Mental Health Treatment Study (Frey et al. 2011)
Frey, W., Drake, R., Bond, G., Miller, A., Goldman, H., Salkever, D., & Holsenbeck, S. (2011). Mental Health Treatment Study: Final Report. Baltimore, MD: Westat.
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- The study’s objective was to examine the impact of the Mental Health Treatment Study (MHTS), which provided supported employment services to Social Security Disability Insurance (SSDI) recipients with psychiatric disabilities.
- The study was a randomized controlled trial with 2,238 participants. The analysis used data from nine surveys administered over the two-year intervention period.
- The study found that MHTS had positive impacts on earnings measured 12 and 24 months after random assignment and on health outcomes 24 months after random assignment. There were no statistically significant impacts on disability benefits receipt.
- The quality of the evidence presented in this study is moderate for earnings and SSDI benefit receipt outcomes. This means we are somewhat confident that the estimated effects are attributable to the MHTS, but other factors might also have contributed. For the health outcomes, the quality of evidence presented in this study is low. This means we are not confident that the estimated effects are attributable to MHTS; other factors are likely to have contributed.
Features of the Mental Health Treatment Study (MHTS)
The MHTS tested a supported employment intervention. Supported employment interventions use a combination of employment and health services and supports to improve employment and other outcomes for people with psychiatric conditions. The MHTS provided a bundled, comprehensive intervention that combined evidence-based mental health treatments and services with integrated mental health and employment services. The program lasted 24 months and included supportive employment services, systematic medication management, behavioral health services, reimbursement for out-of-pocket behavioral health expenses, and coordinated mental health services. In addition, SSDI medical continuing disability reviews were suspended for three years from the date of program enrollment for those receiving the intervention. After 20 months in the program, participants began a four-month transition process to help return to normal services. Program implementation occurred during 2007 to 2010.
Features of the Study
The MHTS was a randomized controlled trial. Across the United States, 23 mental health centers were recruited for the program. Of those, 21 sites were community mental health agencies, one was a vocational center, and one was a housing center that provided vocational services for homeless people with mental illnesses. Within these centers, the Master Beneficiary Record file was used to identify eligible SSDI recipients who (1) were diagnosed with schizophrenia or an affective disorder, (2) were ages 18 to 55, (3) resided within a 30-mile radius of one of the 23 study sites, and (4) volunteered to participate in the study. Those who lived in a nursing home or custodial institution, had a legal guardian, had a life-threatening or terminal health condition, had already received supportive employment services within 30 days of recruitment, or had worked in a competitive job within six months of recruitment were ineligible for random assignment. All eligible, consenting participants were randomly assigned to either the treatment or control group. The treatment group was offered MHTS services, whereas the control group received services as usual, along with a comprehensive packet listing services in the community and $100 for completing follow-up surveys. The study randomized 2,238 people, with 1,121 in the treatment group and 1,117 in the control group.
The analysis relied on survey data. Before random assignment, all participants completed a baseline survey. After random assignment, treatment and control group members completed eight surveys over the two-year program period (one every three months). The surveys asked a variety of questions on earnings, sources of income, employment, mental and physical health, and health care utilization.
- The estimated impact of the program on earnings was $50.12 in the first year following random assignment and $100 in the second year. Over the full study period, the program significantly increased average formal earnings by $72.35 across all eight quarters of the program.
- There was not a statistically significant difference between the treatment and control groups on combined SSDI and Supplemental Security Income receipt over the two-year study period.
- Over the course of two years, the MHTS significantly increased the number of clinic or mental health provider visits and mental health component score, and significantly decreased the number of hospital overnight stays and outpatient psychiatric crisis visits.
Considerations for Interpreting the Findings
Although the study design was a randomized controlled trial, sample attrition was high. This means the study was not eligible for a high causal evidence rating. For the analyses of earnings and SSDI receipt, the authors used 20 control variables in the model, including baseline earnings and employment, age, gender, race, multiple health indicators, and number of months on the SSDI rolls; therefore, these analyses receive a moderate causal evidence rating. However, in the analyses of health outcomes, the authors did not include sufficient controls to receive a moderate evidence rating. In addition, the authors imputed baseline and outcome variables for some of the individuals included in the analysis. Because the study had high attrition, this might bias the results in unknown ways.
Causal Evidence Rating
The quality of the evidence presented in this study is moderate for earnings and SSDI benefit receipt outcomes. This means we are somewhat confident that the estimated effects are attributable to the MHTS, but other factors might also have contributed. For the health outcomes, the quality of evidence presented in this study is low. This means we are not confident that the estimated effects are attributable to MHTS, but other factors are likely to have contributed.