evidence on effective interventions in terms of employment outcomes and cost effectiveness?” 2. “Are there gaps in evidence with regard to the effectiveness of interventions for certain conditions?” Findings There is some evidence that interventions for workers with disabilities and health conditions can produce better outcomes at work, but there are huge gaps in the research data. Most studies focus on lower back pain and more research is needed into cardio-respiratory conditions and mental health. There is also a lack of research into the cost-effectiveness of various interventions. Originality/value This study highlights not only the effectiveness of some approaches but also the gaps in the research which need to be plugged to better inform policies.

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Do return to work interventions for workers with disabilities and health conditions achieve employment outcomes and are they cost effective? A systematic narrative review

Employee Relations ◽

10.1108/er-01-2017-0023 ◽

2018 ◽

Vol 40 (6) ◽

pp. 999-1014 ◽

Cited By ~ 3

Author(s):

Pauline Dibben ◽

Geoffrey Wood ◽

Rachel O’Hara

Keyword(s):

Mental Health ◽

Cost Effectiveness ◽

Return To Work ◽

Cost Effective ◽

Employment Outcomes ◽

Health Conditions ◽

Content Type ◽

Musculoskeletal Conditions ◽

Mental Health Conditions ◽

Lower Back

Purpose The purpose of this paper is to evaluate existing evidence on whether return to work interventions achieve employment outcomes and are cost effective in order to better inform those needing accommodations at work, as well as their line managers and trade union representatives, occupational health specialists and HR managers. Design/methodology/approach The paper uses a systematic narrative review to evaluate the evidence on the employment outcomes and cost effectiveness of return to work initiatives. Findings Evidence on interventions for musculoskeletal conditions such as lower back pain indicates that certain forms of intervention such as vocational rehabilitation and workplace-based rehabilitation facilitate outcomes such as employment, reduced sick leave and effective return to work. However, there is very little evidence on whether these interventions are cost effective. More generally there are glaring gaps in evidence on cardio-respiratory (heart and breathing) and mental health conditions with regard to both employment outcomes and the cost of interventions. Research limitations/implications This systematic review has critical and timely implications for both knowledge development and practice. While highlighting methodological limitations in the existing research base, it also presents avenues for further research on return work strategies and the factors inhibiting and facilitating their adoption and effective operation. Originality/value Although there is much existent literature on the return to work process, far less attention has been paid to the employment outcomes and cost effectiveness of interventions. This paper highlights the interventions for musculoskeletal conditions such as lower back conditions that may result in positive employment outcomes, with implications for practice. However, it also highlights gaps in evidence on the employment outcomes and cost effectiveness of interventions for cardio-respiratory (heart and breathing) and mental health conditions.

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Floatation Therapy for Mental Health Conditions

Canadian Journal of Health Technologies ◽

10.51731/cjht.2021.220 ◽

2021 ◽

Vol 1 (12) ◽

Author(s):

Khai Tran ◽

Hannah Loshak

Keyword(s):

Mental Health ◽

Muscle Tension ◽

Health Conditions ◽

Serious Adverse Events ◽

Mental Health Conditions ◽

Environmental Stimulation ◽

Potential Benefits ◽

Negative Side Effects ◽

The Cost ◽

Evidence Based Guidelines

Limited evidence from 2 randomized controlled trials suggested that floatation with restricted environmental stimulation therapy may provide some potential benefits in reducing anxiety and improving many of the symptoms associated with anxiety, including muscle tension, blood pressure, difficulties in emotion regulation, sleep difficulties, and depression, in individuals with anxiety disorders. Both trials reported no serious adverse events or negative side effects associated with the floatation therapy. No evidence was found on the cost-effectiveness of floatation therapy for the treatment of mental health conditions. No evidence-based guidelines with recommendations regarding the use of floatation therapy for the treatment of mental health conditions were identified.

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Cost-effectiveness of early intervention in psychosis: systematic review

The British Journal of Psychiatry ◽

10.1192/bjp.2018.298 ◽

2019 ◽

Vol 215 (01) ◽

pp. 388-394 ◽

Cited By ~ 13

Author(s):

David Aceituno ◽

Norha Vera ◽

A. Matthew Prina ◽

Paul McCrone

Keyword(s):

