Literature Collection

OBJECTIVE: The study objective was to examine the association between mental health staffing at health centers funded by the Health Resources and Services Administration (HRSA) and patients' receipt of mental health treatment. METHODS: Data were from the 2014 HRSA-funded Health Center Patient Survey and the 2013 Uniform Data System. Colocation of any mental health staff, including psychiatrists, psychologists, and other licensed staff, was examined. The outcomes of interest were whether a patient received any mental treatment and received any such treatment on site (at the health center). Analyses were conducted with multilevel generalized structural equation logistic regression models for 4,575 patients ages 18-64. RESULTS: Patients attending health centers with at least one mental health full-time equivalent (FTE) per 2,000 patients had a higher predicted probability of receiving mental health treatment (32%) compared with those attending centers with fewer than one such FTE (24%) or no such staffing (22%). Among patients who received this treatment, those at health centers with no staffing had a significantly lower predicted probability of receiving such treatment on site (28%), compared with patients at health centers with fewer than one such FTE (49%) and with at least one such FTE (65%). The predicted probability of receiving such treatment on site was significantly higher if there was a colocated psychiatrist versus no psychiatrist (58% versus 40%). CONCLUSIONS: Colocating mental health staff at health centers increases the probability of patients' access to such treatment on site as well as from off-site providers.

BACKGROUND: In the United States (U.S.), the prevalence of anxiety and depression is increasing, yet significant barriers to mental health treatment remain. U.S. military veterans are disproportionately affected by anxiety and depression. Many veterans receive medical care within the Veterans Health Administration (VHA), an integrated healthcare system that has enacted clinical initiatives to reduce barriers to mental health treatment. OBJECTIVE: We examined associations between VHA healthcare use and receipt of mental health counseling or prescription medication for anxiety or depression. DESIGN: Cross-sectional nationally representative study. PARTICIPANTS: U.S. veterans aged ≥ 18 years with past 12-month healthcare use and anxiety or depression (N = 1,161). MAIN MEASURES: In the 2019 National Health Interview Survey, veterans were assessed for their use of the VHA (vs. non-VHA healthcare use) and receipt of past 12-month mental health counseling, prescription medication for anxiety, or prescription medication for depression. KEY RESULTS: Among all veterans with anxiety or depression, only 23% received mental health counseling, while 26% and 23% received prescription medication for anxiety or depression, respectively. Compared to non-VHA veterans, VHA patients were more likely to receive counseling (adjusted odds ratio [aOR] = 6.28, 95% CI: 5.33, 7.40), and prescription medication for anxiety (aOR = 2.03, 95% CI: 1.72, 2.40), or depression (aOR = 2.54, 95% CI: 2.17, 2.97). CONCLUSIONS: Among veterans with anxiety or depression, VHA patients were more likely to receive mental health treatment than non-VHA veterans. Findings suggest that veteran use of counseling and psychiatric interventions remains limited, though the integrated healthcare system of the VHA may facilitate access to mental health treatment and provides a framework for non-VHA medical centers to expand access to and improve delivery of mental health services.