Assessing spatial accessibility to mental health facilities in an urban environment

Measuring Mental Health Service Accessibility for Indigenous Populations: a Systematic Review

Indigenous populations have experienced inequality of accessing mental health services compared with their non-Indigenous counterparts, although the way of measuring mental health service accessibility for Indigenous populations is unclear. This systematic review examines measures of mental health service accessibility for Indigenous people, including the diversity of mental health services that are available to them and the barriers to accessing mental healthcare. Using a systematic search procedure, we identified 27 studies that explored Indigenous populations' mental health service access. Our review shows that 18 studies used interview-based methods to explore how Indigenous people use mental health services, and only nine studies used quantitative methods to measure the uptake of mental health services. While advanced methods for quantifying geographical access to healthcare services are widely available, these methods have not been applied in the current literature to explore the potential access to mental health services by Indigenous populations. This is partially due to limited understanding of how Indigenous populations seek mental healthcare, barriers that prevent Indigenous people from accessing diverse types of mental health services, and scarcity of data that are available to researchers. Future research could focus on developing methods to support spatially explicit measuring of accessibility to mental health services for Indigenous populations.

Scaling-up Child and Youth Mental Health Services: Assessing Coverage of a County-Wide Prevention and Early Intervention Initiative During One Fiscal Year

PURPOSE

In the U.S., the percentage of youth in need of evidence-based mental health practices (EBPs) who receive them (i.e., coverage rate) is low. We know little about what influences coverage rates. In 2010, the Los Angeles County Department of Mental Health (LACDMH) launched a reimbursement-driven implementation of multiple EBPs in youth mental health care. This study examines two questions: (1) What was the coverage rate of EBPs delivered three years following initial implementation? (2) What factors are associated with the coverage rates?

METHODS

To assess coverage rates of publicly insured youth, we used LACDMH administrative claims data from July 1, 2013 to June 30, 2014 and estimates of the size of the targeted eligible youth population from the 2014 American Community Survey (ACS). The unit of analysis was clinic service areas (n = 254). We used Geographic Information Systems and an OLS regression to assess community and clinic characteristics related to coverage.

RESULTS

The county coverage rate was estimated at 17%, much higher than national estimates. The proportion of ethnic minorities, individuals who are foreign-born, adults with a college degree within a geographic area were negatively associated with clinic service area coverage rates. Having more therapists who speak a language other than English, providing care outside of clinics, and higher proportion of households without a car were associated with higher coverage rates.

CONCLUSION

Heterogeneity in municipal mental health record type and availability makes it difficult to compare the LACDMH coverage rate with other efforts. However, the LACDMH initiative has higher coverage than published national rates. Having bilingual therapists and providing services outside the clinic was associated with higher coverage. Even with higher coverage, inequities persisted.

Spatial-Temporal Accessibility and Inequality of Veterinary Service in Hong Kong: A Geographic Information System-Based Study

Veterinary services are vital to the welfare of pets and their owners. Previous studies examined multiple factors affecting pet owners' decision to consult veterinarians, yet few studied the spatial accessibility of veterinary services. This study is one of the pioneering studies on the spatial-temporal accessibility of veterinary service and how it is associated with social and spatial inequality in Hong Kong. We measured the spatial availability and accessibility of both general and 24/7 veterinary clinics (i.e., veterinary clinics offering service for 24 hours, seven days a week or providing emergency services outside of business hours) using Geographic Information System and principal component analysis. We found that the spatial distribution pattern of general and 24/7 veterinary clinics can be explained by the average district-to-district distances and the area of a district. In addition, social and spatial inequality of access to veterinary services were observed. The spatial accessibility of general veterinary clinics within walking distance is negatively correlated with household size and the number of public-housing and subsidized-housing households, but positively correlated with the number of private-housing households. The spatial availability and accessibility of 24/7 veterinary service are positively correlated with the number of private housing households and households with the highest monthly household income, and the latter also positively correlates with a population with a post-secondary degree, further shedding light on the social and spatial inequality issue that communities with wealthier households and highly educated populations have more accessibility to 24/7 veterinary services. Last, we argue that the need-based veterinary support tends to target remote rural areas while overlooking the new growth areas close to the traditional urban core but poor in accessibility to veterinary care. Therefore, a comprehensive investigation into the pet ownership landscape and their needs over space and time will be beneficial to construct a more robust animal welfare system in Hong Kong.

