The Association Between Mental Health Services Utilization and Mental Health Functioning Among Ryan White Clients Living with HIV in New York City

Background and Purpose: There is evidence that people living with HIV (PLWH) are disproportionately impacted by poor mental health, which can negatively impact HIV medical outcomes. Mental health services are therefore critical for this population. To date, few studies have examined the relationship between mental health services utilization and health and mental health outcomes among PLWH. Such studies are needed to inform the design and implementation of mental health services for this population. The aim of this analysis was to evaluate the relationship between mental health services utilization and short-term improvement in mental health functioning among Ryan White clients.

Methods: A total of 1,359 individuals received Ryan White Part A-funded mental health services in New York City between 6/2012 and 3/2016 and completed a measure of mental health functioning (The Short Form Survey; SF-12) at program intake. Our sample for this analysis included 406 individuals who also completed a follow-up SF-12 (4-8 months post-intake). A clinically significant improvement in mental health functioning was defined as a ≥ 3.5 point increase on the mental component summary (MCS) score on the SF-12 from program intake to the follow-up assessment. Levels of mental health services utilization were calculated using the number of individual and/or group services received per day between assessments. Three categories were identified based on terciles of the distribution of the average number of services utilized per day: (a) low (.004-.044); (b) medium (.045-.095); and (c) high (> .095). A multivariate analysis was conducted to examine the association between levels of mental health services utilization and improvement in mental health functioning. Variables that were significantly associated (p< 0.05) with MCS improvement in bivariate analyses were included in the model.

Results: Of the 406 clients assessed, 39% (n=156) demonstrated an improvement in mental health functioning from program intake to the follow-up assessment (median MCS at program intake= 37.98). In a multivariate analysis controlling for housing status and MCS score at program intake, higher proportions of individuals with high (42%; AOR=1.74, CI=1.00-3.03) and medium (45%; AOR=1.97, CI=1.14-3.41) levels of mental health service utilization experienced an improvement in mental health functioning, compared to those with low levels of mental health services utilization (29%).

Conclusions and Implications: The findings of this evaluation demonstrated a clinically significant improvement in mental health functioning between intake and a follow-up assessment for nearly two-fifths of a population of Ryan White Part A-funded mental health services clients in New York City. Further, the significant, independent association between medium to high levels of utilization and improvement in mental health functioning suggests the importance of mental health services access for PLWH. Future analyses should include additional follow-up periods to assess patterns of service utilization over time (e.g., duration and gaps in services) and their association with mental health functioning. Studies of program effects should also include comparison groups of similar Ryan White Part A program clients who are assessed for mental health functioning over time but are not receiving mental health services.