Geographic access to specialty mental health care across high- and low-income US communities
Open accessAbstract
Importance: With the future of the Affordable Care Act and Medicaid program unclear, it is critical to examine the geographic availability of specialty mental health treatment resources that serve low-income populations across local communities. Objectives: To examine the geographic availability of community-based specialty mental health treatment resources and how these resources are distributed by community socioeconomic status. Design, Setting, and Participants: Measures of the availability of specialty mental health treatment resources were derived using national data for 31 836 zip code tabulation areas from 2013 to 2015. Analyses examined the association between community socioeconomic status (assessed by median household income quartiles) and resource availability using logistic regressions. Models controlled for zip code tabulation area-level demographic characteristics and state indicators. Main Outcomes and Measures: Dichotomous indicators for whether a zip code tabulation area had any (1) outpatient mental health treatment facility (more than nine-tenths of which offer payment arrangements for low-income populations), (2) office-based practice of mental health specialist physician(s), (3) office-based practice of nonphysician mental health professionals (eg, therapists), and (4) mental health facility or office-based practice (ie, any community-based resource). Results: Of the 31 836 zip code tabulation areas in the study, more than four-tenths (3382 of 7959 [42.5%]) of communities in the highest income quartile (mean income, $81 207) had any community-based mental health treatment resource vs 23.1% of communities (1841 of 7959) in the lowest income quartile (mean income, $30 534) (adjusted odds ratio, 1.74; 95% CI, 1.50-2.03). When examining the distribution of mental health professionals, 25.3% of the communities (2014 of 7959) in the highest income quartile had a mental health specialist physician practice vs 8.0% (637 of 7959) of those in the lowest income quartile (adjusted odds ratio, 3.04; 95% CI, 2.53-3.66). Similarly, 35.1% of the communities (2792 of 7959) in the highest income quartile had a nonphysician mental health professional practice vs 12.9% (1029 of 7959) of those in the lowest income quartile (adjusted odds ratio, 2.77; 95%, 2.35-3.26). In contrast, outpatient mental health treatment facilities were less likely to be located in the communities in the highest vs lowest income quartiles (12.9% [1025 of 7959] vs 16.5% [1317 of 7959]; adjusted odds ratio, 0.43; 95% CI, 0.37-0.51). More than seven-tenths of the lowest income communities with any resource (71.5% [1317 of 1841]) had an outpatient mental health treatment facility. Conclusions and Relevance: Mental health treatment facilities are more likely to be located in poorer communities, whereas office-based practices of mental health professionals are more likely to be located in higher-income communities. These findings indicate that mental health treatment facilities constitute the backbone of the specialty mental health treatment infrastructure in low-income communities. Policies are needed to support and expand available resources for this critical infrastructure.
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People of color face barriers to care, including limited access to providers, financial and transportation constraints, and stigma.
“POC face numerous barriers to care, including limited access to providers [37], financial and transportation constraints [38], and stigma [39].”
From App-Based Mindfulness Meditation for People of Color Who Experience Race-Related Stress: Protocol for a Randomized Controlled Trial (2022) · cites this paper as [37]
The citation is attached to limited access to providers, not to the separately cited financial, transportation, or stigma barriers. The Results (Distribution by Community SES; page unavailable) show fewer mental-health specialist practices in lower-income communities. The Methods (Measures; page unavailable) say racial and ethnic composition was a control variable, but the cited findings do not establish that people of color specifically have limited provider access. (LLM, conf=0.83)
Experimental — accuracy not yet measuredEconomic, geographic, or cultural barriers may limit access to mental health services in rural and underserved communities.
“This is particularly concerning for rural and underserved communities where economic, geographic, or cultural barriers may limit access to mental health services.9,10”
From Evidence-based youth suicide prevention and intervention in pediatric primary care settings. (2024) · cites this paper as [10]
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- Authors
- Cummings, J. R., Allen, L., Clennon, J., Ji, X., & Druss, B. G.
- Affiliations
- Emory University (US)
- Corresponding author
- Cummings, Janet R.
- Venue
- JAMA Psychiatry
- Publisher
- American Medical Association (AMA)
- Published
- 2017-05-01
- Volume
- 74
- Issue
- 5
- Pages
- 476
- ISSN
- 2168-622X (ISSN-L)
- PMC
- PMC5693377
- OpenAlex
- W2604533355
- Cited by
- 190
- References
- 24
- Citations by year
- 2026: 35 · 2025: 35 · 2024: 26 · 2023: 18 · 2022: 24 · 2021: 21 · 2020: 15 · 2019: 12 · 2018: 3 · 2017: 1
- FWCI
- 12.13
- Type
- journal article
- Language
- en
- Open access
- green
- europepmc.org
- Locations
- JAMA Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Mental Health (K01MH095823)
- Topics
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Healthcare Policy and Management
- Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
- Keywords
- socioeconomic status, median household income, low-income populations, mental health professionals, Medicaid, Affordable Care Act, health care access disparities, ZIP code tabulation areas
- MeSH terms
- Community Mental Health Services, Health Services Accessibility, Humans, Income, Mental Health Services, Poverty, United States
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