Poor Endure Access Problems In All Regions of U.S.

Serious problems with access to mental health services have surfaced in one of the periodic analyses by the Center for Studying Health System Change (HSC) about the viability of the “safety net.”

Every two years HSC researchers visit 12 nationally representative metropolitan communities to track changes in local health care markets. The communities are Boston, Cleveland, Greenville, S.C., Indianapolis, Lansing, Mich., Little Rock, Ark., Miami, northern New Jersey, Orange County, Calif., Phoenix, Seattle, and Syracuse, N.Y.

The researchers interview individuals who are involved directly or indirectly in providing safety-net services to low-income people.

The issue brief, “Health Care Access for Low-Income People: Significant Safety Net Gaps Remain,” published in June, reports on interviews that occurred in 2002-03.

Comments such as “the mental health delivery system is in shambles” expressed the extent of these problems, according to researchers Laurie E. Felland, Suzanne Feit-Lisk, and Megan McHugh.

Access to mental health services surfaced as a significant problem in eight of the 12 communities, although Felland told Psychiatric News that it should not be assumed that access was not a challenge in all the communities.

“We are hearing that more and more patients are showing up at community health clinics and other places that provide primary care with serious mental health problems that have not been treated,” she said.

HSC researchers typically have not interviewed individuals directly involved in providing mental health services, so these reports of problems suggest that mental health access issues are being manifested in the primary health care system.

Felland said that their respondents also reported that more people with psychiatric emergencies are showing up in emergency rooms, a trend that has been documented in other research (Psychiatric News, June 18).

One positive development has been the addition of mental health and substance abuse treatment services to community health centers through the use of federal grants from a program begun in 2002 by President Bush to expand and improve services at those centers.

Felland and colleagues wrote, “State and local policymakers are aware of the access problems for specialty, mental health, and dental services, but communities have been more active in addressing the issue.”

They continued by noting that budget constraints have hampered states' ability to allocate funds over the last few years.

Felland said that although some states had increased Medicaid provider rates, those rates often were still much lower than private insurer rates.

In addition, the HSC analysis was based on 2002-03 interviews before the deepest cuts to Medicaid had begun.

The researchers concluded, “Across communities, low-income and uninsured people face long-standing, and sometimes worsening, difficulties in obtaining specialty, dental, and mental health services.... Safety net providers are not equipped to meet the wide range of health care needs of all low-income people, and access to private practitioners remains limited.”

They identify low payment rates as a major barrier to access.

“Health Care Access for Low-Income People: Significant Safety Net Gaps Remain” is posted online at<www.hschange.com/CONTENT/682/>.▪