Promoting Mental Health Recovery After Hurricanes Katrina and Rita What Can Be Done at What Cost

被引:37
作者
Schoenbaum, Michael [1 ]
Butler, Brittany [2 ,9 ]
Kataoka, Sheryl [2 ]
Norquist, Grayson [3 ]
Springgate, Benjamin [4 ,5 ]
Sullivan, Greer [6 ,7 ,10 ]
Duan, Naihua [2 ,11 ]
Kessler, Ronald C. [8 ]
Wells, Kenneth [2 ]
机构
[1] RAND Corp, Arlington, VA USA
[2] Univ Calif Los Angeles, Hlth Serv Res Ctr, Semel Inst, Los Angeles, CA USA
[3] Univ Mississippi, Dept Psychiat, University, MS 38677 USA
[4] Univ Calif Los Angeles, Robert Wood Johnson Fdn, Clin Scholars Program, Los Angeles, CA 90024 USA
[5] REACH NOLA, New Orleans, LA USA
[6] Little Rock Vet Affairs, Little Rock, AR USA
[7] Univ Arkansas, Dept Psychiat, Fayetteville, AR 72701 USA
[8] Harvard Univ, Sch Med, Dept Healthcare Policy, Boston, MA USA
[9] RAND Corp, New Orleans, LA USA
[10] RAND Corp, Santa Monica, CA USA
[11] Columbia Univ, New York, NY USA
关键词
MAJOR DEPRESSION; CARE MANAGEMENT; ILLNESS; SUICIDALITY; OUTCOMES; PTSD;
D O I
10.1001/archgenpsychiatry.2009.77
中图分类号
R749 [精神病学];
学科分类号
100205 ;
摘要
Context: Concerns about mental health recovery persist after the 2005 Gulf storms. We propose a recovery model and estimate costs and outcomes. Objective: To estimate the costs and outcomes of enhanced mental health response to large-scale disasters using the 2005 Gulf storms as a case study. Design: Decision analysis using state-transition Markov models for 6-month periods from 7 to 30 months after disasters. Simulated movements between health states were based on probabilities drawn from the clinical literature and expert input. Setting: A total of 117 counties/parishes across Louisiana, Mississippi, Alabama, and Texas that the Federal Emergency Management Agency designated as eligible for individual relief following hurricanes Katrina and Rita. Participants: Hypothetical cohort, based on the size and characteristics of the population affected by the Gulf storms. Intervention: Enhanced mental health care consisting of evidence-based screening, assessment, treatment, and care coordination. Main Outcome Measures: Morbidity in 6-month episodes of mild/moderate or severe mental health problems through 30 months after the disasters; units of service (eg, office visits, prescriptions, hospital nights); intervention costs; and use of human resources. Results: Full implementation would cost $1133 per capita, or more than $12.5 billion for the affected population, and yield 94.8% to 96.1% recovered by 30 months, but exceed available provider capacity. Partial implementation would lower costs and recovery proportionately. Conclusions: Evidence-based mental health response is feasible, but requires targeted resources, increased provider capacity, and advanced planning.
引用
收藏
页码:906 / +
页数:11
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