Psychiatric Services

The individual placement and support model of supported employment (IPS-SE) is an effective way to help people with serious mental illness get and keep competitive jobs. However, relatively few people receive IPS-SE services, and policy experts argue for much wider availability. This article describes a framework used by health economists to define and calculate the social costs of health programs. The author applies the framework in a review of 27 IPS-SE studies to determine whether sufficient empirical evidence exists to support large-scale expansion of IPS-SE.

For individuals in crisis, involuntary psychiatric hospitalization can be lifesaving—but also life disrupting. In Virginia, decisions to initiate involuntary commitment are made by emergency evaluators employed by 40 community service boards. Data from more than 2,600 evaluations showed that a lack of intensive community-based alternatives to hospitalization, such as temporary housing and voluntary residential or short-term crisis stabilization, was a significant predictor of evaluators’ decisions to initiate commitment. The findings provide “a sound empirical basis” for investing in a continuum of crisis stabilization services, the authors note.

Many studies of Iraq and Afghanistan veterans with mental disorders document low rates of service use. However, most studies look at use in the first year after returning from a deployment. Do rates of use rise as time since deployment increases? In the National Post-Deployment Adjustment Survey, the median time since deployment was four years, and two-thirds of veterans with probable PTSD or major depression reported past-year use of mental health services. The finding of these notably higher rates is “a valuable message to communicate to veterans,” the authors conclude, and may reduce some veterans’ ambivalence about seeking treatment.