Geographic Access to Mental Health Facilities for People with Disabilities.

backgroundThe need for mental health care is growing in the U.S., yet care is elusive for many patients. Among people experiencing mental illnesses, those with disabilities often face additional obstacles when seeking care. Therefore, proximity to mental health services is especially important for this population. Although regional differences in travel distances to mental health facilities have been documented, their implications for individuals with disabilities are not well understood. AIMS OF THE STUDY: This study compares geographic proximity to mental health facilities between individuals with and without disabilities. We also compare geographic access to facilities across counties with different characteristics, including having high versus low shares of residents with disabilities.

methodsThis study links American Community Survey population data with mental health facility locations from the Mental health and Addiction Treatment Tracking Repository (MATTR) to estimate the number of people living within a 30-minute drive of a facility. We calculate these estimates overall, and by population and county characteristics. We also estimate a multivariate county-level regression in which the population share in each county that lives within a 30-minute drive of a mental health facility is regressed on county characteristics.

resultsMost of the U.S. population (96.2% of individuals without disabilities and 94.8% of individuals with disabilities) lives within a 30-minute drive of one or more mental health facilities. However, geographic access to mental health facilities is low in rural counties, where more than one quarter of the population does not have access to a mental health facility within a 30-minute drive. Compared to non-rural counties, rural counties have a higher concentration of individuals with disabilities and higher rates of clinician-diagnosed depression or self-reported severe depression. After controlling for rurality, state, population, racial composition, income, and depression prevalence at the county level, the share of a county's population within a 30-minute drive of a facility remains negatively correlated with the share of the county's population with disabilities. DISCUSSION: Overall geographic access to mental health facilities is high in the U.S., and there is only a small disparity between individuals with and without disabilities. However, geographic access to mental health facilities is lacking in rural communities. This pattern is especially costly for people with disabilities because of their relatively high concentration in these areas. People with disabilities likely face additional barriers to accessing care compared with people without disabilities living in the same location. IMPLICATIONS FOR HEALTH CARE PROVISION AND USE: The lack of nearby mental health facilities remains a significant access barrier to mental health care for people in rural communities. These access gaps are of concern because rural communities are especially vulnerable, as evidenced by a high proportion of individuals with disabilities and a higher prevalence of depression. IMPLICATIONS FOR HEALTH POLICY FORMULATION AND FUTURE RESEARCH: Measuring disparities in geographic access to mental health facilities by disability status may yield different results depending on whether comparisons are performed at the individual or the community level. Community-level and individual-level disparities may require different policy solutions.