Availability and Accessibility of Mental Health Services in New York City
Joshua Breslau, Dionne Barnes-Proby, Mallika Bhandarkar, Jonathan H. Cantor, Russell Hanson, et al
Mental health services are critical components of public health infrastructure that provide essential supports to people living with psychiatric disorders. In a typical year, about 20 percent of people will have a psychiatric disorder, and about 5 percent will experience serious psychological distress, indicating a potentially serious mental illness. Nationally, the use of mental health services is low, and the use of care is not equitably distributed. In the United States as a whole and in New York City (NYC), non-Hispanic white individuals are more likely to use mental health services than non-Hispanic black individuals or Hispanic individuals. The challenges of ensuring the availability of mental health services for all groups in NYC are particularly acute, given the size of the population and its diversity in income, culture, ethnicity, and language. Adding to these underlying challenges, the coronavirus disease 2019 (COVID-19) pandemic has disrupted established patterns of care.
To advance policy strategy for addressing gaps in the mental health services system, RAND researchers investigate the availability and accessibility of mental health services in NYC. The RAND team used two complementary approaches to address these issues. First, the team conducted interviews with a broad group of professionals and patients in the mental health system to identify barriers to care and potential strategies for improving access and availability. Second, the team investigated geographic variations in the availability of mental health services by compiling and mapping data on the locations and service characteristics of mental health treatment facilities in NYC.
Mental health system professionals identified two main barriers to the availability of services
Experts noted shortages of providers from underserved communities and that shortages are acute for all types of clinicians. They also described how the COVID-19 pandemic has exacerbated the workforce shortage.
Multiple informants identified the need for greater integration among agencies that provide services to people with mental health conditions. Such settings as schools, jails, and shelters encounter challenges when linking people with mental health problems to specialized treatment.
Patients discussed difficulties with accessing care, from navigating the mental health system to identifying a provider
Patients struggled to find resources and to get appointments. They also mentioned a protracted intake process, and some dealt with long wait times. Patients discussed the importance of cost, provider cultural competence, and quality of care.
Although patients faced many barriers, they cited the awareness of mental health, having supportive relationships, and personal resilience as important facilitators to accessing care.
The availability of services, utilization of services, and the total capacity of services vary across the city
In some areas of the city, the number of facilities that accept Medicaid is low, indicating low geographic access to care for people who rely on Medicaid for their health insurance coverage.
Areas with (1) high numbers of people who speak Spanish with low proficiency in English and (2) low numbers of mental health treatment facilities that provide services in Spanish were found in Northern Queens, along the border of Brooklyn and Queens, and in the South Bronx.
City policymakers and leaders should focus on short- and long-term workforce issues. The city should support ongoing efforts to increase clinical training in mental health fields, expand the role of peers in providing services, and improve wages and benefits for workers in mental health facilities. However, the city should not expect hiring and retention of staff to fully address limits on the capacity of the service system.
Stakeholders should continue developing a data system. The data compiled for this study provide an initial view of underserved areas in the city, but that view can be made more valuable to policymakers by integrating additional data, validating certain data elements, and updating facility data over time.
Stakeholders should develop a telehealth strategy. The city can play a role in addressing quality-of-care issues by working with state regulatory agencies on quality assessment and disseminating evidence-based treatment models to clinics.
Providers should continue developing clinical information systems. The city can work with partners in government and in the private nonprofit sector to improve information-sharing, which will enhance integration of care across the system. Health systems and large community-based providers could be convened to create a long-term information system–development strategy.