Poor Communities Have Fewer Options for Mental Health Care

Whether a person with mental illness ever seeks professional help often depends on a variety of factors, including the cost of care and available resources in his or her community.

A study appearing in the May issue of JAMA Psychiatry found that while 70 percent of the U.S. population lives in communities where specialty mental health treatment is available, the distribution of mental health treatment resources varied significantly by the socioeconomic status of the community. While office-based practices of mental health professionals are more likely to be located in higher-income areas, mental health clinics are more common in lower-income communities.

“These findings build on prior workforce research examining the distribution of mental health professional shortage areas across U.S. counties,” Janet Cummings, Ph.D., of Emory University, and colleagues wrote. “The present study adds depth to our understanding of the distribution of mental health treatment resources by examining two mental health systems that serve different clientele.” These systems include specialty community mental health clinics (which often take Medicaid and offer payment assistance) and solo and small-group practices of psychiatrists and therapists.

For the study, Cummings and colleagues analyzed the distribution of specialty outpatient mental health treatment clinics and office-based practices, across 32,000 U.S. communities.

The researchers identified 7,700 specialty mental health treatment centers providing outpatient services using the Substance Abuse and Mental Health Services Administration (SAMHSA) Behavioral Health Treatment Services Locator. From the 2013 U.S. Census Bureau County Business Patterns data, they identified 11,165 psychiatrist office practices and 20,290 nonphysician (therapist) mental health professional practices. Median household incomes were used to assess community-level socioeconomic status.

The analysis revealed that nearly twice as many communities in the highest income quartile of median household income (43 percent) had specialty mental health treatment resources compared with communities in the lowest income quartile (23 percent).

More than three times as many communities in the highest income quartile had a psychiatrist practice compared with the lowest quartile (25 percent versus 8 percent). Similarly, more than 35 percent of the communities in the highest income quartile had therapist practices compared with 13 percent of communities in the lowest income quartile.

In contrast, about 16.5 percent of the communities in the lowest income quartile and 13 percent of communities in the highest income quartile had outpatient mental health facilities.

Although the researchers identified the number of mental health treatment facilities and practices located in many communities, they noted the data do not provide information about their treatment capacity or waiting times.

“[M]ental health treatment facilities—which are more likely to serve vulnerable populations—are the backbone of the outpatient specialty mental health care infrastructure that exist in local low-income and rural areas,” Cummings and colleagues concluded. “To the extent that gaps in geographic accessibility to mental health treatment resources exist in vulnerable communities, policymakers may consider bolstering resources for expanded behavioral health care services in other safety-net facilities.” ■