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Choice and Control over Mental Health Services Can Lead to Better Outcomes


When people have some choice and control over their mental health care, they have better outcomes. That is the conclusion of a couple of recent studies looking at different aspects of choice in treatment and care.

One study looked at a group of adults with posttraumatic stress disorder (PTSD) who were given a choice between medication (sertraline) or prolonged exposure therapy to treat their PTSD. Prolonged exposure therapy is an evidence-based treatment that reduces symptoms by helping people gradually approach and confront their trauma-related memories and feelings.

Study participants viewed videotaped explanations of the two treatments and werman counseling.jpge randomly divided into two groups, one having a choice of treatment and one without a choice. Among those with an opportunity to choose, twice as many study participants chose prolonged exposure therapy over medication.

Patients who received their preferred treatment where more likely to complete treatment and to have better outcomes. They were more likely to lose their PTSD diagnoses and more likely to have lower PTSD, depression and anxiety symptoms.

The ability to choose treatment, regardless of the treatment used, led to better outcomes. The results suggest that “accommodating patients’ preferences in treating PTSD is as important as, if not more so, than the specific choice of an empirically supported treatment,” according to the authors.

Another study looked at broader control over mental health care with the use of self-directed care. Self-directed care “allows individuals with disabilities and elderly persons to control public funds to purchase goods and services that help them remain outside institutional settings.” For many years, the federal Centers for Medicare and Medicaid Services (CMS) has promoted the use of consumer-directed health care for people with a broad range of disabilities. It has been used less frequently in mental health care than in other types of disabilities.

A new study from researchers at the University of Illinois at Chicago looked at the effects a mental health care self-directed program on outcomes, participant satisfaction, and service costs. They found that compared to services, as usual, the self-directed care leads to better outcomes and greater satisfaction at a similar cost.

Study participants, wmen counseling.jpgith the help of staff, developed person-centered plans for recovery and then created individual budgets with specific services and goods based on the plan goals (reviewed and approved by program management). Each participant had an annual budget of $4,000, an amount based on the regional average per-person cost. The budget did not include inpatient care, crisis services and medication, all of which were available to all participants (self-directed program and controls) throughout the two-year study.

The participants in the self-directed program had greater improvement over time in many outcomes, including pursuing and attaining life goals, self-esteem, sense of control over life outcomes, ability to manage their illness, employment and education, and physical symptoms of psychological distress, such as dizziness, pain, nausea, shortness of breath, and numbness.

The self-directed care participants had lower total service costs on average, compared with the control group. The self-directed group did use and spend more on psychotherapy than the control group. Psychotherapy was used by about 20 percent of all study participants. Over the two months, about 80 percent of participants made non-traditional purchases. The most frequent non-traditional purchases were transportation, communication, medical care, residential and health and wellness needs.



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