This research will estimate the amount, distribution and cost of public sector services (inpatient and outpatient mental health services, acute medical services, and criminal justice system services) used by seriously mentally ill (SMI) persons. Because community care for the SMI involves the participation and coordination of many social agencies, it has been difficult to estimate overall costs; further, we have little idea about how costs are distributed across agencies. Better information is needed about where and by whom public funds are used before we can address issues of appropriateness and effectiveness of their use.

The specific aims of this research are: 1) To determine the distribution of use and direct costs of services delivered by public sector agencies (community mental health clinics, public psychiatric hospitals, publicly funded medical services, and the criminal justice system) to SMI persons. 2) To examine demographic and clinical characteristics of SMI persons associated with use of specific agencies.3) To examine how SMI individuals who do and do not receive outpatient CMHC care differ in their patterns of use of the other service agencies.

To address these aims, we will use secondary data from two public mental health systems: (1) survey data previously collected from SMI persons and their families in Mississippi and (2) administrative data sets from service agencies in Harris County (Houston), Texas. Both these mental health systems are relatively resource-poor, serve a high percentage of minority clients, and have rarely been the subject of research studies. This research is intended both to further health services research and to provide data to guide policy in these mental health systems.

R29MH047907

1990-09-30

1996-08-31