Using GIS to Understand the Influence of Hurricane Harvey on Spatial Access to Primary Care

Hurricanes can have a significant impact on the functioning and capacity of healthcare systems. However, little work has been done to understand the extent to which hurricanes influence local residents' spatial access to healthcare. Our study evaluates the change in spatial access to primary care physicians (PCPs) between 2016 and 2018 (i.e., before and after Hurricane Harvey) in Harris County, Texas. We used an enhanced 2-step floating catchment area (E2SFCA) method to measure spatial access to PCPs at the census tract level. The results show that, despite an increased supply of PCPs across the county, most census tracts, especially those in the northern and eastern fringe areas, experienced decreased access during this period as measured by the spatial access ratio (SPAR). We explain this decline in SPAR by the shift in the spatial distribution of PCPs to the central areas of Harris County from the fringe areas after Harvey. We also examined the socio-demographic impact in the SPAR change and found little variation in change among different socio-demographic groups. Therefore, public health professionals and disaster managers may use our spatial access measure to highlight the geographic disparities in healthcare systems. In addition, we recommend considering other social and institutional dimensions of access, such as users' needs, preferences, resource capacity, mobility options, and quality of healthcare services, in building a resilient and inclusive post-hurricane healthcare system.

Identifying areas of potential critical healthcare shortages: A case study of spatial accessibility to ICU beds during the COVID-19 pandemic in Florida

Healthcare resource availability is potentially associated with COVID-19 mortality, and the potentially uneven geographical distribution of resources is a looming concern in the global pandemic. Given that access to healthcare resources is important to overall population health, assessing COVID-19 patients' access to healthcare resources is needed. This paper aims to examine the temporal variations in the spatial accessibility of the U.S. COVID-19 patients to medical facilities, identify areas that are likely to be overwhelmed by the COVID-19 pandemic, and explore associations of low access areas with their socioeconomic and demographic characteristics. We use a three-step floating catchment area method, spatial statistics, and logistic regression to achieve the goals. Findings of this research in the State of Florida revealed that North Florida, rural areas, and zip codes with more Latino or Hispanic populations are more likely to have lower access than other regions during the COVID-19 pandemic. Our approach can help policymakers identify potentially possible low access areas and establish appropriate policy intervention paying attention to those areas during a pandemic.

Spatial accessibility assessment of COVID-19 patients to healthcare facilities: A case study of Florida

During the COVID-19 pandemic, healthcare facilities worldwide have been overwhelmed by the amount of coronavirus patients needed to be served. Similarly, the U.S. also experienced a shortage of healthcare resources, which led to a reduction in the efficiency of the whole healthcare system. In order to evaluate this from a transportation perspective, it is critical to understand the extent to which healthcare facilities with intensive care unit (ICU) beds are available in both urban and rural areas. As such, this study aims to assess the spatial accessibility of COVID-19 patients to healthcare facilities in the State of Florida. For this purpose, two methods were used: the two-step floating catchment area (2SFCA) and the enhanced two-step floating catchment area (E2SFCA). These methods were applied to identify the high and low access areas in the entire state. Furthermore, a metric, namely the Accessibility Ratio Difference (ARD), was developed to evaluate the spatial access difference between the models. Results revealed that many areas in the northwest and southern Florida have lower access compared to other locations. The residents in central Florida (e.g., Tampa and Orlando cities) had the highest level of accessibility given their higher access ratios. We also observed that the 2SFCA method overestimates the accessibility in the areas with a lower number of ICU beds due to the "equal access" assumption of the population within the catchment area. The findings of this study can provide valuable insights and information for state officials and decision makers in the field of public health.

Geographical accessibility of community social services and incidence of self-harm

OBJECTIVE

The study aimed to explore the association between area-based coverage of community services and the incidence of self-harm, which will provide an evaluation framework for the support of self-harm.

METHODS

Enhanced two-Step floating catchment area method was used to estimate the centersto- population ratio and geographical accessibility adjusted by a distance-decay function. Spearman's rank coefficient was used to examine the association between the self-harm rate and adjusted accessibility index.

RESULTS

There was a significant negative correlation between the accessibility index and selfharm rate in youth (rho = -0.87, P < 0.01) and older adults (rho = -0.87, P < 0.01). The survival curves showed no relationship between self-harm repetition and service accessibility in youth or older adults.

