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Are state Medicaid policies sentencing people with mental illnesses to prison?

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New findings about accessibility to anti-psychotic medications have important implications about how we treat people with mental illness.

Researchers from the USC Schaeffer Center for Health Policy and Economics have linked tighter Medicaid policies governing antipsychotic drugs with increased incarceration rates for schizophrenic individuals.

The study comes amid media scrutiny over whether cutbacks in mental health actually save money, when other costs are taken into account.

Some health plans require an extra approval step before tests or treatments can be ordered for patients. This step -- called prior authorization -- is intended to encourage physicians to select cost-effective options by requiring justification for the selection of more expensive options. Likewise, prior authorization policies adopted by state Medicaid programs aim to reduce costs associated with some medications, especially those drugs used to treat schizophrenia. However, an unintended consequence of these policies may be that more mentally-ill patients are being incarcerated, raising questions about the "cost-effectiveness" of these formulary restrictions.

In a study published inΒ The American Journal of Managed Care, researchers found that states requiring prior authorization for atypical antipsychotics had less serious mental illness overall but higher shares of inmates with psychotic symptoms than the national average. The study concluded that prior authorization of atypical antipsychotics was associated with a 22 percent increase in the likelihood of imprisonment, compared with the likelihood in a state without such a requirement.

http://www.sciencedaily.com/releases/2014/07/140722142656.htm

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So I was looking to see who funded the study at USC (having done cancer research at UM with Eli Lilly Funding - I know of the money influence of the pharmaceutical companies). I could not find out where the funding for this study came from then I saw at the end of the article:

Darius Lakdawalla, Quintiles Chair in Pharmaceutical Development and Regulatory Innovation, and a professor at the Schaeffer Center at USC (Pharmaceutical - I am not denying that medicaid tries to save money but paying top dollar for the newest antipsychotic when research has shown that antipsychotic use in many patients may result inΒ premature death, is used to control behavior in elderly, is used as a chemical control in children... at the expense of medicaid paying for the more costly trauma sensitive care - which is the effective care) that is where I question this article and the motivation behind the study.

or are time pressed psychiatrists who had no training in trauma. Β i have seen this occur over and over and mis-diagnosis is so common it is a travesty.Β 

was the prior authorization for a just released second generation atypical, or could they use the earlier atypicals which would be cheaper - all the atypicals work basically the same way (kind of like penicillin and amoxicillin). Β there may be subltle clained differences like a little less weight gain with this one or better sleep with that one. etc

who funded this study, was it Eli-Lilly, was it Pfeizer, was it McNeal Pharmaceutical Company?

There is a danger here. The pharmaceutical companies want doctors to use atypicals and newer antipsychotics for profits. These drugs are often pushed in favor of assisted living and any kind of supportive program for schizophrenia. Again my delusional brother doesn't have schizophrenia. I saw this at VA hospitals in medic school. These drugs ALL antipsychotics have very dangerous side effects so 1. Is the correct diagnosis made? This is often in places where trauma and mental health services may really be absent --- are FP's making the serious diagnosis of schizophrenia? 2. As I said assisted living services are essential but in a state where the first generation antipsychotics are preferred (with the really horrible side effect of tardive dyskinesia) are there any so ain't network programs for that individual? 3. I bet no one has ever asked that patient about trauma.
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