Improving Mental Health Service Access: Exploratory Study of Existing Data

Background and Purpose. Although about 20% of children (ages 3 to 17) experience mental health disorders, only one in five youth receive specialized treatment. Without intervention, youth experience long lasting adverse effects. Barriers to service access include stigma, poverty, race/ethnicity, gender, and geography. Routine utilization of existing data could inform program and policy planning and monitor progress, but such information is seldom available. This study explored the use of administrative data to examine service utilization and to identify and address disparities in a midwestern state.

Methods. Access to mental health (MH) services was defined as utilizing publically funded mental health. Two types of existing data were evaluated: mental health block grant (MHBG) and Medicaid claims. Uniform Reporting System (URS) Client Level Data for transition age youth (TAY, ages 18-20) 2004-2016 trends were compared by gender and race/ethnicity. Child Medicaid behavioral health service utilization in 2014 was contrasted by age, gender, race/ethnicity, and language. Relationships among language, identification of MH needs, and service utilization were also explored.

Results. According to URS data, TAY youth’s utilization of MHBG funded services doubled then plateaued between 2013 and 2016. A pattern of more young women (55%) receiving services than men remained constant over time, although the 2015 census population estimates were similar. Disportionate access between white and non-white TAY decreased during a home and community based service grant (2008-2012).

Based on SFY14 Medicaid claims, MH needs were most frequently identified for 12-14 year old boys, but service intensity peaked for adolescents between ages 15 and 17. In contrast to MHBG data, more young men, ages 18-25, utilized MH services. After age 25, women more frequently utilized services. However, boys and men consistently received more MH services. MH service utilization by youth of color was lower than by Caucasian youth. A limitation of using administrative date emerged as language was missing for foster youth who had the highest level of Medicaid MH service utilization. Most young Medicaid members (90%) lived in English speaking households; other households primarily spoke Spanish (5%), Burmese, or other languages. Children in English speaking homes received more than twice the amount services compared to children in Spanish speaking homes. MH health needs for children were less often identified in the four largest urban counties than in smaller communities. In contrast to research, the intensity of MH services varied across urban and rural settings.

Conclusions and Implications. Consistent with research, this examination of administrative data found disproportionate identification of behavioral health needs and utilization of services by age, gender, race and ethnicity. Routine monitoring of existing data could help monitor MH service utilization and the impact of policy or programs on access to care. Gender differences between MHBG and Medicaid MH service utilization require further exploration. Additional research is needed regarding factors affecting geographic differences and the effectiveness of routinely using existing data to manage programs and inform policy.