Communities with local health departments that promote and provide mental health care have lower rates of preventable hospitalizations.
The issue: Disparities in mental health status and care across race and socioeconomic status are persistent in the United States, according to the National Institute of Mental Health (NIMH). Statistics from the Substance Abuse and Mental Health Services Administration indicate that across all age groups, white adults are more likely than minority adults to use mental health services. And the need for such services is widespread — the NIMH estimated that in 2015, about 9.8 million adults in the U.S. experienced a serious mental illness.
Community health services can play a role in promoting both mental and physical health, especially by offering ongoing care to patients with mental disorders. One such resource, local health departments, are government-funded agencies that often provide public health services. Local health departments commonly work to fulfill the needs of underserved populations. According to a report produced by the National Association of County and City Health Officials, 57 percent of local health departments work to address this issue.
A group of researchers tested how local health departments might facilitate access to care for people with chronic physical health conditions and coexisting mental disorders, with the goal of reducing hospitalization and disparities.
An academic study worth reading: “Reducing Preventable Hospitalization and Disparity: Association with Local Health Department Mental Health Promotion Activities,” published in the American Journal of Preventive Medicine, January 2018.
About the study: Researchers looked at data collected in the state of Maryland on hospital discharges from 2012 to 2013. They looked at the probability of a preventable hospitalization for chronic illness among patients who had coexisting mental disorders. They also examined local health departments, assessing their provision of preventive care (for example, screening and monitoring outcomes) and health promotion (e.g., policy/advocacy activities). They made a model to determine whether local health departments’ involvement in mental health care is linked to rates of preventable hospitalizations. In other words, they examined whether through the promotion and provision of mental health services, people with coexisting chronic illnesses such as heart disease and diabetes were less likely to be hospitalized unnecessarily for these conditions.
- Preventable hospitalizations occurred at double the rate for black patients (10 percent of this group were hospitalized needlessly) compared to white patients (5 percent).
- Black people were less likely to live in counties where local health departments actively worked to promote mental health.
- “Among patients with mental illness who had preventable hospitalizations, 49 percent of whites and 29 percent of African Americans were from counties with direct LHDs [local health departments] preventive care provision.”
- Rates of preventable hospitalizations were significantly lower if local health departments provided preventive mental health care and/or if they actively promoted health.
- The researchers suggest that active local health departments could reduce disparities in preventable hospitalization rates between black and white people by 9 percent.
- A 2017 study published in Medical Care Research and Review, “Assessing the Individual, Neighborhood, and Policy Predictors of Disparities in Mental Health Care,” suggests that black and Latino people are more likely to live in neighborhoods with lower average education levels and higher minority density. These factors, they write, predict less mental health care initiation compared to neighborhoods which are predominantly white.
- A 2016 study published in Perspectives in Public Health, “Addressing Psychological, Mental Health and Other Behavioral Healthcare Needs of the Underserved Populations in the United States: The Role of Local Health Departments,” finds that most of these departments do not have strategies to target the mental health needs of underserved communities.
- A 2013 study published in the American Journal of Preventive Medicine, “Local Health Department Activities to Ensure Access to Care,” highlights the differences in local health departments’ outreach activities across the country. Those in areas with larger populations and higher per capita expenditures were more likely to provide services meant to improve access to care.