Examining Healthcare Decision-Making Among Consumers of Mental Health Services?
Methods. Data were obtained from a large-scale assessment of client reported outcomes in San Diego County Adult and Older Adult Mental Health Services (N = 1223). Informed by Andersen’s Behavioral Model that identifies predisposing, enabling, and needs factors that affect healthcare access, two separate analyses were then conducted. First, a multinomial regression analysis was used to evaluate what factors influences the use of physical health services from a mental health provider, a primary health provider, or both types of provider, relative to neither type of provider. Binary logistic regression then examined what factors influences the decision to access services from a mental health vs. primary health provider.
Results. Multinomial results revealed that Asian ethnicity was a predisposing factor associated with decreased odds of accessing a primary health provider (OR=0.427; 95%CI =0.183-0.983). Having a regular physical health provider was an enabling factor associated with increased odds of accessing care from a primary health provider (OR=26.27; 95%CI=16.22-42.57), a mental health provider (OR =1.897; 95%CI=1.165-3.089), and both types of providers (OR=25.84; 95%CI=16.917-39.48). Difficulty obtaining physical healthcare in the past year was associated with decreased odds of accessing a primary health provider (OR=0.631; 95%CI=0.398-0.976). Having one or more chronic condition such as diabetes or hypertension was a need factor, which increased odds of accessing physical healthcare from a primary health provider (OR =1.808; 95%CI=1.164-2.809), a mental health provider (OR=1.998; 95%CI=1.33-2.99) and from both types of providers (OR=1.853; 95%CI = 1.203-2.854). Binary logistic regression results revealed that Asian ethnicity (OR =3.13, 95%CI=1.38-7.09) and experiencing difficulty getting care (OR=1.69, 95% CI=1.088-2.628) increased likelihood of using physical health services from a mental health provider, while having a regular physical health provider decreased likelihood (OR = 0.072 95%CI=0.046-0.114).
Conclusion. This study reveals factors that should be targeted by efforts to improve physical health of mental health consumers. Asian consumers and consumers without a regular health provider are less likely to access physical healthcare and when they do are more likely to discuss their physical health concerns with their mental health providers rather than with a primary health provider. These findings suggest the importance of enhancing availability of physical health services in mental health settings in order to facilitate optimal physical health service use among individuals with SMI, yet also stress the importance of delivering culturally appropriate and tailored care. Results from this study can inform efforts to integrate health and mental health services under the Affordable Care Act.