227 Summary Chapter 3, 4 and 5 studied interventions, programs and policies linked to considerable challenges of contemporary mental health policy agendas, aimed at eliciting their causal effects and potential impact on inequalities. These chapters cover three related but distinct key policy levers in granting access to mental health support: coverage, eligibility and availability. Chapter 3 studied the impact of coverage in the transitional gap in mental health care. We evaluated the effects of a 180-euro deductible increase, between 2009 and 2014, in the use of mental health care by young adults that turn 18 and become eligible to this cost-sharing (difference-in-discontinuity). We studied heterogenous effects by household income quartile and explored differences in treatment cessation by level of treatment need, proxied by consumption at 17. Our results show that the deductible raise reduced the probability of females starting or continuing mental health treatment at the transition to adulthood. Importantly, this reduction was primarily observed in girls from the lowest and second lowest income quartiles. Focusing on patients at the age of 17 we found that increased treatment cessation in high deductible years happened to both females and males, across all levels of previous mental health treatment intensity and medication use for mental disorders. These findings indicate that cost-sharing is compounding to poor transitional care into adulthood, when foregoing mental health treatment may have long-term consequences on health and development. The larger reductions in mental health care use among low-income females uncover the role of the cost-sharing in widening mental health care inequalities at this developmentally-sensitive phase of the life-course. Chapter 4 looked at providing appropriate arrangements for individuals who need living support due to their mental disorders, a challenge that has been around since early deinstitutionalization efforts in 1950s. We estimated the effects of eligibility to the Dutch supported housing program (Beschermd Wonen), which offers a structured living environment in the community as an intermediate alternative to independent housing and inpatient care. Through an instrumental variable design, we explored the exogenous variation in eligibility arising from the conditionally random assignment of applications to assessors with different leniencies. Based on the universe of applicants to supported housing in the Netherlands between 2011 and 2013, we concluded that supported housing eligibility increased the probability of moving into supported housing and decreased the use of home care. It also resulted in higher total care expenditures, primarily due to the costs of supported housing, but potentially also due to higher consumption of curative mental health care. Supported housing eligibility reduced considerably the income from work and personal income, but the later to a lesser extent. Findings do also suggest lower participation in the labour market by individuals granted eligibility, while the labour participation of their parents increased in the long-run. These conflicting findings for the individual, the family and the system highlight important trade-offs of granting access to supported housing for those at the margin of eligibility, which should inform the design of long-term mental health care systems around the world. A
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