ACCESS Open Minds Linked to Lower Youth Mental Health Costs

Key Takeaways

• Among youth receiving mental health care in Edmonton, Canada, ACCESS Open Minds was associated with lower public-system costs and greater reductions in hospital admissions and public residential admissions, as well as several outpatient service categories, than traditional mental health care.
• Program spending was reported to be more than offset by downstream savings, with a net cost reduction of C$4,355 per person per year, implementation costs of C$448, and a reported return on investment of 9.7.
• Youth receiving ACCESS Open Minds were described as having more intensive service needs throughout the study period.
• ACCESS Open Minds was associated with greater reductions in hospital admissions and public residential admissions, while emergency department visits and contracted residential admissions did not differ significantly between groups.

Hospital stays and residential treatment can account for substantial system burden in youth mental health care when young people have intensive service needs. That makes community-based models clinically and economically important to evaluate, especially when they are intended to shift care away from institutional settings. In Edmonton, Canada, investigators examined whether ACCESS Open Minds, delivered within a pan-Canadian youth mental health program, was associated with different patterns of service use and public spending than traditional mental health care.

In a retrospective cohort study, published in The Lancet Psychiatry, investigators evaluated the Edmonton site of ACCESS Open Minds, a pan-Canadian youth mental health program. They compared 1,415 young people receiving ACCESS Open Minds with 9,217 youth receiving standard community mental health services. Using a difference-in-differences approach, investigators compared changes in service use and associated costs before versus after exposure to ACCESS Open Minds over 1 year with changes among youth receiving non-transformed services; propensity score matching and sensitivity analyses were used to reduce bias and assess robustness.

The net cost reduction associated with ACCESS Open Minds was C$4,355 per person per year, with implementation costs of C$448 and a net benefit of C$3,907, yielding a reported return on investment of 9.7. Youth receiving ACCESS Open Minds had more intensive service needs throughout the study period and had greater reductions in hospital admissions, outpatient visits, specialist visits, general practitioner visits, and public residential admissions than the comparison group. There were no significant differences in emergency department visits, prescriptions dispensed, community mental health visits, or contracted residential admissions.

Because the Edmonton evaluation used a retrospective cohort comparison, the findings support an association rather than establishing a causal effect of the service model. The authors argued that cost savings from novel services can be realized when those services include youth who were previously intensive users of standard services, rather than focusing only on new cases.

In Edmonton, an enhanced primary-care youth mental health model within a pan-Canadian program was associated with lower public-system costs and greater reductions in several service categories, including hospital admissions and public residential admissions. The authors concluded that the long-term return on investment of enhanced primary youth mental health models will likely depend on their commitment to including youth who have been intensive users of standard services.

Clinician Questions

Why did the authors connect ACCESS Open Minds savings to serving youth with intensive service needs?

According to the authors, cost savings can be realized when novel services identify and treat not only new cases but also youth who were previously intensive users of standard services. They concluded that the long-term return on investment of enhanced primary youth mental health models will likely depend on continuing to include this population.

What outcomes were tracked in the ACCESS Open Minds return-on-investment analysis?

Investigators used administrative data to assess service utilization and associated costs, including program implementation costs. ACCESS Open Minds was associated with greater reductions in hospital admissions, outpatient visits, specialist visits, general practitioner visits, and public residential admissions. There were no significant differences in emergency department visits, prescriptions dispensed, community mental health visits, or contracted residential admissions.

Does the ACCESS Open Minds economic signal extend beyond the Edmonton site? The reported findings are from a major urban site within the pan-Canadian ACCESS Open Minds network. The supplied study does not report economic evaluation results from other ACCESS Open Minds sites, so whether similar cost and service-use findings apply in other settings remains uncertain.