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Burns A, Vest JR, Menachemi N, Mazurenko O, Musey PI, Salyers MP, Yeager VA. Availability of behavioral health crisis care and associated changes in emergency department utilization. Health Serv Res 2024. [PMID: 39117992 DOI: 10.1111/1475-6773.14368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2024] Open
Abstract
OBJECTIVE To determine whether availability of behavioral health crisis care services is associated with changes in emergency department (ED) utilization. DATA SOURCES AND STUDY SETTING We used longitudinal panel data (2016-2021) on ED utilization from the Healthcare Cost and Utilization Project's State ED Databases and a novel dataset on crisis care services compiled using information from the Substance Abuse and Mental Health Services Administration's National Directories of Mental Health Treatment Facilities. A total of 1002 unique zip codes from Arizona, Florida, Kentucky, Maryland, and Wisconsin were included in our analyses. STUDY DESIGN To estimate the effect of crisis care availability on ED utilization, we used a linear regression model with zip code and year fixed effects and standard errors accounting for clustering at the zip code-level. ED utilization related to mental, behavioral, and neurodevelopmental (MBD) disorders served as our primary outcome. We also examined pregnancy-related ED utilization as a nonequivalent dependent variable to assess residual bias in effect estimates. DATA COLLECTION/EXTRACTION METHODS We extracted data on crisis care services offered by mental health treatment facilities (n = 14,726 facility-years) from the National Directories. MBD-related ED utilization was assessed by applying the Clinical Classification Software Refined from the Healthcare Cost and Utilization Project to the primary ICD-10-CM diagnosis code on each ED encounter (n = 101,360,483). All data were aggregated to the zip code-level (n = 6012 zip-years). PRINCIPAL FINDINGS The overall rate of MBD-related ED visits between 2016 and 2021 was 1610 annual visits per 100,000 population. Walk-in crisis stabilization services were associated with reduced MBD-related ED utilization (coefficient = -0.028, p = 0.009), but were not significantly associated with changes in pregnancy-related ED utilization. CONCLUSIONS Walk-in crisis stabilization services were associated with reductions in MBD-related ED utilization. Decision-makers looking to reduce MBD-related ED utilization should consider increasing access to this promising alternative model.
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Affiliation(s)
- Ashlyn Burns
- Department of Health Policy and Management, Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, Indiana, USA
| | - Joshua R Vest
- Regenstrief Institute Center for Biomedical Informatics, Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, Indiana, USA
| | - Nir Menachemi
- Department of Health Policy and Management, Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, Indiana, USA
| | - Olena Mazurenko
- Department of Health Policy and Management, Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, Indiana, USA
| | - Paul I Musey
- Eskanazi Health Foundation Chair and Scholar of Emergency Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Michelle P Salyers
- Department of Psychology, Indiana University School of Science, Indianapolis, Indiana, USA
| | - Valerie A Yeager
- Department of Health Policy and Management, Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, Indiana, USA
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Odes R, Looper P, Manjanatha D, McDaniel M, Goldman ML. Mobile Crisis Teams' Implementation in the Context of new Medicaid Funding Opportunities: Results from a National Survey. Community Ment Health J 2024:10.1007/s10597-024-01296-1. [PMID: 38831197 DOI: 10.1007/s10597-024-01296-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 05/12/2024] [Indexed: 06/05/2024]
Abstract
This cross-sectional survey study describes characteristics of mobile crisis teams (MCTs) in the United States. Mobile crisis teams (MCTs) are increasingly recognized as essential responders to help those experiencing mental health crises get urgent and appropriate care. Recent enhanced federal funding is designed to promote adoption of MCTs, but little is known about their current structure and function and whether teams meet new Medicaid rules governing their utilization. Survey participants (N = 554) are a convenience sample of MCT representatives recruited through professional organizations, listservs, and individual email contacts from October 2021 - May 2022. Respondents most frequently identified themselves as MCT program director/manager (N = 237, 43%). 63% (N = 246) of respondents reported billing insurance for services provided (including Medicaid), while 25% (N = 98) rely on state or county general funds only. Nearly all respondents (N = 390, 98%) reported including behavioral health clinicians on their teams, and 71% (N = 281) reported operating on a 24/7 basis, both of which are required by Medicaid's enhanced reimbursement. Just over half of respondents (N = 191, 52%) reported being staffed with 11 or more FTE staff members, our estimated number required for adequate 2-person coverage on a 24/7 basis. MCTs are a popular policy initiative to reduce reliance on law enforcement to handle mental health emergencies, and enhanced federal funding is likely to expand their utilization. Federal rule makers have a role in establishing guidelines for best practices in staffing, billing, and outcomes tracking, and can help ensure that stable financing is available to improve stability in service delivery.
