State and Facility Factors Predictive of Community Mental Health Center's Provision of Service for Serious Mental Illness and Post-Traumatic Stress Disorder

Background/Purpose: Individuals diagnosed with a serious mental illness (SMI) report higher rates of traumatic experiences and are diagnosed with post-traumatic stress disorder (PTSD) more frequently than the general population. Despite the need, many individuals with SMI and PTSD do not receive integrated treatment for these co-morbid issues. Community mental health centers (CMHCs), where the majority of individuals with SMI receive treatment, have struggled to provide trauma-informed care for SMI. One important aspect of trauma-informed care is the integration of treatments as opposed to addressing each treatment issue with a separate program. Despite the therapeutic advantages of the approach, the presence of integrated treatment services for SMI and PTSD at CMHCs is an understudied area of research.

There are many factors that influence the program offerings of individual CMHCs. The present study explored macro-level variables to determine if it is possible to predict the presence of services for both SMI and PTSD in CMHCs. It explored the relationship between SMI and PTSD services, mental health funding, the need for SMI services, availability of mental health clinicians and presence of evidence-based programs at CMHCs.

Methods: Data: Data from the 2010 National Mental Health Services Survey (NMHSS-2010) and the Substance Abuse and Mental Health Services Administration (including data on mental health funding, population of SMI, and mental health providers per 100,000 residents) were combined for this secondary data analysis. The NMHSS-2010 is a survey of all mental healthcare facilities in the United States and includes information for over 16,000 unique facilities.

Measures: Mental health providers per 100,000 was created by combining the per capita numbers of psychologists, clinical social workers, and counselors in each state. The State Mental Health Agency expenditure per capita was used to represent mental health funding. Population of SMI was measured as the percentage of adults in each state diagnosed with a serious mental illness in the past year. A scale was created to measure each facility’s willingness to adopt evidence-based programs. Logistic regression was used to explore whether these variables were predictive of the presence of services for both SMI and PTSD at a CMHC.

Results: The logistic regression indicated that increased mental health funding, higher percentage of SMI population, higher number of mental health providers and greater presence of other evidence-based programs were predictive of a CMHC facility offering services for SMI and PTSD. Of the variables explored, the evidence-based program scale was the most predictive. For each additional evidence-based program offered by a facility the likelihood that the facility offered services for SMI and PTSD increased 62 percent.

Conclusions and Implications: These findings indicate that a portion of the variability in providing services for SMI and PTSD can be attributed to state and facility-level factors. They underscore the need to consider macro-level conditions that contribute to each CMHC’s ability to provide programs to fit the needs of their community.