CONCLUSIONS

The uneven spatial accessibility of community social service centers and the independence between spatial accessibility and self-harm highlights the need to explore personal barriers to community service utilization.

Mental Health Care Access Using Geographic Information Systems: An Integrative Review

A decade after the Mental Health Parity and Addiction Equity Act was implemented to ensure access to mental health and substance abuse services for U.S. citizens, accessing mental health care still is problematic for many needing services. More than 123 million Americans reside in federally-designated Mental Health Professional Shortage Areas (MHPSA) compared to 84 million living in similarly-designated primary care shortage areas and 62 million in dental health shortage areas. Health professional shortage areas are geographic areas that have a shortage of primary medical, dental, or mental health providers. Geographic Information Systems (GIS) with spatial analysis approaches provide tools to understand the ever-changing distribution of health care, outcomes, and delivery to improve care. The aim of this integrative review is to describe and synthesize the literature on GIS approaches to improve access to mental health care services. GIS Bibliography, PubMed, CINAHL, PsycINFO, Academic Search Premier, Social Sciences Citation Index, and Oalster were searched for articles between January 1, 1998 and January 1, 2018 that met established inclusion/exclusion criteria. Among the 138 articles reviewed, 18 met criteria and were included in the review. GIS approaches to improve access to mental health care can be categorized as (1) type of care (integrated, community), (2) contributions to access (distance, time, cost, perception of traveling, inequalities), and (3) the utilization of services. Results from the literature suggest closer examination of measures used to assess geographic variations in accessibility is needed for ultimately improving quality of care for people in MHPSA.

Geographic disparities in accessing community pharmacies among vulnerable populations in the Greater Toronto Area

OBJECTIVES

Geographic accessibility to community pharmacies (CPs) plays an increasingly important role for the well-being of a community. This study examines the geographic distribution of CPs within the Greater Toronto Area (GTA) relative to the residential patterns of vulnerable populations, including older adults (65+ years), infants and children (0-9 years), and low-income households.

METHODS

The study develops a geographic accessibility index at a dissemination area (DA) level by employing the enhanced two-step floating catchment area (E2SFCA) method to measure geographic accessibility to pharmacies. A vulnerability index is also developed to assess and visualize the residential patterns of vulnerable groups. A combined vulnerability-accessibility index is then constructed to identify low-access areas associated with high levels of socio-economic vulnerability. A range of geo-referenced datasets are analyzed within a geographical information system.

RESULTS

The study reveals geographical disparities in accessing pharmacies between urban and suburban areas and across different neighbourhoods, while accounting for population density and distance decay. About 19% of the population (or 15% of DAs) are under-serviced, with very poor geographic access to CPs (1.7 CPs per 10,000 persons), compared to 29.6% of the DAs that are well-/over-serviced, with an average score of 2.8 CPs per 10,000 persons.

CONCLUSION

The spatial-quantitative analysis at a small geography (DA) allows for improved accuracy for identifying specific neighbourhoods that are in need of greater access to pharmacies by vulnerable residents and areas that have an excessive supply of pharmacies. It provides implications for addressing barriers to accessing pharmacies among high-needs groups, including the rapidly growing older adult population in the GTA.

Modeling Accessibility of Screening and Treatment Facilities for Older Adults using Transportation Networks

Increased lifespans and population growth have resulted in an older U.S. society that must reckon with the complex oral health needs that arise as adults age. Understanding accessibility to screening and treatment facilities for older adults is necessary in order to provide them with preventive and restorative services. This study uses an agent-based model to examine the accessibility of screening and treatment facilities via transportation networks for older adults living in the neighborhoods of northern Manhattan, New York City. Older adults are simulated as socioeconomically distinct agents who move along a GIS-based transportation network using transportation modes that mediate their access to screening and treatment facilities. This simulation model includes four types of mobile agents as a simplifying assumption: walk, by car, by bus, or by van (i.e., a form of transportation assistance for older adults). These mobile agents follow particular routes: older adults who travel by car, bus, and van follow street roads, whereas pedestrians follow walkways. The model enables the user to focus on one neighborhood at a time for analysis. The spatial dimension of an older adult's accessibility to screening and treatment facilities is simulated through the travel costs (indicated by travel time or distance) incurred in the GIS-based model environment, where lower travel costs to screening and treatment facilities imply better access. This model provides a framework for representing health-seeking behavior that is contextualized by a transportation network in a GIS environment.

