Leveraging 'Big Data' to Identify Geographic Areas of Need Among Low-Income Young Adults Living with Serious Mental Illness

Background and Purpose: The US Surgeon General declared a mental health crisis among our nation’s youth, particularly those who are minoritized and low-income. To inform policy and targeted resource allocation, an interdisciplinary team of data scientists, health policy experts, and health services researchers leveraged population-level ‘big data’ to identify geographical areas of mental health need and drivers of outpatient mental health service use (MHSU).

Methods: Our study used the Medicaid behavioral health claims database for New York from 4/1/2021 to 3/31/2022. We focused on young adults aged 18-34 with Medicaid enrollment during the full study period. We excluded members with dual Medicaid and Medicare enrollment and zip codes with less than 12 members. SMI was defined as having at least 1 inpatient or two outpatient visits and a diagnosis of schizophrenia-spectrum, major depression, or bipolar disorders. First, the prevalence of SMI and mental health service use (mental health outpatient, inpatient, and emergency department visits) was estimated statewide and by zip code. Second, logistic regression was used to identify individual (sex, race/ethnicity, age, region, aid, homelessness), clinical (diagnosis and provider type), and community-level (Distress Community Index) factors associated with past year outpatient MHSU. The Distress Community Index aggregates seven economic well-being indices related to poverty, education, income, and housing into one indicator.

Results: Our study population included 1,603,162 young adults (37.8% of the Medicaid population) residing across 1,519 zip codes. Statewide 132,532 young adults (8.3%) had SMI, with wide geographic variation (0.0%-47.1%). SMI varied by race and ethnicity (12.5% American Indian, 11.9% White, 9.2% Latinx, 8.6% Black, and 3.9% Asian), sex (9.8% Females vs. 6.5% Males), region (14.0% rural vs. 6.6% urban), and homelessness (32% with a history of homelessness vs. 7.9% without). Statewide two-thirds of young adults with SMI had a mental health outpatient visit during the year, over 10% had a psychiatric ED visit, and 8.3% had a psychiatric inpatient visit. Identifying as American Indian, Black, or Latinx, those with a disability, having bipolar disorder or schizophrenia, receiving services from a mental specialty clinician/program, living in a rural area, and living in areas with greater community distress, were associated with higher odds of outpatient MHSU compared to other groups (AOR ranged from 1.21 (American Indian), 95% CI [1.04, 1.41] to 3.11 (mental health specialty), [3.01, 3.22]). Identifying as Asian and older age was associated with lower odds of outpatient MHSU (AOR ranged from 0.81 (age), [0.78, 0.83 to 0.86] to 0.86 (Asian), [0.81, 0.91]).

Conclusions and Implications: Across New York State, approximately 10% of Medicaid-enrolled young adults had SMI yet only two-thirds accessed outpatient mental health services. The prevalence of SMI varied geographically and by other characteristics. Findings emphasize the role of key individual, clinical, and community-level factors as drivers of outpatient MHSU and unmet need characterized by high prevalence of SMI, high psychiatric inpatient and emergency department use, and low outpatient visits. Leveraging ‘big data’ can help target and allocate limited resources to geographic areas with unmet mental health need.