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The influence of state mental health perceptions and spending on an individual’s use of mental health services

Social Psychiatry and Psychiatric Epidemiology volume 48, pages 673–683 (2013)Cite this article

Abstract

Purpose

To explore the possible contextual effects of state-level mental health perceptions and public spending for mental health treatment on an individual’s use of mental health services, independent of the individual’s own perceptions.

Methods

Cross-sectional data from the 2007 Behavioral Risk Factor Surveillance System were used. A total of 216,514 participants from 35 states and the District of Columbia were included in the study. Logistic regression and multilevel modeling were used to estimate the effects of individual-level characteristics and three state-level factors—per capita spending on community mental health services, aggregated perceptions of the effectiveness of mental health treatment and the stigma of mental illness—on the individual’s current use of mental health services.

Results

Adjusting for the individual’s perceptions and characteristics, state-level perception of treatment effectiveness was positively associated with the use of mental health services [odds ratio (OR) for 5 % increase in the percentage perceiving effectiveness = 1.08; 95 % confidence interval (CI): 1.01, 1.16]. This association was strongest for individuals who experienced 1–4 days of mental distress in the past 30 days (OR = 1.17; 95 % CI 1.06, 1.29). State-level public spending on community mental health services was also positively associated with an individual’s use of mental health services (OR for a $40 increase in spending = 1.09; 95 % CI 1.01, 1.17); however, state-level perceptions of mental-illness stigma was not.

Conclusions

Our findings suggest there may be contextual effects of state-level perceptions of treatment effectiveness and state spending on community mental health services on the use of mental health services.

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Acknowledgments

This study was partially funded by the Hispanic Association of Colleges and Universities which helped support the first author’s internship with the Substance Abuse and Mental Health Services Administration where he began the analysis for this study.

Conflict of interest

The authors declare that they have no conflict of interest. The findings and conclusions in this article are those of the authors and do not necessarily represent the views of the Substance Abuse and Mental Health Services Administration.

Author information

Affiliations

  1. Thomson Reuters, Washington, DC, 20008, USA

    John Richardson

  2. Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, 48109-2029, USA

    Hal Morgenstern

  3. Department of Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor, MI, 48109-2029, USA

    Hal Morgenstern

  4. Department of Economics and Finance, School of Business and Social Science, Shepherd University, Shepherdstown, WV, 25443-5000, USA

    Raquel Crider

  5. Division of State and Community Systems Development, Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, Rockville, MD, 20847-2345, USA

    Olinda Gonzalez

Authors
  1. John Richardson
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  2. Hal Morgenstern
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  3. Raquel Crider
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  4. Olinda Gonzalez
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Corresponding author

Correspondence to John Richardson.

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Richardson, J., Morgenstern, H., Crider, R. et al. The influence of state mental health perceptions and spending on an individual’s use of mental health services. Soc Psychiatry Psychiatr Epidemiol 48, 673–683 (2013). https://doi.org/10.1007/s00127-012-0520-y

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  • DOI: https://doi.org/10.1007/s00127-012-0520-y

Keywords

  • Mental health services
  • Perception of mental health treatment
  • Stigma
  • State mental health spending
  • Health Belief Model
  • Contextual effects