176587 Evolution of state variations in public mental health policymaking and its effect on access

Wednesday, October 29, 2008: 12:30 PM

Walter Jones, PhD , Division of Health Administration and Policy, Medical University of South Carolina, Charleston, SC
Anouk Grubaugh, PhD , Division of Public Psychiatry, Medical University of South Carolina, Charleston, SC
Christopher Freuh, PhD , Director, Masters Program in Counseling Psychology, University of Hawaii at Hilo 200, Hilo, HI
Richard Lindrooth, PhD , Department of Health Administration and Policy, Medical University of South Carolina, Charleston, SC
The number of acute psychiatric inpatient beds has declined dramatically over the past decade, with corresponding declines in state-run long-term beds. State policies play an important role in both long-term bed supply and (through reimbursement) the financial viability of acute psychiatric beds. Historically, states were similar in public mental health funding approaches. However, with deinstitutionalization, state policies have diverged in both funding levels and the mechanisms and incentives built into the system. This has led to state differences in the viability of acute care inpatient beds, resulting in access difficulties in some states. The current research, part of a multiyear funded study, examines the relationships between state political factors and their ongoing policymaking with respect to public mental health services. All fifty states are included in this analysis. We classify states according to: generosity of funding; degree of funding centralization (county versus state); which entity risks cost overruns (e.g. county, state, or private entity); any existing Medicaid waivers; and the role of state long-term beds. We show that the above policies are significant predictors of the supply of private psychiatric beds. Furthermore, we model policy dimensions as a function of exogenous policymaking variables including: political party control; executive versus legislative control; socioeconomic evolution; and state regulation levels. We find that state public mental health policy has evolved in ways reflecting the state government structure; socioeconomic conditions; and elected officeholders. The structure of the government, in turn, determines the viability of public mental health care and access through policy implementation.

Learning Objectives:
1. Recognize the impact of state policies on long-term mental health beds and the financial viability of acute psychiatric beds. 2. Describe how states vary in funding patterns and availability of psychiatric beds. 3. Identify political/policymaking variables that determine state mental health policies in these areas.

Keywords: Mental Health Services, Mental Health System

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a co-investigator on the described research project
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.