Exploring Geographic Variation of Mental Health Risk and Service Utilization of Doctors and Hospitals in Toronto: A Shared Component Spatial Modeling Approach

Mental Health has been known to vary geographically. Different rates of utilization of mental health services in local areas reflect geographic variation of mental health and complexity of health care. Variations and inequalities in how the health care system addresses risks are two critical issues for addressing population mental health. This study examines these issues by analyzing the utilization of mental health services in Toronto at the neighbourhood level. We adopted a shared component spatial modeling approach that allows simultaneous analysis of two main health service utilizations: doctor visits and hospitalizations related to mental health conditions. Our results reflect a geographic variation of both types of mental health service utilization across neighbourhoods in Toronto. We identified hot and cold spots of mental health risks that are common to both or specific to only one type of health service utilization. Based on the evidence found, we discuss intervention strategies, focusing on the hotspots and provision of health services about doctors and hospitals, to improve mental health for the neighbourhoods. Limitations of the study and further research directions are also discussed.

The Role of Social Support for Patients with Mental Disorders in Primary Care in Brazil

The aim of this article was to identify the health care providers and other agencies in a given region where psychiatric patients included in the study reside. In addition, we evaluated how these patients perceive social support for specific needs related to mental health. This study was carried out using fieldwork and face-to-face semistructured interviews with 25 patients who were receiving psychiatric treatment through primary health care. We performed structural analysis of the data focusing on relationship structure. We identified that a significant number of health care providers were involved with the patients; however, some of them were ignored by patients interviewed. Participants cited mostly general practitioners, psychiatrists, and nurses, as professional references.

Spatial Distribution Balance Analysis of Hospitals in Wuhan

The spatial distribution pattern of hospitals in Wuhan indicates a core in the central urban areas and a sparse distribution in the suburbs, particularly at the center of suburbs. This study aims to improve the gravity and Huff models to analyze healthcare accessibility and resources. Results indicate that healthcare accessibility in central urban areas is better than in the suburbs, where it increasingly worsens for the suburbs. A shortage of healthcare resources is observed in large-scale and high-class hospitals in central urban areas, whereas the resources of some hospitals in the suburbs are redundant. This study proposes the multi-criteria evaluation (MCE) analysis model for the location assessment in constructing new hospitals, which can effectively ameliorate healthcare accessibility in suburban areas. This study presents implications for the planning of urban healthcare facilities.

A multi-level analysis of the relationship between spatial clusters of outpatient-treated depression, risk factors and mental health service planning in Catalonia (Spain)

BACKGROUND

Previous research identified high/low clusters of prevalence of outpatient-treated depression at municipal level in Catalonia (Spain). This study aims to analyse potential risk factors, both socioeconomic and related to the mental health service planning, which could influence the occurrence of hot/cold spots of depressed outpatients at two geographical levels: municipalities and service catchment areas.

METHOD

Hot/cold spots were examined in relation to socioeconomic indicators at municipal level, such as population density, unemployment, university education, personal income, and also those related to service planning at catchment area level, such as adequacy of healthcare, urbanicity, accessibility and the availability of mental health community centres. The analysis has been carried out through multilevel logistic regression models in order to consider the two different scales.

RESULTS

Hot spots are related to high population density, unemployment, urbanicity, the adequacy of provision of mental health services, and accessibility to mental health community centres at both study levels. On the other hand, the multilevel model weakly explains cold spots, associating them with high personal incomes.

LIMITATIONS

The dependent variables of the multi-level models are binary. This limits the interpretation of the results, since they cannot provide information about the variance of the dependent variables explained by the models.

CONCLUSIONS

The results described diverse risk factors at two levels which are related to a high likelihood of hot and cold spots of depression. The findings show the relevance of health planning in the distribution of diseases and the utilisation of healthcare services.

