Through the Mental Health Services Act (MHSA, California voters approved a dramatic increase in funds for public mental health services for SMI. LA DMH's new FSPs represent a major allocation of these funds toward an Assertive Community Treatment (ACT) model of care for a very small proportion of LA DMH's clients. Many researchers have found ACT to be cost-effective relative to other types of public mental health care,159 but nothing is known about the incremental costeffectiveness of FSPs relative to usual care for LA DMH clients with SMI. Reference Case cost-effectiveness analyses are valuable for assessing interventions that are of policy interest, because they follow a standard protocol to facilitate comparison of interventions for different illnesses in terms of incremental costeffectiveness over alternative interventions, measured in costs per quality-adjusted life year.160 These evaluations are rare in mental health services research due to the difficulty of measuring health utilities in individuals with SMI.161""""""""164 Utilities can be derived from Positive and Negative Symptom Scale (PANSS) scores and side effect profiles,165""""""""168 a newly-developed approach that is well-suited to controlled trials of antipsychotic medications but that requires trained observer ratings and is diagnosis-specific, limiting its application and comparability. Cost-effectiveness analysis of SMI interventions will benefit from the availability of a self-report measure that is appropriate for individuals with SMI and responsive to changes in SMI severity. The AQoL was validated in a cross-sectional sample of individuals with psychosis and holds promise for this purpose..

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National Institute of Mental Health (NIMH)
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Special Emphasis Panel (ZMH1)
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University of California Los Angeles
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