Mental health care provision in community health centers and hospital emergency department utilization

Abstract

Objectives: To examine whether community health centers (CHCs) are effective in offsetting mental health emergency department (ED) visits.

Data sources and study setting: The HRSA Uniform Data System and the HCUP State ED Databases for Florida patients during 2012-2019.

Study design: We identified CHC-year-specific service areas using patient origin zip codes. We then estimated panel data models for number of ED mental health visits per capita in a CHC's service area. Models measured CHC mental health utilization as number of visits, unique patients, and intensity (visits per patient).

Principal findings: CHC mental health utilization increased approximately 100% during 2012-2019. Increased CHC mental health provision was associated with small reductions in ED mental health utilization. An annual increase of 1000 CHC mental health care visits (5%) was associated with 0.44% fewer ED mental health care visits (p = 0.153), and an increase of 1000 CHC mental health care patients (15%) with 1.9% fewer ED mental health care visits (p = 0.123). An increase of 1 annual mental health visit per patient was associated with 16% fewer ED mental health care visits (p = 0.011).

Conclusions: Results suggest that mental health provision in CHCs may reduce reliance on hospital EDs, albeit minimally. Policies that promote alignment of services between CHCs and local hospitals may accelerate this effect.

Keywords: community health centers; hospital emergency departments; mental health services.

FIGURE 1

Florida Community Health Centers 2012 to 2019: visits (thousands) with mental health (MH) diagnoses grew from 12.9 to 25.6, unique patients (thousands) with MH diagnoses 3.8 to 8.3, intensity (visits/patient) 2.2 to 2.7. Source: Health Resources and Services Administration Uniform Data System Table 6A.