Short Takes On News & Events

Study: Health Law Boosts Hospital Psych Care For Young Adults

By Jay Hancock

June 11th, 2014, 5:00 AM

Expanded coverage for young adults under the Affordable Care Act substantially raised inpatient hospital visits related to mental health, finds a new study by researchers at Indiana and Purdue universities.

That looks like good news: Better access to care for a population with higher-than-average levels of mental illness that too often endangers them and people nearby.

But it might not be the best result, said Kosali Simon, an economist at Indiana University and one of the authors. Greater hospital use by the newly insured might be caused by inadequate outpatient resources to treat mental-health patients earlier and less expensively, she said.

The health law let people under age 26 stay on their parents’ group insurance plans starting in late 2010. Other research shows the provision raised coverage for young adults. The paper by Yaa Akosa Antwi, Asako S. Moriya and Simon, based on a big national sample from community hospitals, found it also increased their hospital use.

Total inpatient visits for those aged 19 to 25 increased 3.5 percent compared with people aged 27 to 29, who couldn’t be on their parents’ plans. Mental health admissions increased much more — by 9 percent.

That’s a little puzzling. When Massachusetts broadened medical coverage with its 2006 state-based health reform law there were no big increases in mental-health hospitalizations for young adults there.

But psychiatrists, psychologists and other mental-health providers are more available in Massachusetts than elsewhere, Simon said. Perhaps community caregivers largely met the needs of newly insured Bay Staters, saving them from crisis visits to the emergency room.

In the national study, a large portion of psychiatric admissions came through the emergency department.

Neither the Massachusetts study nor the national study looked at the volume of outpatient mental-health care. But even if they had, they wouldn’t have produced a final answer on the effectiveness of expanded coverage.

That will take more research. Increasing insurance and treatments aren’t necessarily the same as helping patients.

“We eventually judge all these [insurance] expansions based on the final outcomes that we care about,” said Simon. “How did this affect the well-being of young adults? Is there a measurable improvement of health status? Does it appear that there is better mental health as a result of this increase?”

3 Responses to “Study: Health Law Boosts Hospital Psych Care For Young Adults”

  1. junetta watson says:

    I am an LPC at a South ga C S B , I have worked crisis in 5 counties, therapy, community support services, and our children and young adults do not and have not received the mental health coverage needed at mental health psych hospitals due to either lack of availabilty in rural areas from closings or from non coverage of insurance. Our young adults need help and you can increase all the ins you want but if the clients can’t afford to get to the clinic due to lack of transportation and resources to the clinics that continuously are getting cut by the state, sometimes maybe people need to be thought of as people and not “research.” What to do? The # not accounted for in your study, “the self pay” population, with no ins, age 17- up, usually wind up in our hospital emergency rooms, with no where to go for adequate care then follow up with outpatient care which they probably can’t get to or afford. So what’s the answer. It’s frustrating.

  2. Robin Neiheisel says:

    You are right on target with your comments. We have the same problem in the northern counties of Georgia. Continuous cutbacks in services and personnel, unemployment, lack of affordable insurance or transportation = many teens and young adults with little or no access to mental health care apart from the emergency room. We know that this is a significant burden to the ER and to the families who are desperate for help. Its difficult to refer young adults to resources that don’t exist, and yet this is our job….whether we work in school systems,law enforcement, community mental health, DFCS or public health departments.

  3. Louisa Smith says:

    Congress held hearings on inappropriate use of inpatient psychiatric facilities for young people, in April 1992 (just one year before the hearings started gettting placed on the Internet, alas). The GAO booklet is called, “The Profits of Misery: How Inpatient Psychiatric Care Bilks the System [and Harms Our Children]” (paraphrase of long title). Pat Schroeder, now retired, chaired the hearings. DOJ (US Dept of Justice) then prosecuted a chain of psych hospitals for TAKING KIDS INTO INPATIENT PROGRAMS FOR EXACTLY AS LONG AS THEY HAD INSURANCE TO PAY FOR TX, AND THEN DISCHARGING THEM, WHEN OFTEN THEY DID NOT NEED ANY INPATIENT TX ANYWAY. THIS IS NOT A NEW PROBLEM. Follow the money. Email me (to this site) and I will provide full circle background for a wider story, if you are interested.