Patterns and Predictors of Specialty Mental Health Service Utilization in the U.S
Although stigma associated with psychiatric illness has decreased over time, concerns remain that many people who could benefit from services do not seek them. Of particular importance is an understanding of who is accessing care in specialty settings, such as outpatient and inpatient programs, where evidence-based assessments and intervention are more likely to occur. The objective of this study is to advance knowledge about access to care and treatment patterns of people with mental illness. Specifically, this study uses nationally representative data to systematically examine patterns of specialty mental health service utilization and separately investigates correlates of types of mental health treatments.
Method
Data are from the 2008-2011 National Survey on Drug Use and Health (NSDUH), which is a nationally representative household survey conducted via computer-assisted face-to-face interviews in the 50 states and the District of Columbia. Only people age 18 years or older with a mental illness (N= 40,753) were selected for this analysis. Utilization patterns are based on three questions asking respondents’ past year use of psychotropic medication, inpatient mental health services, and outpatient mental health services. Predictors of utilization include sociodemographic characteristics (e.g., gender, race, age, educational attainment, income, insurance status, public assistance receipt, criminal history) and indicators of health status (e.g., substance use, perceived need for substance use treatment, HIV status, and severity of mental illness). SPSS was used to conduct bivariate and multivariate logistic regression. All significance tests were two-tailed, P<.05.
Results
The majority of people with a mental illness (62.2%) did not receive any specialty mental health care in the past year. Psychotropic medication is the most common treatment (32.7%), followed by outpatient treatment (21.8%) and inpatient treatment (3.0%). Among those who received any treatment, most received only one type of service (53.3%), which was most often psychotropic medication (75.0%); 41.8% received two types of service, which in almost all cases (99%) included psychotropic medication. Controlling for perceived need for mental health care and mental illness severity, sociodemographic factors were associated with mental health service utilization. However, the correlates of utilization differed depending on the type and number of services. For example, recipients of psychotropic medication and outpatient treatment were more likely to be older, more highly educated, female, non-Hispanic White (compare to Hispanic) and have higher family incomes. In contrast, respondents receiving inpatient mental health care were more likely to be male, lower educated, and have lower family income.
Conclusion and Implications
The findings suggest that gender and socioeconomic status are consistent indicators of access to care, regardless of the type of specialty service investigated. Additionally, the use of medication in the absence of other specialty mental health services raises questions about quality of care. The paper will highlight policies and programs that can be developed to address health care disparities and to insure equity of treatment.