National Alliance on Mental Illness
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Outpatient Services Experience Big Decline In Availability According To New Study

For Immediate Release, November 17, 2000
Contact: Chris Marshall

Current trends in mental illness and substance abuse treatment spending are adding to the already large treatment gaps for people with severe mental illnesses. According to the annual survey conducted by the National Association of Psychiatric Health Systems (NAPHS), outpatient care and partial hospitalization programs for people with serious brain disorders are not growing fast enough to meet the increasing need for these services. The survey, entitled "Trends in Behavioral Healthcare Systems: A Benchmarking Report," was distributed to 104 psychiatric facilities owned and operated by NAPHS members. Results of the survey revealed that although mental illness and substance abuse provider organizations continue to grow outpatient services, insurance industry pressures and psychiatric hospital policies have led to the lack of availability of needed outpatient treatment and services.

The report cites "managed behavioral healthcare" benefit trends toward low reimbursement rates and shortened hospital lengths of stay as leading psychiatric hospitals to adopt policies geared toward rapid stabilization and early discharge. NAMI's managed care report card released in 1997, "Stand and Deliver: Action Call to A Failing Industry," documented the failure of managed behavioral healthcare to deliver on many needs of people with severe mental illnesses, including flexible hospital length of stay and discharge planning. NAPHS concludes that hospital services are increasingly focusing on discharging patients as soon as they are stabilized. This has in turn added to the high demand for outpatient services and the inability of outpatient services providers to keep pace.

A 1999 study by the Hay Group that examined behavioral healthcare trends over a ten year period found that the value of behavioral healthcare benefits has declined 54 percent from 1998 to 1997. That study, commissioned by NAPHS, NAMI and the Association of Behavioral Group Practices (ABGP), showed that resources desperately needed by those with serious brain disorders were being eliminated. For example, the number of plans with annual visit limits for outpatient behavioral health care has nearly doubled. In 1997, 48 percent of plans imposed annual visit limits for outpatient behavioral health care compared to just 26 percent in 1988, according to the Hay Group report. By 1997, the most prevalent limit was 20 outpatient visits. By contrast, 46 percent of the plans that imposed a visit limit in 1988 allowed a maximum of 50 visits. This most recent study found that only 17 percent allow 50 visits.

Taken together these reports clearly suggest that once again individuals with serious brain disorders, and their families, who most need access to effective treatments are seeing the value of their benefits erode. Moreover, it is equally clear that these savings have not been used to increase the availability of behavioral healthcare services, including outpatient services.

The following are among the other findings of the 1999 NAPHS survey:

  • Continued abbreviation in hospital lengths of stay. Over the past decade (from 1990-1999) hospital lengths of stay have dropped dramatically (60.1%) from 25.6 days in 1990 to 10.2 days in 1999.
  • Residential treatment settings have also seen a decline in lengths of stay, from 76.6 days in 1997 to 64.4 days in 1999.
  • Occupancy rates in hospitals have increased 14.3 percent between 1997 and 1999, going from 54.5% in 1997 to 62.3% in 1999.
  • Average partial hospitalization admissions remained nearly steady with a 0.5% increase between 1997 and 1999.
  • Average regular and intensive outpatient admissions saw a remarkable drop of 33.1 % between 1997 and 1999.
  • Average partial hospitalization visits increased 6.4% between 1997 and 1999.
  • Average regular and intensive outpatient visits increased 6.8% between 1997 and 1999.

Additional information can be found on the NAPHS survey at