Mental Health Facilities Capacity & Covid-19 aftermath
Is our mental health system ready for the Covid-19 aftermath? USA Mental Health Facilities and services, analysis of the National Mental Health Services Survey (N-MHSS): 2019.
quotes,If we take into consideration the following two quotes, one by National Institute of Mental Health (NIMH), and the other by The New England Journal of Medicine and after looking at how many Mental Health facilities with have, there are reasons to be concern.
“Mental illnesses are common in the United States. Nearly one in five U.S. adults live with a mental illness (46.6 million in 2017)”
(NIMH » Mental Illness (2019). Available at: https://www.nimh.nih.gov/health/statistics/mental-illness.shtml (Accessed: 21 August 2020).)
“Stressors that undoubtedly will contribute to widespread emotional distress and increased risk for psychiatric illness associated with Covid-19.”
“Uncertain prognoses, looming severe shortages of resources for testing and treatment and for protecting responders and health care providers from infection, imposition of unfamiliar public health measures that infringe on personal freedoms, large and growing financial losses, and conflicting messages from authorities are among the major stressors that undoubtedly will contribute to widespread emotional distress and increased risk for psychiatric illness associated with Covid-19.”
Mental health and the Covid-19 Pandemic | NEJM “Mental Health and the Covid-19 Pandemic | NEJM” (2020), p. Available at: https://www.nejm.org/doi/full/10.1056/NEJMp2008017 (Accessed: 19 August 2020).
I used the National Mental Health Services Survey 2019 (N-MHSS-2019) (2) questionnaire and dataset to explore what the data shows.
Obviously, the subject of Mental health and Substance abuse is vast, and we cannot cover all ramifications of a potential surge in demand for these services in a blog-post. Hence, I focused on a certain aspect of the data to find some insights, but I must recognize is barely scratching the surface. I focused my attention mainly on the supply side of the mental health equation, the number of facilities and services they offer.
Let’s look at the forest before we look at the trees:
2019-USA Projected Population, 331,433,217
according to US Census (1)
12,472 Total Number Of Known Mental Health Facilities eligible from the N-MHSS-2019 report. (2)
Base on the reporter facilities, there are 3.8 Facilities Nationwide per 100,000 people according to my-data analysis.
Let’s look at the details of the N-MHSS-2019 data by State.
Total numbers sometimes can mislead, hence the graph below shows how each state fairs out in several facilities per 100,000 of its residents. As we can see, some of our most populous states, such as CA, NY, TX and FL, lag in number facilities per 100,000 people. (1)
It is not sufficient to just have enough facilities; it is equally important, the number of services provided by the facilities. For this post, we won’t examine the quality of given services as it is not the scope.
What does data show about the mental health services provided by the above enumerated facilities?
To better visualize the data, we have used PCA method on the features of the dataset that represent the different questions about the services for each known Mental Health facility.
Examples of services the features of dataset represent are:
- Court-ordered outpatient treatment
- Therapeutic foster care
- Mental health intake
- Suicide prevention services
We can clearly see in the above graph that California (CA) and New York (NY) are outliers, which can be expected since both states projected populations number: $39,512,223 and $19,399878 respectively (2010 Census), and those states rank 1 and 2 in numbers of facilities but what about Texas (TX) and Florida (FL)? The same intuition should follow with population size of 28,995,881 and 21,477,737 respectively. Also, if we reference our first graph in which FL occupies 4th place and TX occupies a 10th place in the total number of facilities. TX and FL should be outliers in the total number of services available per facility, as well. Data shows that is not the case.
To better understand some differences of a total number of services offer per State. Let’s zoom into Florida (FL) and Pennsylvania (PA), as the PCA data show them closed together relative to other states.
To make an adequate comparison, I selected 125 features of the 140 found in the dataset. In which at least one facility in either state answer yes to offering the service represented by the dataset’s feature. Also, some multiple-choice questions regarding categorical labeling were omitted.
After running a statistical t-test FL and PA facilities’ features, data shows there is around 66% commonality between the two states base on 125 features selected.
Below we can see (3) graphs showing the mean/average of the selected 125 features from the dataset, representing services or specifics of a service by index number.