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Affiliation(s)
- Rachel Odes
- School of Nursing, University of Wisconsin-Madison, Madison, WI, USA
| | | | - Deepa Manjanatha
- Department of Clinical Psychology, San Diego State University/University of California San Diego, San Diego, CA, USA
| | - Megan McDaniel
- University of Pittsburgh Medical Center, Pittsburgh, USA
| | - Matthew L Goldman
- Department of Psychiatry, University of California San Francisco, 401 Parnassus Ave, San Francisco, CA, 94143, USA.
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Owsley KM, Hasnain-Wynia R, Rooks RN, Tung GJ, Mays GP, Lindrooth RC. US Hospital Service Availability and New 340B Program Participation. JAMA HEALTH FORUM 2024; 5:e240833. [PMID: 38700853 PMCID: PMC11069079 DOI: 10.1001/jamahealthforum.2024.0833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 02/16/2024] [Indexed: 05/06/2024] Open
Abstract
Importance The US 340B Drug Pricing Program enables eligible hospitals to receive substantial discounts on outpatient drugs to improve hospitals' financial sustainability and maintain access to care for patients who have low income and/or are uninsured. However, it is unclear whether hospitals use program savings to subsidize access as intended. Objective To evaluate whether the 340B program is associated with improvements in access to hospital-based services and to test whether the association varies by hospital ownership. Design, Setting, and Participants Difference-in-differences and cohort analysis from 2010 to 2019. Never and newly participating 340B general, acute, nonfederal hospitals in the US using data from the American Hospital Association's Annual Survey of Hospitals merged with hospital and market characteristics. Data were analyzed from January 1, 2023, to January 31, 2024. Exposures New enrollment in 340B between 2012 and 2018. Main Outcomes and Measures Total number of unprofitable service lines, ie, substance use, psychiatric (inpatient and outpatient), burn clinic, and obstetrics services; and profitable services, ie, cardiac surgery and orthopedic, oncologic, neurologic, and neonatal intensive services. Results The study sample comprised a total of 2152 hospitals, 1074 newly participating and 1078 not participating in the 340B program. Participating hospitals were more likely than nonparticipating hospitals to be critical access and teaching hospitals, have higher Medicaid shares, and be located in rural areas and in Medicaid expansion states. At public hospitals, participation in the 340B program was associated with a significant increase in total unprofitable services (0.21; 95% CI, 0.04 to 0.38; P = .02) and marginal increases in substance use (5.4 percentage points [pp]; 95% CI, -0.8 pp to 11.6 pp; P = .09) and inpatient psychiatric (6.5 pp; 95% CI, -0.7 pp to 13.7 pp; P = .09) services. Among nonprofit hospitals, there was no significant association between 340B and service offerings (profitable and unprofitable) except for an increase in oncologic services (2.5 pp; 95% CI, 0.0 pp to 5.0 pp; P = .05). Conclusions and Relevance The finding of the cohort study indicate that participation in the 340B program was associated with an increase in unprofitable services among newly participating public hospitals. Nonprofit hospitals were largely unaffected. These findings suggest that public hospitals responded to 340B savings by improving patient access, whereas nonprofits did not. This heterogeneous response should be considered when evaluating the eligibility criteria for the 340B program and how it affects social welfare.
