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Cited by 190Mental Health Treatment and AccessHealthcare Policy and ManagementPsychiatric care and mental health services

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Geographic Access to Specialty Mental Health Care Across High- and Low-Income US Communities

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Cummings, Janet R., Allen, Lindsay, Clennon, Julie, Ji, Xu, Druss, Benjamin G.·2017·JAMA Psychiatry
DOI 10.1001/jamapsychiatry.2017.0303PMC PMC5693377
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Abstract

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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  1. [17]Smith K Kuramoto-Crawford J Lynch S Availability of Payment Assistance for Mental Health Services in US Mental Health Treatment Facilities 2013 http://www.samhsa.gov/data/sites/default/files/report_2123/ShortReport-2123.pdf. Accessed July 18, 2016 27054225

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Metadata

Authors
Cummings, J. R., Allen, L., Clennon, J., Ji, X., & Druss, B. G.
Affiliations
Emory University (US)
Corresponding author
Cummings, Janet R.
ORCID
Venue
JAMA Psychiatry
Publisher
American Medical Association (AMA)
Published
2017-05-01
Volume
74
Issue
5
Pages
476
ISSN
2168-622X (ISSN-L)
DOI
10.1001/jamapsychiatry.2017.0303
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
Locations
  • JAMA Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Institute of Mental Health (K01MH095823)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › 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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