Changes in Children’s Mental Health Care, Tatiana Andreyeva, Pardee RAND Graduate School Roland Sturm, RAND

06/26/05Annual Research Meeting Has Access to Mental Health Care Improved? Many children have mental health problems that interfere with normal development and functioning –Only a minority of vulnerable children receives mental health services –5 years ago, the Surgeon General warned of national crisis in mental health care for children Has access to care improved? –Increasing awareness of mental health issues –Mental health parity legislation –Expanded health insurance programs for children

06/26/05Annual Research Meeting This Presentation Nationally representative children ages 6-17 surveyed in 1997, 1999 and 2002 Research issues: –Changes in utilization of mental health care for school-age children over –Differences across socioeconomic populations –Differences across states

06/26/05Annual Research Meeting Data and Methods (1) National Survey of America’s Families (NSAF): –Nationally representative survey of children, adults younger than 65 years, and their families –Fielded in 13 states and smaller balance of the nation for the Urban Institute Children ages 6-17 surveyed in 1997 (N = 21,824), 1999 (N = 23,423), and 2002 (N = 22,064).

06/26/05Annual Research Meeting Data and Methods (2) Measure access to mental health care: –Indicator for any use of mental health services from a doctor, mental health counselor, or therapist # of times children received mental health services year before interview Treatment for substance abuse or smoking cessation excluded –Reported by caregivers Measure need for mental health care: –Parental responses to 6 items from the Child Behavioral Checklist (threshold score: 12)

06/26/05Annual Research Meeting % of Children Ages 6-17 Receiving Any Mental Health across Geographic Regions, 1997 and 2002 Note: Error bars indicate 95% CI. The horizontal lines represent the national averages for 13 states and the balance of the nation.

06/26/05Annual Research Meeting Summary of Results Children’s use of any mental health care nationwide increased substantially, from 7.1% in 1997 to 8.9% in 2002, or by 25 % (p<0.01) Average need for mental health services remained the same in 2002 as in 1997 (7.7%) Despite the overall increase in service use, large geographic variation continues to exist –Smallest increase in service use in states with use below the national average in 1997, e.g. Mississippi/Alabama.

06/26/05Annual Research Meeting Changes in Use of Mental Health Services across Socioeconomic Groups Only uninsured children had a decrease in use of services during : –From ~2/3 of the national average in 1997 to ½ of the national average in 1999 and 2002 Rates of use were slowest to grow for black children and children with public insurance – % annually Fastest increase for youth in high-income families – % annually

06/26/05Annual Research Meeting Conclusions Large increase in children’s mental health care utilization between 1997 and 2002 Significant differences in trends across states and socioeconomic groups No guarantee that the increase actually benefited children most in need.