The Role of Licensed Mental Health Staffing in Improving Patient Outcomes at Health Centers

Background: In 2016, close to 45 million adults in the United States had some form of mental illness, but only 43% received treatment for their condition. This unmet need for mental health (MH) services has been attributed to the cost of care or insufficient insurance coverage. Research has also shown that patients with comorbid MH and medical conditions are at a higher risk for health complications and are frequently high utilizers of health services. Research Objective: I aimed to assess the potential benefits of MH staffing within health centers (HCs) funded by HRSA, a crucial part of the safety net which provides primary care services regardless of patients’ ability to pay. My research questions are whether licensed MH staffing within a patient’s HC is associated with higher likelihood of MH service utilization (paper 1) and lower likelihood of high utilization of outpatient and acute care services (paper 2). Data and Sample: In the first study I use data from HRSA’s 2014 Health Center Patient Survey and administrative data on patients’ HCs from the UDS 2013 report. The study sample included 4,575 patients aged 18-64 who identified their HC as their usual source of care. In the second study, I use patient level encounter data from California’s Low-Income Health Program (LIHP) from 2011-2013, and administrative data on patients’ HCs from California’s OSHPD 2012 Primary Care Utilization report. This study sample included 26,833 patients between the ages of 19-64, enrolled in LIHP and assigned to an HC as their medical home. Results: My first research paper showed that more overall licensed MH staffing at HCs (versus none) increased the likelihood of patients receiving MH treatment anywhere and on-site (at the patient’s HC), and any level of psychiatrist staffing also increased the likelihood of receiving MH treatment on-site. My second study showed that licensed MH staffing of at least 0.5 FTE (versus none) was associated with high patient utilization of outpatient visits. I also found that any level of psychiatrist staffing (versus none) increased the likelihood of having three or more ED visits, and any level of LCSW staffing decreased the likelihood of 3 or more ED visits and any hospitalization. Discussion: Access to MH services for low-income populations continues to be a challenge in the United States. Due to the strategic location of HCs in medically under-served areas, co-locating an adequate number of licensed MH providers at HCs is likely to help reduce disparities in access to MH services. Staffing levels for specific types of providers in these studies may have been too low to help reduce high utilization of services. More research is needed on the role of specific types of MH providers and the necessary level of FTE to adequately meet patient needs