Mental Health ◽

Early Intervention ◽

Cost Effectiveness ◽

Health Systems ◽

Psychotic Disorders ◽

First Episode ◽

Economic Evaluations ◽

Eligibility Criteria ◽

The Cost ◽

Early Intervention In Psychosis

BackgroundEarly intervention in psychosis (EIP) has been developed as an approach to improve the prognosis of people with psychotic disorders and it has been claimed to be a more efficient model of care. However, the evidence is not definitive and doubts have spread regard to the economic outcomes of EIP services amid the usually restricted mental health budget.AimsWe aimed to review the cost-effectiveness evidence of EIP services worldwide.MethodWe systematically reviewed the economic literature about EIP following the Preferred Reporting Items for Systematic reviews and Meta-Analyses statement guidelines. Studies were selected according to previously stated criteria and analysed with standardised critical appraisal tools for trial-based economic evaluations and modelling studies.ResultsA total of 16 studies were selected after applying the eligibility criteria. Most of them were economic evaluations alongside clinical trials. The overall evidence was consistent in the cost-effectiveness of EIP compared with standard care for first episode of psychosis and the Clinical High Risk for Psychosis paradigm. Such evidence was replicated among different health systems, but mainly in high-income countries. The methodological quality of such evidence, however, was moderate and heterogeneity was significant across the studies.ConclusionsThere is consistent evidence that the implementation of EIP services might be a cost-effective alternative across different health systems. Such evidence, nevertheless, derives from heterogeneous and sometimes methodologically flawed studies, reducing the certainty of such statement. More efforts must be done to rigorously assess the value of this intervention, before expanding it among systems where mental health budgets are more constrained.Declaration of interestNone.

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Out-of-pocket healthcare expenditure and chronic disease – do Australians forgo care because of the cost?

Australian Journal of Primary Health ◽

10.1071/py16005 ◽

2017 ◽

Vol 23 (1) ◽

pp. 15 ◽

Cited By ~ 32

Author(s):

Emily J. Callander ◽

Lisa Corscadden ◽

Jean-Frederic Levesque

Keyword(s):

Mental Health ◽

Chronic Obstructive Pulmonary Disease ◽

Healthcare Expenditure ◽

Health Condition ◽

Chronic Health Conditions ◽

Health Conditions ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Mental Health Conditions ◽

The Cost

Although we do know that out-of-pocket healthcare expenditure is relatively high in Australia, little is known about what health conditions are associated with the highest out-of-pocket expenditure, and whether the cost of healthcare acts as a barrier to care for people with different chronic conditions. Cross-sectional analysis using linear and logistic regression models applied to the Commonwealth Fund international health policy survey of adults aged 18 years and over was conducted in 2013. Adults with asthma, emphysema and chronic obstructive pulmonary disease (COPD) had 109% higher household out-of-pocket healthcare expenditure than did those with no health condition (95% CI: 50–193%); and adults with depression, anxiety and other mental health conditions had 95% higher household out-of-pocket expenditure (95% CI: 33–187%). People with a chronic condition were also more likely to forego care because of cost. People with depression, anxiety and other mental health conditions had 7.65 times higher odds of skipping healthcare (95% CI: 4.13–14.20), and people with asthma, emphysema and chronic obstructive pulmonary disease had 6.16 times higher odds of skipping healthcare (95% CI: 3.30–11.50) than did people with no health condition. People with chronic health conditions in Canada, the United Kingdom, Germany, France, Norway, Sweden and Switzerland were all significantly less likely to skip healthcare because of cost than were people with a condition in Australia. The out-of-pocket cost of healthcare in Australia acts as a barrier to accessing treatment for people with chronic health conditions, with people with mental health conditions being likely to skip care. Attention should be given to the accessibility and affordability of mental health services in Australia.

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Early Intervention in Psychiatric Disorders Across Cultures

10.1093/med/9780198820833.001.0001 ◽

2019 ◽

Keyword(s):

Mental Health ◽

Early Intervention ◽

Psychotic Disorders ◽

Global Mental Health ◽

Real Life ◽

Health Conditions ◽

Major Theme ◽

Early Presentation ◽

Mental Health Conditions ◽

Timely Fashion

This volume emerges as a result of a dialogue that involves leading proponents of early intervention and global mental health in a variety of contexts. Since the revival of early intervention for psychotic disorders two decades ago, the early intervention paradigm has been elaborated and consolidated in a number of different cultural and clinical settings, and has also been developed to address other mental health conditions. The paradigm for early intervention involves addressing barriers to early detection of illness, the identification of early risk states, as well as the provision of specialized intervention to steer the psychopathology trajectory away from an adverse outcome in a timely fashion. This volume starts with a discussion of relevant cultural factors involved in these endeavours. Current ideas about brain changes in the different stages of the illness trajectory are then reviewed. This is followed by a discussion of real-life implementations of early intervention for psychosis in a number of different cultural settings, highlighting how the basic paradigm for early intervention has been adapted to different populations in diverse service settings to improve outcome. The second major theme of this book is about the application of this paradigm to other mental health conditions that share an onset around the youth developmental period. These disorders include personality disorders, substance use disorders, and bipolar disorder. Each of these disorders has a different early presentation trajectory, which brings specific challenges. Current approaches and future prospects in addressing these challenges are discussed.

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