Health Care for Communities

Studies of the impact of changes in substance abuse and mental health care programs

Field of Work: Research on treatment for substance use and mental health challenges

Problem Synopsis: Although policy changes and market forces in the mid-1990s were exerting a significant impact on how alcohol, drug, and mental health problems were treated and reimbursed, no national research was under way to examine the clinical and social effects of these shifts.

Synopsis of the Work: From 1996 to 2010, under Healthcare for Communities, researchers tracked changes in the organization and financing of alcohol abuse, drug abuse, and mental health services, and the impact of those changes on individuals’ access to care and the quality and cost of that care.

To pursue the project, investigators at the Health Services Research Center at the University of California-Los Angeles (UCLA) surveyed households in 60 communities across the country in 1997 and 1998, and again in 2000 and 2001. The project team also surveyed employers, state Medicaid administrators, and directors of state mental health agencies.

The Treatment Research Institute in Philadelphia and the Institute for Health Policy at Brandeis University, in Waltham, Mass., conducted research related to Healthcare for Communities, and helped inform the project.

Key Findings: Among findings published in more than 100 peer-reviewed articles are the following:

  • Adults with probable depressive or anxiety disorders often fail to receive appropriate treatment.
  • Women are unlikely to be asked whether they have experienced domestic violence, even when they are at higher risk of abuse.
  • Stressors (such as violence) and stress-buffering features (such as churches) in residential neighborhoods are associated with the likelihood that people will have alcohol, drug, and mental health disorders.
  • Almost 40 percent of those who reported contemplating suicide and perceived a need for alcohol, drug, or mental health care did not receive adequate care.
  • African Americans and Hispanics have a greater unmet need for substance abuse treatment and mental health care compared with Whites.

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