Mental health care situation in family health units: perceptions of community health agents

This was a qualitative, descriptive study, performed with 17 Community Health Agents. The aim was to analyze the perception of these professionals regarding the most frequent mental health cases in the region. Data was collected through observation of the region and two focus groups. We used the structuralist perspective for the analysis. The results showed that these professionals perceived mental health demands from an expanded concept of health, in which the resources fit together between the various sectors. They deal with difficulties, develop actions based on soft technologies and do not necessarily focus on the disease. It was concluded that these elements reinforce the power of the Community Health Agents as performers of mental health care practices and as an important link between the healthcare service and the community.

Prediction of community mental health service utilization by individual and ecological level socio-economic factors

Individuals with a more deprived socioeconomic status (SES) are more likely to have higher rates of psychiatric morbidity and use of psychiatric services. Such service use is also influenced by socioeconomic factors at the ecological level. The aim of this article is to investigate the influence of these variables on service utilization. All patients in contact with three Italian community psychiatric services (CPS) were included. Community and hospital contacts over 6 months were investigated. Socio-economic characteristics were described using a SES Index and two new Resources Accessibility Indexes. Low SES was found to be associated with more community service contacts. When other individual and ecological variables were controlled for, SES was negatively associated only with the number of home visits, which was about half the rate in deprived areas. An association between service utilization and the resources of the catchment area was also detected. The economic crisis in Europe is increasing inequality of access, so paying attention to SES characteristics at both the individual and the ecological levels is likely to become increasingly important in understanding patterns of psychiatric service utilization and planning care accordingly.

Assessing spatial accessibility to maternity units in Shenzhen, China

BACKGROUND

With the rapid development of urbanization, pregnant population is growing rapidly in Shenzhen, and it has been a difficulty to serve more and more pregnant women and reduce spatial access disparities to maternity units (MUs). Understanding of the current status of accessibility to MUs is valuable for supporting the rational allocation of MUs in the future.

METHODS

Based on pregnant population data and MUs data, this study uses a two-step floating catchment area (2SFCA) method based on Geographic Information System (GIS) to analyze the current spatial accessibility to MUs, and then make a comparison between that to public MUs and private MUs.

RESULTS

Our analysis of the accessibility to all MUs within a distance of 20 km shows that the accessibilities of the areas alongside the traditional border management line are acceptable, meanwhile highlights some critical areas, such as the west part of Nanshan district and the vast east part of Longgang district. The comparison between spatial accessibility to public MUs and private MUs shows statistically significant difference.

DISCUSSION

Results of this study suggest a great effort should be made to improve the equity of spatial accessibility to MUs in Shenzhen. For policy-making, strategy for the siting and allocation of future MUs, no matter public or private, should guarantee the greatest spatial accessibility for every pregnant woman.

Assessing potential spatial accessibility of health services in rural China: a case study of Donghai County

INTRODUCTION

There is a great health services disparity between urban and rural areas in China. The percentage of people who are unable to access health services due to long travel times increases. This paper takes Donghai County as the study unit to analyse areas with physician shortages and characteristics of the potential spatial accessibility of health services. We analyse how the unequal health services resources distribution and the New Cooperative Medical Scheme affect the potential spatial accessibility of health services in Donghai County. We also give some advice on how to alleviate the unequal spatial accessibility of health services in areas that are more remote and isolated.

METHODS

The shortest traffic times of from hospitals to villages are calculated with an O-D matrix of GIS extension model. This paper applies an enhanced two-step floating catchment area (E2SFCA) method to study the spatial accessibility of health services and to determine areas with physician shortages in Donghai County. The sensitivity of the E2SFCA for assessing variation in the spatial accessibility of health services is checked using different impedance coefficient valuesa. Geostatistical Analyst model and spatial analyst method is used to analyse the spatial pattern and the edge effect of potential spatial accessibility of health services.

RESULTS

The results show that 69% of villages have access to lower potential spatial accessibility of health services than the average for Donghai County, and 79% of the village scores are lower than the average for Jiangsu Province. The potential spatial accessibility of health services diminishes greatly from the centre of the county to outlying areas. Using a smaller impedance coefficient leads to greater disparity among the villages. The spatial accessibility of health services is greater along highway in the county.

CONCLUSIONS

Most of villages are in underserved health services areas. An unequal distribution of health service resources and the reimbursement policies of the New Cooperative Medical Scheme have led to an edge effect regarding spatial accessibility of health services in Donghai County, whereby people living on the edge of the county have less access to health services. Comprehensive measures should be considered to alleviate the unequal spatial accessibility of health services in areas that are more remote and isolated.