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Affiliation(s)
- Kelsey M. Owsley
- Department of Health Policy and Management, University of Arkansas for Medical Sciences, Little Rock
- Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock
| | - Romana Hasnain-Wynia
- Office of Research, Denver Health and Hospital Authority, Denver, Colorado
- Department of Medicine, University of Colorado-Anschutz Medical Campus, Aurora
| | - Ronica N. Rooks
- Department of Health and Behavioral Sciences, University of Colorado Denver, Denver
| | - Gregory J. Tung
- Department of Health Systems, Management, and Policy, Colorado School of Public Health, University of Colorado-Anschutz Medical Campus, Aurora
| | - Glen P. Mays
- Department of Health Systems, Management, and Policy, Colorado School of Public Health, University of Colorado-Anschutz Medical Campus, Aurora
| | - Richard C. Lindrooth
- Department of Health Systems, Management, and Policy, Colorado School of Public Health, University of Colorado-Anschutz Medical Campus, Aurora
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Burns A, Menachemi N, Mazurenko O, Salyers MP, Yeager VA. State Policies Associated with Availability of Mobile Crisis Teams. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2024:10.1007/s10488-024-01368-0. [PMID: 38498103 DOI: 10.1007/s10488-024-01368-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2024] [Indexed: 03/20/2024]
Abstract
Mobile crisis teams are comprised of multidisciplinary mental health professionals that respond to mental health crisis calls in community settings. This study identified counties with mobile crisis teams and examined state policies associated with mobile crisis teams. Descriptive statistics and geographic information system software were used to quantify and map counties with mobile crisis teams in the United States. Relationships between state policies and mobile crisis teams were examined using an adjusted logistic regression model, controlling for county characteristics and accounting for clustering by state. Approximately 40% (n = 1,245) of all counties in the US have at least one mobile crisis team. Counties in states with legislation in place to fund the 988 Suicide and Crisis Lifeline were more likely to have a mobile crisis team (Adjusted Odds Ratio (AOR): 2.0; Confidence Interval (CI): 1.23-3.26), whereas counties in states with 1115 waivers restricting Medicaid benefits were less likely to have a mobile crisis team (AOR: 0.43; CI: 0.21-0.86). Additionally, counties with the largest population were more likely to have a mobile crisis team (AOR: 2.20; CI:1.43-3.38) than counties with the smallest population. Having a mobile crisis teams was positively associated with legislation to fund 988. Legislation that encourages expansion of existing crisis care services, specifically funding aimed at mobile crisis teams, may help increase availability of services for people who are experiencing a mental health crisis in the community.
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Affiliation(s)
- Ashlyn Burns
- Department of Health Policy and Management, Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, IN, USA.
| | - Nir Menachemi
- Department of Health Policy and Management, Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, IN, USA
| | - Olena Mazurenko
- Department of Health Policy and Management, Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, IN, USA
| | - Michelle P Salyers
- Department of Psychology, Indiana University School of Science, Indianapolis, IN, USA
| | - Valerie A Yeager
- Department of Health Policy and Management, Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, IN, USA
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Burns A, Vest JR, Menachemi N, Mazurenko O, Salyers MP, Yeager VA. Market Factors Associated with Comprehensive Behavioral Health Crisis Care Availability: A Resource Dependence Theory Study. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2024; 61:469580241256822. [PMID: 38842194 PMCID: PMC11159547 DOI: 10.1177/00469580241256822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 05/07/2024] [Accepted: 05/07/2024] [Indexed: 06/07/2024]
Abstract
Behavioral health crisis care (BHCC) is a care delivery model for individuals experiencing acute distress related to a mental health or substance use disorder. We examined market factors associated with comprehensive BHCC availability using 2022 data on mental health treatment facilities (n = 9385) obtained from the Substance Abuse and Mental Health Services Administration. We aggregated facility-level data by county (n = 3142) and merged with county-level market factors. Logistic regression models were used to examine the adjusted associations between market factors and BHCC availability. We found that 468 (14.9%) counties had at least one mental health treatment facility offering comprehensive BHCC services. Specifically, counties with more mental health providers (Adjusted Odds Ratio = 2.26, Confidence Interval = 1.32-3.86) and metropolitan counties (AOR = 3.26, CI = 1.95-5.43) had higher odds of having a comprehensive BHCC facility. Our findings highlight the importance of developing the mental health workforce to increase BHCC availability and a need to address disparities in rural counties.
