State and Facility Level Predictors of Latino Mental Health Service Use

Background and Purpose

            Despite having similar prevalences of mental health disorders, Latinos are less likely to use mental health services than non-Latino Whites. However, there is a scarcity of research that examines facility level factors that predict mental health service use for Latinos by state.

            Research has shed light on the social and regional differences in mental health care services and called for greater attention to community and system level factors that impact Latinos’ access to mental health services. Many states may be better prepared to provide appropriate access for Latinos when they are experiencing mental health issues. For instance, states that expanded Medicaid eligibility under the Affordable Care Act may provide better access for Latinos than those states that declined the expansion. This study aims to examine the facility and state level factors that are associated with Latino’s access to mental health services.

Methods

Data: Data for this analysis comes from the 2012 National Mental Health Services Survey (N-MHSS) supplemented with the Pew Research Center’s Latinos as Percent of Population, By State, 2011dataset. This analysis focused on 7,931 of the 10,374 mental health facilities throughout the United States of America included in N-MHSS, which provided outpatient services.

Measures: The percentage of outpatients at each facility who were Latino was the primary outcome of interest. The facility-level data included language concordant services, family psychoeducation, family outpatient therapy, facility religious affiliation, and emergency psychiatric service. The state-level data included percentage of Latinos, Latinos’ without insurance, Latinos’ median income, and Latinos’ median age per state.

Analysis: Four multilevel models were estimated to assess whether state- and facility-level variables were associated with Latino mental health service use. The level-1 equation estimated the effect of facility-level factors on percentage of Latinos using mental health services. The level-2 equation estimates the contribution of state-level factors on percentage of Latinos using mental health services.

Results:

            Descriptive statistics indicate there were fewer Latinos using mental health services (8.95%) than Latinos in states (13.94%). Results from the intraclass correlation indicate 33% of the variance in the proportion of Latinos in facilities is due to state level factors (ρ = 0.33). Facilities with Spanish-speaking services have 7.91% more Latinos using their services compared to facilities without Spanish-speaking services. Facilities that provided psychoeducation for families had a 1.20% greater likelihood of Latinos using their services. Facilities with emergency services had a -1.41% likelihood in Latinos using their services. Finally, greater concentration of Latinos in a state was associated with 0.91% likelihood of Latinos using services.

Conclusions and Implications:

            There is scant research on facility and state-level factors that inform Latinos’ mental health service use. The findings indicate that three facility-level factors (language concordance, emergency services, and family psychoeducation) and one state-level factor (Latino concentration) were significantly associated with mental health service use among Latinos. Social workers have a pivotal role in creating programs that provide Latinos with adequate access to mental health services. Social workers should promote the inclusion of language services and family psychoeducation to assure access.