Changes in Children’s Mental Health Care, 1997-2002

1. Changes in Children’s Mental Health Care, 1997-2002 Tatiana Andreyeva, Pardee RAND Graduate School Roland Sturm, RAND

2. 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 Annual Research Meeting 2005

3. 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 Annual Research Meeting 2005

4. 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). Annual Research Meeting 2005

5. 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) Annual Research Meeting 2005

6. % 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. Annual Research Meeting 2005

7. 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. Annual Research Meeting 2005

8. 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 Annual Research Meeting 2005

9. 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. Annual Research Meeting 2005