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Affiliation(s)
- Ashlyn Burns
- Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, IN, USA
| | - Joshua R. Vest
- Indiana University Richard M. Fairbanks School of Public Health, Regenstrief Institute Center for Biomedical Informatics, Indianapolis, IN, USA
| | - Nir Menachemi
- Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, IN, USA
| | - Olena Mazurenko
- Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, IN, USA
| | | | - Valerie A. Yeager
- Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, IN, USA
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Xi W, Banerjee S, Zima BT, Alexopoulos GS, Olfson M, Xiao Y, Pathak J. Effects of Geography on Risk for Future Suicidal Ideation and Attempts Among Children and Youth. JAACAP OPEN 2023; 1:206-217. [PMID: 37946932 PMCID: PMC10635419 DOI: 10.1016/j.jaacop.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
Objective Geography may influence the relationships of predictors for suicidal ideation (SI) and suicide attempts (SA) in children and youth. Method This is a nationwide retrospective cohort study of 124,424 individuals less than 25 years of age using commercial claims data (2011-2015) from the Health Care Cost Institute. Outcomes were time to SI or SA within 3 months after the indexed mental health or substance use disorder (MH/SUD) outpatient visit. Predictors included sociodemographic and clinical characteristics up to 3 years before the index event. Results At each follow-up time period, rates of SI and SA varied by the US geographic division (p < .001), and the Mountain Division consistently had the highest rates for both SI and SA (5.44%-10.26% for SI; 0.70%-2.82% for SA). Having MH emergency department (ED) visits in the past year increased the risk of SI by 28% to 65% for individuals residing in the New England, Mid-Atlantic, East North Central, West North Central, and East South Central Divisions. The main effects of geographic divisions were significant for SA (p<0.001). Risk of SA was lower in New England, Mid-Atlantic, South Atlantic, and Pacific (hazard ratios = 0.57, 0.51, 0.67, and 0.79, respectively) and higher in the Mountain Division (hazard ratio = 1.46). Conclusion To understand the underlying mechanisms driving the high prevalence of SI and SA in the Mountain Division and the elevated risk of SI after having MH ED visits, future research examining regional differences in risks for SI and SA should include indicators of access to MH ED care and other social determinants of health.
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Affiliation(s)
- Wenna Xi
- Weill Cornell Medicine, New York
| | | | - Bonnie T Zima
- Center for Health Services and Society, UCLA-Semel Institute for Neuroscience and Human Behavior, Los Angeles, California
| | | | - Mark Olfson
- New York State Psychiatric Institute, Columbia University Irving Medical Center, New York
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Burns A, Menachemi N, Yeager VA, Vest JR, Mazurenko O. Adoption of Best Practices in Behavioral Health Crisis Care by Mental Health Treatment Facilities. Psychiatr Serv 2023; 74:929-935. [PMID: 36872894 PMCID: PMC10565906 DOI: 10.1176/appi.ps.20220427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
OBJECTIVE The authors aimed to examine adoption of behavioral health crisis care (BHCC) services included in the Substance Abuse and Mental Health Services Administration's (SAMHSA's) best practices guidelines. METHODS Secondary data from SAMHSA's Behavioral Health Treatment Services Locator in 2022 were used. BHCC best practices were measured on a summated scale capturing whether a mental health treatment facility (N=9,385) adopted BHCC best practices, including provision of these services to all age groups: emergency psychiatric walk-in services, crisis intervention teams, onsite stabilization, mobile or offsite crisis responses, suicide prevention, and peer support. Descriptive statistics were used to examine organizational characteristics (such as facility operation, type, geographic area, license, and payment methods) of mental health treatment facilities nationwide, and a map was created to show locations of best practices BHCC facilities. Logistic regressions were performed to identify facilities' organizational characteristics associated with adopting BHCC best practices. RESULTS Only 6.0% (N=564) of mental health treatment facilities fully adopted BHCC best practices. Suicide prevention was the most common BHCC service, offered by 69.8% (N=6,554) of the facilities. A mobile or offsite crisis response service was the least common, adopted by 22.4% (N=2,101). Higher odds of adopting BHCC best practices were significantly associated with public ownership (adjusted OR [AOR]=1.95), accepting self-pay (AOR=3.18), accepting Medicare (AOR=2.68), and receiving any grant funding (AOR=2.45). CONCLUSIONS Despite SAMHSA guidelines recommending comprehensive BHCC services, a fraction of facilities have fully adopted BHCC best practices. Efforts are needed to facilitate widespread uptake of BHCC best practices nationwide.
