Changes in Children’s Mental Health Care,

1997-2002

Tatiana Andreyeva, Pardee RAND Graduate School

Roland Sturm, RAND

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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

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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 1997-2002– Differences across socioeconomic populations– Differences across states

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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).

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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)

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% 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.

0

2

4

6

8

10

12

14

16

AL CA CO FL MA MI MN MS NJ NY TX WA WI

%

1997, National average = 7.1 2002, National average = 8.9

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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.

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Changes in Use of Mental Health Services across Socioeconomic Groups

• Only uninsured children had a decrease in use of services during 1997-2002:– 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 – 1.3-1.4% annually

• Fastest increase for youth in high-income families – 5.6-6.0% annually

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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.