Research Roundup is a monthly public service of the Office of Research and Public Affairs. Each edition describes a striking new data point about serious mental illness and summarizes recently published research reports or developments.

It has been more than 10 years since the passage of the Mental Health Parity and Addiction Equity Act, which was a federal law passed in 2008 that requires equal coverage of mental health and substance use treatment options to that of physical health treatments. Yet, revealed by a report from Milliman that was released last week, only three states are at parity in provider payments for mental health office visits compared to primary care office visits. In fact, for 11 states, provider payments for mental healthcare are more than 50% lower than in primary care. 

RESEARCH of the month

Mobile phone applications are increasingly being used for healthcare, including being used for medication reminders and relaying real-time information on health indicators to clinicians such as an individual's blood pressure or heart rate. In addition, as we have written about previously, mental healthcare applications have been developed and shown to improve outcomes for people with schizophrenia.

New research published this month in Psychiatric Services indicates that most patients (86%) with serious mental illness own and utilize a mobile phone. However, only 60% of these patients had a smart phone that had web or data capabilities. The authors conclude that the results indicate that mobile phone interventions for people with serious mental illness is feasible. However, caution must be taken when tailoring these interventions in order to ensure all people with serious mental illness, not just those with smartphones, receive quality care.

Substance-induced psychosis is when an individual develops symptoms of psychosis, such as hallucinations and delusions, as a result of substance use. Although the vast-majority  of individuals who use substances never experience substance-induced psychosis, a percentage of those that do have an increased risk for developing schizophrenia. A recently published meta-analysis, a research method that combines all published research on a given topic, attempted to determine what factors may influence the conversion of substance-induced psychosis to schizophrenia.

The authors found that about 25% of individuals with substance-induced psychosis later develop schizophrenia. The type of substance was the largest predictor of this conversion, with cannabis having the highest risk, followed by hallucinogens and amphetamines. The authors conclude that because of the high-risk of conversion from substance-induced psychosis to schizophrenia, especially with cannabis, an assertive psychiatric intervention to individuals at risk is warranted.

Murrie, B., et al. (2019). Transition of substance-induced, brief and atypical psychoses to schizophrenia: A systematic review and meta-analysis.

Schizophrenia Bulletin.

Many individuals with schizophrenia are insured by Medicaid. In fact, schizophrenia is 12 times more prevalent in the Medicaid-insured population than those with private insurance. However, in many states Medicaid is discontinued if an individual is incarcerated, even if it is for a short-jail stay and without a criminal conviction. It can then take months with tedious paperwork to be reinstated. In an analysis of Medicaid data for people with schizophrenia, a recently published article found that a longer coverage gap is associated with an increase in inpatient hospitalization and emergency department visits compared to those with shorter or no Medicaid coverage gaps. The study authors conclude that polices to help quickly facilitate Medicaid reinstatement after incarceration for patients with schizophrenia are needed to reduce costs and improve outcomes.