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Affiliation(s)
- Ashlyn Burns
- Department of Health Policy and Management, Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis
| | - Nir Menachemi
- Department of Health Policy and Management, Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis
| | - Valerie A Yeager
- Department of Health Policy and Management, Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis
| | - Joshua R. Vest
- Department of Health Policy and Management, Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis
| | - Olena Mazurenko
- Department of Health Policy and Management, Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis
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Fogo RC, Martins-da-Silva AS, Blaas IK, Galvão LP, Hasegawa EH, Castaldelli FI, Gimenes GK, de Azevedo-Marques Périco C, Paiva H, Castaldelli-Maia JM. Exploring correlates of involuntary treatment in substance use disorders: a global systematic review and meta-analysis. Int Rev Psychiatry 2023; 35:418-433. [PMID: 38299646 DOI: 10.1080/09540261.2023.2228921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 06/14/2023] [Indexed: 02/02/2024]
Abstract
Given the legislative heterogeneity about involuntary treatment and psychoactive substance users, we opted to perform a systematic review and meta-analysis of the correlates of involuntary substance use disorders (SUD) treatment across different countries. We conducted research on the Pubmed database, searching for involuntary SUD treatment data worldwide. The systematic review analysed a total of 36 articles and included a sample of 47,739 patients. Our review highlights the elevated risk of involuntary treatment among male, unmarried individuals with alcohol and/or opioid use disorders. Targeted preventive and therapeutic interventions should focus on addressing the underlying factors contributing to involuntary treatment, such as psychosis, aggressiveness, suicidal ideation, legal problems, and severe social exposure. By targeting these factors and providing comprehensive care, we can strive to improve outcomes and reduce the burden of substance use disorders in this vulnerable population. It is essential to critically examine and understand the factors contributing to the selection of patients for compulsory treatment. By doing so, we can identify potential gaps or inconsistencies in the current processes and work towards ensuring that decisions regarding compulsory treatment are based on sound clinical and ethical principles.
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Affiliation(s)
- Rodrigo Casa Fogo
- Health Secretariat of São Bernardo do Campo, São Bernardo do Campo, SP, Brazil
| | | | - Israel Kanaan Blaas
- Department of Neuroscience, Medical School, FMABC University Center, Santo André, SP, Brazil
- Perdizes Institute, Clinical Hospital, Medical School, University of São Paulo, SP, Brazil
| | | | | | | | - Gislaine Koch Gimenes
- Perdizes Institute, Clinical Hospital, Medical School, University of São Paulo, SP, Brazil
| | - Cintia de Azevedo-Marques Périco
- Health Secretariat of São Bernardo do Campo, São Bernardo do Campo, SP, Brazil
- Department of Neuroscience, Medical School, FMABC University Center, Santo André, SP, Brazil
| | - Henrique Paiva
- Health Secretariat of São Bernardo do Campo, São Bernardo do Campo, SP, Brazil
| | - João Maurício Castaldelli-Maia
- Department of Psychiatry, Medical School, University of São Paulo, São Paulo, SP, Brazil
- Department of Neuroscience, Medical School, FMABC University Center, Santo André, SP, Brazil
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Purtle J, Chance Ortego J, Bandara S, Goldstein A, Pantalone J, Goldman ML. Implementation of the 988 Suicide & Crisis Lifeline: Estimating State-Level Increases in Call Demand Costs and Financing. THE JOURNAL OF MENTAL HEALTH POLICY AND ECONOMICS 2023; 26:85-95. [PMID: 37357873 PMCID: PMC10758993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 04/06/2023] [Indexed: 06/27/2023]
Abstract
BACKGROUND Per federal law, "988" became the new three-digit dialing code for the National Suicide & Crisis Lifeline on July 16, 2022 (previously reached by dialing "1-800-283-TALK"). AIMS OF THE STUDY This study aimed to produce state-level estimates of: (i) annual increases in 988 Lifeline call volume following 988 implementation, (ii) the cost of these increases, and (iii) the extent to which state and federal funding earmarked for increases in 988 Lifeline call volume are sufficient to meet call demand. METHOD A 50 state pre-post policy implementation design was used. State-level Lifeline call volume data were obtained. For each state, we calculated the absolute difference in number of Lifeline calls in the four-month periods between August-November 2021 (pre-988 implementation) and August-November 2022 (post-988 implementation), and also expressed this difference as percent change and rate per 100,000 population. The difference call volume was multiplied by a published estimate of the cost of a single 988 Lifeline call (USD 82), and then by multiplied by three to produce annual, 12-month state-level cost increase estimates. These figures were then divided by each state's population size to generate cost estimates per state resident. State-level