Mental Health Care
About
Mental Health Care measures the rate of mental health care providers per 100,000 population in a county. Individuals from all races and ethnicities are included. As of December 2023, more than half (169 million) of the U.S. population lives in a Mental Health Professional Shortage Area (Mental Health HPSA) 1. While the mental health parity provisions of the Affordable Care Act (ACA) have expanded coverage for mental health services, challenges persist in accessing care 2. Persistent disparities in access to mental health care exist between racial-ethnic minorities and White individuals. Over time, these disparities have remained significant, with minority groups consistently being less likely to utilize mental health services compared to their White counterparts 3.
Why is Mental Health Care important to the Structural Racism and Discrimination (SRD) Index?
Access to mental health care is a critical component of a quality and equitable healthcare system. Along with general stigma towards mental health issues, structural, institutional, and interpersonal racism have perpetuated inequalities in mental health outcomes, particularly among racial and ethnic minorities 4. Historical and ongoing disparities in resource allocation have created significant barriers, including shortages of mental health care providers in racially segregated and low-income neighborhoods. Lack of adequate health insurance or no coverage further adds to the low access to mental healthcare. These obstacles prevent many individuals from accessing essential mental health care services 5. In addition, racial discrimination within the healthcare system has eroded trust, further reducing mental health service utilization among marginalized populations 6. Including Mental Health Care as an indicator of the SRD Index is essential for identifying and addressing these disparities, promoting equity, and improving outcomes for racially marginalized populations. This integration underscores the importance of dismantling systemic barriers to ensure that all individuals have fair and equitable access to mental health care.
What is the expected relation to Structural Racism and Discrimination?
A lower rate of mental health care providers represents a higher need for medical resources in a county. A higher rate of mental health care providers contributes to the lower score of the SRD Index.
How is Mental Health Care calculated?
Data Source
We obtained data from the Health Resources & Services Administration (HRSA) 7. The data is publicly available.
Data
We used the following two variables at the county level.
| Variables* | Year | Unit |
|---|---|---|
| Total population | 1990 | 2000 | 2010 | 2020 | Number |
| Number of Mental Health Care Providers | 1990 | 2000 | 2010 | 2020 | Number |
Methodology
We calculated Mental Health Care using a ratio formula:
$$
RMentalProv = \left( \frac{MentalProv}{TotPop} \right) \times 100000
$$
Where:
RTotPCphy: Rate of mental health care providers per 100,000 population (all races and ethnicities)
TotPCPhy: Number of mental health care providers
TotPop: Total Population
Missing Data
Missing values were filled using the median value of the adjacent neighbors. The adjacent neighbors were identified using the PolygonNeighbors tool in Python’s arcpy.analysis module 8. The adjacency is defined by any common boundary or vertex between two counties. After imputing missing data, 13 counties (primarily island counties) remained without data for 2020, while 85 counties lacked data for 2010, including 7 in the contiguous United States and the rest in island regions, and no counties were missing data for the year 2000. Additionally, the entirety of Alaska had no data for 1990.
Limitations
There are inconsistencies in the type of mental healthcare providers across the years 2020, 2010, 2000, and 1990, which may affect comparability and interpretation. For the years 2020 and 2010, data were obtained from the HRSA’s Area Health Resource File (AHRF) county-level data, which included mental health care providers specializing in psychiatry and patient care, encompassing both office-based and hospital full-time staff. The 2000 data, sourced from the AHRF Access System (2021-2022 Edition), include only psychiatrists and psychologists. The 1990 data, also from the AHRF Access System (2021-2022 Edition), are further limited, including only psychologists.
References
1. Health Resources and Services Administration. Health Workforce Shortage Areas [Dashboard]. U.S. Department of Health and Human Services. Published 2023. Accessed December 20, 2024.
2. Rapfogel, N. (2022). The behavioral health Care affordability problem. Center for American Progress.
3. Cook, B. L., Trinh, N. H., Li, Z., Hou, S. S. Y., & Progovac, A. M. (2017). Trends in racial-ethnic disparities in access to mental health care, 2004–2012. Psychiatric services, 68(1), 9-16.
4. Nazroo, J. Y., Bhui, K. S., & Rhodes, J. (2020). Where next for understanding race/ethnic inequalities in severe mental illness? Structural, interpersonal and institutional racism. Sociology of health & illness, 42(2), 262-276.
5. Shim, R. S., & Starks, S. M. (2021). COVID-19, structural racism, and mental health inequities: Policy implications for an emerging syndemic. Psychiatric Services, 72(10), 1193-1198.
6. Matthews, K., Morgan, I., Davis, K., Estriplet, T., Perez, S., & Crear-Perry, J. A. (2021). Pathways To Equitable And Antiracist Maternal Mental Health Care: Insights From Black Women Stakeholders: Study examines pathways to equitable and antiracist maternal mental health care. Health Affairs, 40(10), 1597-1604.
7. Health Resources and Services Administration. (n.d.). Area Health Resource File (AHRF) county-level data. U.S. Department of Health and Human Services.
8. Virtanen, P., Gommers, R., Burovski, E., Oliphant, T. E., Weckesser, W., Cournapeau, D., … & Feng, Y. (2021). scipy/scipy: SciPy 1.6. 0. Zenodo.