The influence of state mental health perceptions and spending on an individual's use of mental health services.
OBJECTIVE
To explore the possible contextual effects of state-level mental health perceptions and public spending for mental health treatment on an individual's use of mental health services, independent of the individual's own perceptions.


METHODS
Cross-sectional data from the 2007 Behavioral Risk Factor Surveillance System were used. A total of 216,514 participants from 35 states and the District of Columbia were included in the study. Logistic regression and multilevel modeling were used to estimate the effects of individual-level characteristics and three state-level factors-per capita spending on community mental health services, aggregated perceptions of the effectiveness of mental health treatment and the stigma of mental illness-on the individual's current use of mental health services.


RESULTS
Adjusting for the individual's perceptions and characteristics, state-level perception of treatment effectiveness was positively associated with the use of mental health services [odds ratio (OR) for 5 % increase in the percentage perceiving effectiveness = 1.08; 95 % confidence interval (CI): 1.01, 1.16]. This association was strongest for individuals who experienced 1-4 days of mental distress in the past 30 days (OR = 1.17; 95 % CI 1.06, 1.29). State-level public spending on community mental health services was also positively associated with an individual's use of mental health services (OR for a $40 increase in spending = 1.09; 95 % CI 1.01, 1.17); however, state-level perceptions of mental-illness stigma was not.


CONCLUSIONS
Our findings suggest there may be contextual effects of state-level perceptions of treatment effectiveness and state spending on community mental health services on the use of mental health services.
Thomson Reuters, Washington, DC 20008, USA. john.richardson@thomsonreuters.com
John
J
Richardson
Hal
H
Morgenstern
Raquel
R
Crider
Olinda
O
Gonzalez
D003156:Community Mental Health Services / Q000191:economics* / Q000706:statistics & numerical data*; D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis; D003430:Cross-Sectional Studies; D006801:Humans; D016015:Logistic Models; D001523:Mental Disorders / Q000628:therapy*; D008603:Mental Health; D016017:Odds Ratio; D010342:Patient Acceptance of Health Care; D010465:Perception; D057545:Social Stigma; D016896:Treatment Outcome; D014481:United States