information on the amount of state (FY 2023) and federal SAMHSA (FY 2022) funding earmarked for 988 Lifeline centers in response to 988 implementation were obtained from legal databases and government websites and expressed as dollars per state resident. State-level differences between per state resident estimates of increased cost and funding were calculated to assess the extent to which state and federal funding earmarked for increases in 988 Lifeline call volume were sufficient to meet call demand. RESULTS 988 Lifeline call volume increased in all states post-988 implementation (within-state mean percent change = +32.8%, SD = +20.5%). The total estimated cost needed annually to accommodate increases in 988 Lifeline call volume nationally was approximately USD 46 million. The within-state mean estimate of additional cost per state resident was +USD 0.16 (SD = +USD 0.11). The additional annual cost per state resident exceeded USD 0.40 in three states, was between USD 0.40- USD 0.30 in three states, and between USD 0.30 - USD 0.20 in seven states. Twenty-two states earmarked FY 2023 appropriations for 988 Lifeline centers in response to 988 (within-state mean per state resident = USD 1.51, SD = USD 1.52) and 49 states received SAMHSA 988 capacity building grants (within-state mean per state resident = USD 0.36, SD = USD 0.39). State funding increases exceeded the estimated cost increases in about half of states. CONCLUSIONS The Lifeline's transition to 988 increased 988 Lifeline call volume in all states, but the magnitude of the increase and associated cost was heterogenous across states. State funding earmarked for increases in 988 Lifeline center costs is sufficient in about half of states. Sustained federal funding, and/or increases in state funding, earmarked for 988 Lifeline centers is likely important to ensuring that 988 Lifeline centers have the capacity to meet call demand in the post-988 implementation environment.
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Affiliation(s)
- Jonathan Purtle
- New York University School of Global Public Health, 708 Broadway, New York, NY 10003, USA,
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Purtle J, Rivera‐González AC, Mercado DL, Barajas CB, Chavez L, Canino G, Ortega AN. Growing inequities in mental health crisis services offered to indigent patients in Puerto Rico versus the US states before and after Hurricanes Maria and Irma. Health Serv Res 2023; 58:325-331. [PMID: 36310433 PMCID: PMC10012226 DOI: 10.1111/1475-6773.14092] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To assess changes in the availability of mental health crisis services in Puerto Rico relative to US states before and after Hurricanes Maria and Irma. DATA SOURCES/STUDY SETTING National Mental Health Services Surveys conducted in 2016 and 2020. STUDY DESIGN Repeated cross-sectional design. The independent variable was mental health facility location in Puerto Rico or a US state. Dependent variables were the availability of three mental health crisis services (psychiatric emergency walk-in services, suicide prevention services, and crisis intervention team services). DATA COLLECTION/EXTRACTION METHODS The proportion and per 100,000 population rate of facilities offering crisis services were calculated. PRINCIPAL FINDINGS The availability of crisis services at mental health facilities in Puerto Rico remained stable between 2016 and 2020. These services were offered less at indigent care facilities in Puerto Rico than US states (e.g., 38.2% vs. 49.5% for suicide prevention, p = 0.06) and the magnitude of difference increased following Hurricane Maria. CONCLUSIONS There are disparities between Puerto Rico and US states in the availability of mental health crisis services for indigent patients.
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Affiliation(s)
- Jonathan Purtle
- Department of Public Health Policy & Management, Director of Policy Research, Global Center for Implementation ScienceNew York University School of Global Public HealthNew York CityNew YorkUSA
| | - Alexandra C. Rivera‐González
- Drexel University Dornsife School of Public HealthDepartment of Health Management & PolicyPhiladelphiaPennsylvaniaUSA
| | - Damaris Lopez Mercado
- Drexel University Dornsife School of Public HealthDepartment of Health Management & PolicyPhiladelphiaPennsylvaniaUSA
| | - Clara B. Barajas
- Drexel University Dornsife School of Public HealthDepartment of Health Management & PolicyPhiladelphiaPennsylvaniaUSA
| | - Ligia Chavez
- Medical Sciences CampusBehavioral Sciences Research InstituteRio PiedrasPuerto Rico
| | - Glorisa Canino
- University of Puerto Rico, Medical Sciences CampusBehavioral Sciences Research InstituteRio PiedrasPuerto Rico
| | - Alexander N. Ortega
- Drexel University Dornsife School of Public HealthDepartment of Health Management & PolicyPhiladelphiaPennsylvaniaUSA
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Brooks Holliday S, Matthews S, Bialas A, McBain RK, Cantor JH, Eberhart N, Breslau J. A Qualitative Investigation of Preparedness for the Launch of 988: Implications for the Continuum of Emergency Mental Health Care. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2023:10.1007/s10488-023-01263-0. [PMID: 36988833 PMCID: PMC10054205 DOI: 10.1007/s10488-023-01263-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2023] [Indexed: 03/30/2023]
