1. Effects of the General Economy On Mental Health Outcome Measures September 2006 to August 2011 Tim Santoni, M.A. Systems Evaluation Center, Division of Services Research School of Medicine, Department of Psychiatry University of Maryland

2. Maryland’s Mental Health Outcomes Measurement System (OMS) Initiated September 2006 Quantify effects of treatment Collaboratively developed Intended to provide value to consumers, providers, administrators Required for authorization of outpatient services – Integrated into authorization system – Youth and Adult versions – Consumers aged 6 to 64 – Administered at admission and every six months

3. Issue Despite model employment programs, rate of employment among consumers started declining Decline began late 2008 – early 2009 Changes appeared to coincide with increasing unemployment rate in Maryland Began with examination of employment and added other measures

4. Method Obtained monthly Maryland unemployment data from the Bureau of Labor Statistics Calculated the monthly OMS responses from adults for: – Current employment – Employment in last six months – Arrest in last six months – BASIS 24® overall score – Federally defined functioning score – Over 250,000 interviews – Over 92,000 consumers Calculated Pearson r

5. UnemploymentCurrent6 Mos. BASIS 24®Functioning Rate-MDEmploy. HomelessArrestOverall(URS) Unemployment R1-.886-.907.362-.725.576-.401 Rate-MD p.000.004.000.002 Current R-.8861.921-.404.656-.559.329 Employment p.000.001.000.010 6 Mos. R-.907.9211-.207.814-.568.500 Employment p.000.109.000 6 Mos. R.362-.404-.2071-.034.452.268 Homeless p.004.001.109.794.000.037 6 Mos. R-.725.656.814-.0341-.681.727 Arrest p.000.794.000 BASIS 24® R.576-.559-.568.452-.6811-.234 Overall p.000.070 Functioning R-.401.329.500.268.727-.2341 (URS) p.002.010.000.037.000.070

6. * Either currently employed or employed within the last six months. Maryland Unemployment Rate and Employed in last 6 months

7. Maryland Unemployment Rate and Arrested in last 6 months

8. BASIS® is scored from 0 to 4 with a higher score indicating increased symptomatology. Maryland Unemployment Rate and BASIS® Score

9. * Either currently employed or employed within the last six months. Employed in last 6 months and Arrested in last 6 months

10. Employed in last 6 months and BASIS® Score

11. Arrested in last 6 months and Functioning Score * Functioning score ranges from 1 to 5 with higher score indicating lower functioning.

12. Employed in last 6 months and Functioning score

13. Findings Employment, arrests, BASIS 24® are significantly correlated with unemployment rate Arrest, BASIS 24® and functioning are significantly correlated with consumer employment BASIS 24® and functioning are significantly correlated with arrests Caveats – Does not speak to causality – Large n has effect on significance

14. Conclusions Employment rates among mental health consumers must be viewed in the context of overall unemployment rate Arrests, measures of symptoms also vary with unemployment Consumers in a public mental health system are likely to have some more positive outcomes if they are employed – Fewer symptoms – Better functioning score – Fewer arrests