Data shows wide disparities among counties and ethnicities
Will Data Drive Policy?
CCCMHA has had the support of a summer intern, Chelsea Parker, who compiled data about MediCal penetration rate among counties age groups and ethnicities and also developed reports about how readily different populations access mental health services.
The findings are tabulated for the twenty five largest counties by population. They show the MediCal penetration rate and expenditure for each individual served in the 2008-09 year and the 2013-14 year. Please note that years are subject to change based on available CHIS data for a given sample question. For exacting dates, check the data keys on each table (attached). The data also breaks out the results by age group and ethnicity.
The variation among counties in penetration rate ranges from 3.6% in Fresno to 10.2% in San Francisco. The penetration rate among ethnicity varies even more from 21% for Caucasians and 17% for African Americans in San Francisco County to 6% for Caucasians and 5% for African Americans in Solano. Overall penetration rates for Latinos and Asian and Pacific Islanders are significantly lower in every county. The range for Hispanic penetration is 6% in San Francisco to 1.6% in San Joaquin. For Asian and Pacific Islander the high is 5% in San Francisco and the low is 1.5% in Placer. In making these statements we disregarded numbers from counties where there was a huge change in the number of “other” from 2008-09 to 2013-14 as it suggests that the definitions changed and it is not clear what the numbers mean.
The fact that Asian and Latino penetration rates are significantly lower is also borne out in the California Health Information Survey (CHIS) data. The CHIS is a survey of 50,000 people over 2 years that conducts telephone interviews on a large variety of health topics. The data is accessible to the public through the Ask CHIS website. We reviewed mental health data and found that the most interesting variation is in the extent to which people don’t seek care for a mental health problem. 61% of African Americans won’t seek care and while that is a concern reflecting stigma and other factors it is the best of any racial group. 75% of Caucasians won’t seek help, 87% of Latinos and a shocking 95% of Asians.
Putting all of this together what does it mean?
First and foremost is that relying on people to seek mental health care on their own is unrealistic. Strategies such as the Section 1115 MediCal waiver pending before CMS to screen everyone in primary care for behavioral health and ensure that there is a warm hand off to behavioral health will change this pattern as will growth of school mental health programs that offer on campus support for all students at any level of need as may be observed by teachers.
The wide disparity of resources among counties is also a factor and as the state determines how to allocate growth in 2011 Realignment and the Mental Health Services Act, this data should lead to different formulas than have been used in the past.
In addition it suggests a need to study the higher performing counties and study what they are doing differently to see if it is just funding or if there are other factors that lead to higher penetration rates among each significant population.
Another question that must be addressed is what is the impact of better penetration rates. It should lead to lower hospitalization rates and other health care costs (especially among adults), lower special education and child welfare placement rates, lower rates of people with mental illness in the criminal justice system. To the extent that it does not lead to such improvements in those rates than how do we measure the success of services?
Spending per person also varies by county and that also should be associated with better results.
The bottom line is that data should drive policy and in all of the major state level policy forums. This data should be a starting point for policy discussions which are long overdue.
Now that the economy is recovering and there is growth in funding there is an opportunity to address these issues in ways that were not possible during the recession when the main priority was appropriately just to maintain current services and programs.
Click here for Chelsea’s Spreadsheets