Abstract
On July 16, 2022, the 988 mental health crisis hotline launched nationwide. In addition to preparing for an increase in call volume, many jurisdictions used the launch of 988 as an opportunity to examine their full continuum of emergency mental health care. Our goal was to understand the characteristics of jurisdictions' existing continuums of care, identify factors that distinguished jurisdictions that were more- versus less-prepared for 988, and explore perceived strengths and limitations of the planning process. We conducted 15 qualitative interviews with state and local mental health program directors representing 10 states based on their preparedness for the 988 rollout. Interviews focused on 988 call centers, mobile crisis response, and crisis stabilization, as well as strengths and limitations of the 988 planning process. Data were analyzed using rapid qualitative analysis, an approach designed to draw insights on evolving processes and extract actionable findings. Interviewees from jurisdictions that reported that they were more-prepared for the launch of 988 tended to have local 988 call centers and already had local access to mobile crisis teams and crisis stabilization units. Interviewees across jurisdictions described challenges to offering a robust continuum of crisis services, including workforce shortages and geographic constraints. Though jurisdictions acknowledged the importance of integrating peer support staff and serving diverse populations, many perceived room for growth in these areas. Though 988 has launched, efforts to bolster the existing continuum will continue and hinge on efforts to expand the behavioral health workforce, engage diverse partners, and collect relevant data.
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Affiliation(s)
| | | | - Armenda Bialas
- RAND Corporation, 1776 Main Street, 90405, Santa Monica, CA, USA
| | - Ryan K McBain
- RAND Corporation, 1776 Main Street, 90405, Santa Monica, CA, USA
| | | | - Nicole Eberhart
- RAND Corporation, 1776 Main Street, 90405, Santa Monica, CA, USA
| | - Joshua Breslau
- RAND Corporation, 1776 Main Street, 90405, Santa Monica, CA, USA
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Bacolod M, Heissel J, Shen YC. Spatial Analysis of Access to Psychiatrists for US Military Personnel and Their Families. JAMA Netw Open 2023; 6:e2249314. [PMID: 36595295 PMCID: PMC9856908 DOI: 10.1001/jamanetworkopen.2022.49314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
IMPORTANCE Military service members and their families have greater mental health care needs compared with their civilian counterparts. Some communities have inadequate access to psychiatrists for this population. OBJECTIVES To identify geographic variations in the availability of military and civilian psychiatrists within a 30-minute driving time of TRICARE (the US military's health care program) beneficiaries' communities and compare the likelihood of living in areas with inadequate access to psychiatrists for historically underserved and other communities. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study of all zip code communities in the continental US, Hawaii, and Alaska with at least one TRICARE beneficiary between January 1, 2016, and September 30, 2020, combines data from the Defense Health Agency, the National Plan and Provider Enumeration System, and the US Census to estimate a logistic regression to compare differences between communities with and without a psychiatrist shortage. Data were analyzed from September 2021 to November 2022. MAIN OUTCOMES AND MEASURES A community's likelihood of having a shortage of military and civilian psychiatrists within a 30-minute driving time and a community's likelihood of having no psychiatrists. Odds ratios were calculated to estimate likelihood of the outcomes. RESULTS This study includes 39 487 unique communities where 13% of the population is Black and 14% of the population is Hispanic. During the study period, 35% of TRICARE beneficiaries lived in communities with a shortage of both military and civilian psychiatrists, and 6% lived in communities with no access to military or civilian psychiatrists. Low-income communities with high income inequality were 1.64 (95% CI, 1.30-2.07) times more likely to have inadequate access to psychiatrists and 2.59 (95% CI, 1.82-3.69) times more likely to have no access to psychiatrists, compared with reference communities (average income without high income inequality); low-income communities without high income inequality were 1.37 (95% CI, 1.05-1.78) times more likely to have inadequate access to psychiatrists and 1.93 (95% CI, 1.28-2.89) times more likely to have no access to psychiatrists. Rural communities were 6.65 (95% CI, 5.09-8.69) times more likely to have inadequate access to psychiatrists than urban communities. CONCLUSIONS AND RELEVANCE In this cohort study of US communities, 35% of TRICARE beneficiaries lived in communities with inadequate access to psychiatrists. Psychiatric capacity was structurally inequitable along 2 separate dimensions: the income gradient and rurality. Developing targeted strategies for these shortage areas could alleviate disparities.
