HIGHLIGHTS

This Months Highlights

An Intervention for Depressed Older Workers

Updated Estimates of Unmet Need for Treatment

Middle-aged and older workers with depression were more

productive at work after they completed a phone-based intervention that focused on restoring their work functioning.
The multisite trial, conducted by Debra Lerner, M.S., Ph.D.,
and colleagues, randomly assigned workers age 45 and older
who screened positive for depression and lost work productivity to the work-focused intervention (WFI) or to usual
care (referral to a health care provider or an employee assistance plan). Each WFI participant was allocated up to eight
50-minute telephone sessions every two weeks with a specially trained clinician. The WFI helped employees to develop
strategies for coping with thoughts, feelings, and behaviors
that interfered with work and to make changes in work
routines or conditions to improve their effectiveness. Four
months after the intervention, the researchers found that days
absent from work had declined by 53% in the WFI group,
compared with 13% in usual care. Depression symptoms improved signicantly among WFI participants, compared with
those in usual care. A cost analysis found substantial savings
for employers owing to WFI participants greater productivity (page 570). In a Taking Issue commentary, Paul
Summergrad, M.D., Immediate Past President of APA, notes
that telephone and Web-based interventions, such as the
WFI, can increase access to mental health care, especially in
settings where services are limited (page 561).

Future evaluations of the ACAs impact will require good

baseline data for comparison. Before implementation of the
ACA, what proportion of people with mental illnesses received treatment, and how extensive was perceived unmet
need for care? To provide such data, Elizabeth Reisinger
Walker, Ph.D., M.P.H., and a research team from Emory
University analyzed data from the National Survey on Drug
Use and Health for more than 12,000 adults with mental
illness. The researchers found that many of these adults
did not receive any mental health care in the past year: 62%
of those with any mental illness and 41% of those with a
serious mental illness. The strongest correlate for receipt
of care was insurance status. Among those without insurance, 75% with any mental illness and 56% of those with
serious mental illness did not receive treatment. Among
those who reported unmet need, the cost of treatment was
the most frequently cited structural barrier (cited by 51%),
and the belief that problems could be handled without
treatment was the most common attitudinal barrier (23%).
The ACA and national parity regulations can help reduce
costs, the authors conclude, but efforts to broaden access
must also address attitudinal barriers, such as stigma and
misconceptions about the effectiveness of treatments (page
578).

Parity on State Exchanges? What Consumers See

Some health plans offered on the health exchanges established
by the Affordable Care Act (ACA) appear to be out of compliance with federal parity law, according to a study reported
in this months Economic Grand Rounds column. Kelsey N.
Berry and colleagues sought to duplicate the experience of
consumers shopping for health care coverage on two state-run
exchanges during the rst open enrollment period (October
2013March 2014). To do so, they accessed online benets
summary documents available to potential enrollees for all
insurance products, and they documented instances of apparent inconsistency with requirements of the Mental Health
Parity and Addiction Equity Act of 2008. Some of the inconsistencies may reect actual noncompliance. But more subtle
inconsistencies may represent efforts at the point of sale
to dissuade consumers from enrolling in a health plan. The
authors concluded that their ndings underline the need
for close monitoring of health plans for parity compliance
(page 565).
Psychiatric Services 66:6, June 2015

Briey Noted
Performance and quality measures are of critical importance under new systems of care promoted by the ACA. An
online search of the state Medicaid sites before ACA implementation highlighted a need for additional nationally
endorsed measures, especially in the areas of substance
abuse, treatment outcome, and crisis services (page 585).
At Home/Chez Soi, a research demonstration project in ve
Canadian cities, randomly assigned individuals with mental
illness to Housing First or usual treatment. At 18-month
follow-up interviews, Housing First participants were twice
as likely as those in the comparison group to report positive
life changes (page 592).
Peer respite programs, which are increasingly being implemented across the United States to relieve overburdened
mental health systems, are voluntary, short-term residential
programs for individuals experiencing or at risk of crisis. This
months Open Forum outlines a research agenda for establishing the effectiveness of these programs (page 638).
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