Through the Mental Health Services Act (MHSA, www.dmh.cahwnet.gov/lv1HSA/).California voters approved a dramatic increase in funds for public mental health services for SMI. LA DMH'snew FSPs represent a major allocation of these funds toward an Assertive Community Treatment (ACT) modelof care for a very small proportion of LA DMH's clients. Many researchers have found ACT to be cost-effectiverelative to other types of public mental health care,159 but nothing is known about the incremental costeffectivenessof FSPs relative to usual care for LA DMH clients with SMI. Reference Case cost-effectivenessanalyses are valuable for assessing interventions that are of policy interest, because they follow a standardprotocol to facilitate comparison of interventions for different illnesses in terms of incremental costeffectivenessover alternative interventions, measured in costs per quality-adjusted life year.160 Theseevaluations are rare in mental health services research due to the difficulty of measuring health utilities inindividuals with SMI.161'164 Utilities can be derived from Positive and Negative Symptom Scale (PANSS) scoresand side effect profiles,165'168 a newly-developed approach that is well-suited to controlled trials of antipsychoticmedications but that requires trained observer ratings and is diagnosis-specific, limiting its application andcomparability. Cost-effectiveness analysis of SMI interventions will benefit from the availability of a self-reportmeasure that is appropriate for individuals with SMI and responsive to changes in SMI severity. The AQoLwas validated in a cross-sectional sample of individuals with psychosis and holds promise for this purpose..
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