Autism & Mental Health: Problems & Solutions

May 24, 2018

Two new studies point to higher and growing healthcare costs for autism spectrum disorders (ASD) across the lifespan, particularly in the area of mental health. A new model program in New York might have an answer to this critical problem.

A new study reports that children with autism were up to 30 times more likely to use emergency departments (ED) than youth without ASD. Many of those visits were for non-urgent ED visits, which is a costly way to provide routine healthcare. Up to 13 percent of visits were for behavioral or psychiatric problems, far more than for children without autism, for whom less than two percent of visits were for psychiatric problems. Youth with ASD were also likely to have repeat visits to the ED and more likely to be admitted to a psychiatric unit or medical floor. The study was a review of the literature published between 1985 and 2016.

Adults with autism also have many more healthcare visits for psychiatric conditions, 11 times more than the general adult population, according to a new study which we reported on in our April SafeMinds e-news.

Adults with ASD were eight times more likely to be on psychiatric medications, and their overall psychiatric care costs were almost 12 times higher than those without ASD. For all medical costs, annual costs for adults with autism were 70 percent higher ($7,118 vs. $3,197 for those without autism). The higher costs were largely driven by psychiatric/neurological needs.

The study was among adult members of the Northern California Kaiser Permanente system. Notably, the mean age of the autism study population was just 29 years, with approximately half (52 percent) between 18 and 24 years of age, and just 9.5 percent 50 years or older. The younger skew—everyone in the Kaiser system with autism was included in the study—provides more evidence that the prevalence of autism is really increasing. There just aren’t that many older adults with the condition. The study found that older adults with autism have higher health needs and costs, and the authors state that “a recent survey of more than 900 adult healthcare providers found that the vast majority reported that they lacked the adequate training to care for the ASD population.”

These findings bode poorly for the future, as more and more children with autism become young adults, and then older adults. The Kaiser study authors conclude that more research is needed “to develop strategies to improve delivery of healthcare to adults with ASD. Our study suggests that healthcare systems will need to plan ahead to adequately accommodate the needs of this growing and aging population.”

On the bright side, a new model for psychiatric care for families affected by autism has been developed by SafeMinds Board Vice President Dr. Michael Cummings, M.D., and his colleague and SafeMinds Research Committee Member Janelle Van Cleve. Access to Psychiatry Through Intermediate Care, or APIC, trains and fields teams that visit the urban and rural communities of Buffalo, NY to provide comprehensive, coordinated care for mental health and other needs to families facing autism. The program diverts costly and often traumatic visits to the ER, saving the health system dollars and improving the lives of the person with autism and their families.

The New York Office of Mental Health recognized the outstanding work of APIC for Mental Health Awareness Month, honoring those “people and programs making a major impact on children’s mental health.” In its Facebook post, the NY Office of Mental Health had this to say about APIC:

Expansion of this model to other parts of the country would be a big step forward in addressing the multiple co-occurring conditions of autism, particularly the mental health challenges and increased healthcare utilization costs

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