A mental health capitation program: II. Cost-benefit analysis.

Objective: Total monetized and nonmonetized costs and benefits to society of the Monroe-Livingston demonstration project's capitated payment system (CPS) were analyzed.

Methods: Total costs and benefits of care for individuals who were prerandomized to an experimental group (of whom about 57 percent were enrolled in the CPS) were compared with those for a control group who received traditional fee-for-service care. Separate two-year results are presented for continuous patients, who were enrolled in a comprehensive CPS plan (N = 201) and for intermittent patients, who were enrolled in a partial plan (N = 155).

A mental health capitation program: I. Patient outcomes.

Objective: The Monroe-Livingston demonstration project's capitation payment system (CPS) was evaluated to determine whether capitated funding of mental health care, compared with fee-for-service funding, could reduce hospitalization rates and improve functioning and symptoms for severely and persistently mentally ill adults without increasing the total cost of care.

Methods: The experiment was a communitywide prerandomized clinical trial involving 422 patients. Patients who were randomized into the experimental group were eligible for enrollment in a capitated funding program administered by one of five community mental health centers.

Methodology for evaluating the Monroe-Livingston capitation system.

This paper presents the methodology for evaluating the Monroe-Livingston demonstration project's capitation payment system (CPS), based in Rochester, New York, for chronic mentally ill patients. To allow for both patient and provider choice within the experimental design, 1,587 CPS-eligible patients were randomly assigned at the start of the study to control or experimental conditions, with the intent of capturing in the experimental group a significant number of patients who would later be enrolled in the CPS. Protocols, which included measures of symptomatology, functioning, and resource utilization, were completed at baseline for 422 of the 605 patients contacted for inclusion in the study.

The epidemiology of treatment for chronic and nonchronic mental disorders.

To estimate the annual treated incidence and prevalence of chronic and nonchronic mental disorders, data from the Monroe County Psychiatric Register were analyzed. Patients were classified as either chronic or nonchronic based upon their utilization of inpatient psychiatric treatment. A chronic illness was defined as one requiring at least three psychiatric hospitalizations or at least 365 inpatient days during a 5-year follow-up period.

Behavioral disorders in multiple sclerosis, temporal lobe epilepsy, and amyotrophic lateral sclerosis. An epidemiologic study.

Certain CNS diseases can produce specific behavioral abnormalities. We used a computer search technique to identify all inpatients at Strong Memorial Hospital, Rochester, NY, who had received diagnoses of multiple sclerosis (MS), temporal lobe epilepsy (TLE), and amyotrophic lateral sclerosis (ALS) between 1965 and 1978. We found 368 patients with MS, 402 patients with TLE, and 124 patients with ALS.

Mental health problems of children: analysis of a cumulative psychiatric case register.

The advent of community mental health centers has brought a marked increase in treatment of mental health problems of children, especially for minorities. The number of children receiving care and the prevalence and the utilization rates by age, sex, and race from 1960 to 1977 in a large metropolitan county in upstate New York have been described previously. For the same time and community, the episodes of care by diagnostic grouping, type and length of treatment, and health status at the end of an episode have now been examined.

Epidemiologic considerations in electroconvulsive therapy.

Data from the Monroe County (New York) Psychiatric Case Register were grouped for 1961 through 1965, 1966 through 1970, and 1971 through 1975 for comparisons of incidence, prevalence, mortality, and length of stay associated with electroconvulsive therapy (ECT). While incidence of first ECT series declined substantially from 1961 through 1965 to 1971 through 1975 in most age-sex groups, significant declines in prevalence of admissions involving ECT occurred only among young female patients. Both prevalence and incidence analyses showed increasing specificity over time of ECT use in cases of depression.

The increasing number of children using psychiatric services: analysis of a cumulative psychiatric case register.

Psychosocial problems of children have received increasing attention in the pediatric literature, but it remains unclear to what extent psychiatric services are available and used for the treatment of these problems. This paper examines the utilization of psychiatric services by children over an 18-year period in Monroe County, NY, where a psychiatric case register monitors utilization since 1960. Reporting to the register is estimated at more than 90% of utilization for the child population.

Epidemiology of anorexia nervosa in Monroe County, New York: 1960-1976.

The Monroe County Psychiatric Case Register and hospital records were used to investigate the incidence of anorexia nervosa in Monroe County, New York, during the periods 1960-1969 and 1979-1976 to determine whether the number of newly diagnosed cases has increased over time. The results support the general clinical impression of a recent increase in the incidence of anorexia nervosa. This pattern of overall change was accounted for by the sharp increase in the number of females with the disorder, particularly those aged 15-24.

Migrant farm workers: social conditions, adaptive belief systems, and psychiatric care.

Two migrant farm labor camps were observed during two summer harvesting seasons. A part of the observations consisted of interviews with 104 farm laborers, with 16 of them being interviewed intensively. Migrant farm workers were exploited by the crew boss and the farm owner, and they in turn exploited each other.

Birth outcomes in the offspring of mentally disordered women.

The course of pregnancy and birth were studied among schizophrenic, neurotic depressive, and personality-disordered women, compared to a normal control group. The lighter birthweight of schizophrenic women's offspring was found more strongly related to the severity and chronicity of their mental illness than to the diagnosis itself. Children of neurotic depressive women had lower APGAR scores and more fetal deaths.

The impact of community mental health centers on the utilization of services.

The impact of community mental health centers on the utilization of psychiatric services in Monroe County, New York, was evaluated by means of data from the Monroe County Psychiatric Case Register. The catchment areas that received centers served as their own controls. In addition, yearly utilization rates were compared for areas that obtained centers with those remaining centerless.