RAND Study Shows Disparities Among States in Mental Health Care for Children

For Release

October 6, 2003

Mental health programs serve a far greater share of children in some states than in others, but states with higher use of mental health services do not necessarily have a higher need for them, according to a RAND Corporation study released today.

Using information about children in 13 states that represent a cross-section of the nation, researchers from RAND Health conducted the first large comparison of the use of mental health services and the need for mental health care among children in each state. The findings are described in an article by RAND Health economists Roland Sturm, Jeanne S. Ringel, and Tania Andreyeva in the October edition of the medical journal Pediatrics.

Children's use of mental health care services differs more than twofold across states. Yet these differences in use are not necessarily paralleled by differences in need. Some states, such as Alabama and Texas, have high rates of need and low rates of use. In contrast, Washington state has a low level of need and a high level of use.

The table shows the percentages of children in the states who have received some type of mental health services and the percentage of children likely to benefit from mental health services, based on their caregivers' assessments:

State Percent of children using mental health services Percent of children needing mental health services
Alabama 6.5 percent 8.3 percent
California 5.1 percent 6.3 percent
Colorado 10.0 percent 6.7 percent
Florida 6.5 percent 8.1 percent
Massachusetts 11.6 percent 7.1 percent
Michigan 7.7 percent 7.1 percent
Minnesota 9.3 percent 7.5 percent
Mississippi 6.6 percent 9.4 percent
New Jersey 6.9 percent 5.6 percent
New York 8.1 percent 6.7 percent
Texas 5.7 percent 7.9 percent
Washington 8.0 percent 5.9 percent
Washington 8.0 percent 7.9 percent

Need and service use within a state may also be mismatched. In these cases, children most in need are not necessarily the ones using mental health services.

Some states seem to be doing a better job of getting services to the children with the highest need, even if they have low overall rates of use of mental health services. For example, Alabama and Mississippi have high levels of need and low levels of use. But these states do not have a level of unmet need statistically different from the rest of the nation. In contrast, California, Florida, and Texas had significantly higher rates of unmet need, compared with the other states.

The researchers also analyzed whether service use or unmet need were associated with state differences in poverty rates, income levels, or percentage of the population who were minorities. They found no relationship.

“A white child from a higher income family in Texas is less likely to get services than a poorer Hispanic child with similar need in Massachusetts,” Sturm said. “Our findings suggest that these differences are most likely caused by differences in state policies and health care markets that make services more or less available.”

The study highlights the need for more mental health services in many states. However, the researchers say their findings also suggest that some states need to do a better job of making sure mental health services are targeted to children who have the greatest need.

RAND conducted the study by analyzing information from the National Survey of America's Families, which included information on more than 45,000 children ages 6 to 17 who were surveyed in 1997 and 1999. The 13 states in the study represent more than half the nation's population and were chosen because they vary in terms of location, size, demographics and political traditions.

The study measured use of services by whether the child's caregiver reported that the child received mental health services in the past 12 months. Mental health need was measured by the caregiver's response to six items from the Child Behavioral Checklist, including questions about whether the child is unhappy, sad or depressed, has problems concentrating, or does not get along with other children.

The research was supported by the Child Mental Health Foundations and Agencies Network, and the Robert Wood Johnson Foundation's Health Care Financing and Organization Initiative.

RAND Health is the nation's largest independent health policy research organization, with a broad research portfolio that focuses on health care quality, costs, and delivery, among other topics.

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