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Affiliation(s)
- Marigee Bacolod
- Department of Defense Management, Naval Postgraduate School, Monterey, California
| | - Jennifer Heissel
- Department of Defense Management, Naval Postgraduate School, Monterey, California
| | - Yu-Chu Shen
- Department of Defense Management, Naval Postgraduate School, Monterey, California
- National Bureau of Economic Research, Cambridge, Massachusetts
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Newton H, Beetham T, Busch SH. Association of Access to Crisis Intervention Teams With County Sociodemographic Characteristics and State Medicaid Policies and Its Implications for a New Mental Health Crisis Lifeline. JAMA Netw Open 2022; 5:e2224803. [PMID: 35838666 PMCID: PMC9287760 DOI: 10.1001/jamanetworkopen.2022.24803] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE The mental health crisis lifeline 988 will begin operating July 16, 2022. In the absence of appropriately trained first responders, including crisis intervention teams (CITs), persons experiencing behavioral health crises face the risk of incarceration and even death. OBJECTIVE To assess county-level access to CIT in 2015 and 2020 and its association with area characteristics and state policies in 2020. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study included 10 430 facilities from the 2015 National Directory of Mental Health Treatment Facilities and 10 591 facilities from the 2020 National Directory of Mental Health Treatment Facilities, attributed to 3142 US counties. EXPOSURES Area measures included need (suicide, drug-related overdose mortality), rurality, and demographic characteristics. State-level policies included 5 Medicaid policies enacted prior to 2020 and 2 recent policies intended to assist implementation of the 988 lifeline. MAIN OUTCOMES AND MEASURES Whether there was at least 1 facility that reported offering a CIT that handled acute mental health issues at the facility or off-site for each county in 2015 and, separately, in 2020. RESULTS Most US residents (88%) resided in a county with at least 1 facility offering CIT, although half of US counties had no facility offering CIT (2015: 1537 of 3142 [49%]; 2020: 1512 [48%]). Almost 1 in 5 counties, representing 9% of the population, experienced a change in county-level access from 2015 to 2020. Unadjusted analyses indicated residents of counties without vs with CIT access were more likely to be older and uninsured (top quartile of percentage of residents aged >55 years: 502 of 1512 [33%] vs 283 of 1630 [17%]; P < .001; top quartile of percentage of residents uninsured: 500 [33%] vs 285 [17%]; P < .001) and were more likely be rural (frontier: 500 [33%] vs 144 [9%]; P < .001). Similar results, excluding counties in the top quartile of residents aged older than 55 years, were found in adjusted analyses. Counties without vs with CIT access were less likely to be in states that expanded Medicaid (788 [52%] vs 1102 [68%]; P = .01) and in states that allow Medicaid to pay for short-term stays in psychiatric hospitals (34 [2%] vs 73 [4%]; P = .02). Other Medicaid-related associations were not statistically significant in adjusted analyses. CONCLUSIONS AND RELEVANCE In this study, most US residents lived in counties with access to at least 1 CIT, but fewer than half of US counties had such access. Policies to encourage facilities in rural counties to offer CIT may help realize the potential of the new lifeline.
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Affiliation(s)
- Helen Newton
- Yale School of Public Health, New Haven, Connecticut
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Périco CDAM, Santos RMD, Baldaçara LR, Símaro CS, Junqueira RC, Pedro MOP, Castaldelli-Maia JM. Psychiatric emergency units in Brazil: a cross-sectional study. Rev Assoc Med Bras (1992) 2022; 68:622-626. [DOI: 10.1590/1806-9282.20211267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 02/27/2022] [Indexed: 08/30/2023] Open
Affiliation(s)
| | | | | | - Camila Santos Símaro
- Centro Universitário de Saúde FMABC, Brazil; Centro ABC de Estudos de Saúde Mental, Brazil
| | - Renata Costa Junqueira
- Centro Universitário de Saúde FMABC, Brazil; Centro ABC de Estudos de Saúde Mental, Brazil
| | | | - João Mauricio Castaldelli-Maia
- Centro Universitário de Saúde FMABC, Brazil; Centro ABC de Estudos de Saúde Mental, Brazil; Universidade de São Paulo, Brazil
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