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
"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
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
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/>.▪