Blue plot corresponds to National means, followed by Florida in red and State of Pennsylvania in green.
Let’s pick individual features from the above graph and see how they compare at a National level, and per individual states selected: FL and PA.
Feature number 100
Represents facilities which: Accept Medicare as a source of payment for mental health treatment services. National mean or average 68%, FL is 66%, PA 56%
Feature number 50
Represents facilities which: Accept children (aged 12 years or younger) for treatment. National mean or average of facilities is 59%, FL is 55% and PA 64%
Feature number 75
Represents facilities which: Staff provide mental health treatment services in a language other than English. National mean or average of facilities is 73%, FL is 81% and PA 59%
Feature number 76
Which represents facilities which: Staff provide mental health treatment services in Spanish. National mean or average of facilities is 95%, FL is 98% and PA 89%
Feature number 86
Which represents facilities which: Staff provide mental health treatment services in Hindi. National mean or average of facilities is 16%, FL is 5% and PA 26%
Feature number 65
Which represents facilities which: Facility offers dedicated mental health treatment program for veterans. National mean or average of facilities is 17%, FL is 26%, PA 14%
Let’s look at the last feature listed above (65) representing services for Veterans: Roughly 19.5 million Americans are veterans.
According to a report by US Census Bureau roughly 18 million Americans, or about 7 percent of the adult population, who were veterans of the U.S. Armed Forces in 2018. This report uses data from the 2014 Survey of Income and Program Participation to describe the wealth of veterans of various ages. The projection for the veteran population for 2019 is 19.5 Million in 2020. (3) (4)
I focused on veterans as a sample group to show cause and effect and potential impact of a lack of Mental Health facilities and services.
As for full disclosure, I am an Army veteran which uses VA health services.
“Recent military operations in Iraq and Afghanistan represent the most sustained ground combat operations involving American forces since the Vietnam era.”
“Many military personnel experience high-intensity guerrilla warfare and the chronic threat of roadside bombs and improvised explosive devices. Some soldiers endure multiple tours of duty, many experience traumatic injury, and more of the wounded survive than ever before. Reports have suggested high rates of mental health disorders including posttraumatic stress disorder (PTSD), depression, and alcohol use disorders among active duty military personnel and veterans of Operation Iraqi Freedom (OIF) and, to a lesser extent, Operation Enduring Freedom (OEF).” K. H. Seal (5)
“In fiscal year (FY) 2017, over 1.7 million Veterans received mental health treatment in a VA mental health program; this number has risen each year from about 900,000 in FY2006. Nearly one-third (29.2 percent) of these patients received care from a mental health care provider working in the primary care clinic, while 350,000 (70.8 percent) had their depression documented by providers who only practice primary care.” (6)
The Data shows: There is 1 Mental Health Facility per 100,000 Veterans Nationwide.
As per facilities which offers dedicated mental health treatment program for veterans and only those included final N-MHSS-2019 report. Population base on the USA Census projection of Veteran 2019 population. (4)
“Lack of access to mental health services contributing to the high suicide rates among veterans” Ronal D. Hester (7)
So If we take a population such as Veterans that are at significant risk to be affected by mental illness. You add the effects of Covid-19 pandemic and how it is projected to affect our general population in the USA. The situation for veterans currently dealing with mental health issues that our part of our communities could aggravate. For those veterans who are not affected by combat traumas or that are not using mental health facilities. We could see a spike in mental health issues in this cohort as part of the general risk pool of the general population.
Conclusion
If we take the NIMH’s number of 46.6 million U.S. Adults, that live with a mental illness in 2017. Let’s assume that levels of mental illness have remained flat, that is still a staggering 14% of US adults dealing with a mental illness. Obviously, to deal with any health challenges, you need health facilities and access to services.
Veterans represent a unique segment of the population. Specially at risk for mental health illness for the reasons listed above. I think using the veterans as a sample population gives us insight into our Mental Health system capacity and efficacy and potential pitfalls.
Covid-19 has shown American public deficiencies we have in our society and systems. Many systems such as state unemployment, schools, health facilities and supply chains, to mention a few, our being stress to their full capacity. The Mental Health system could be one that gets stress in the aftermath of the covid-19 pandemic, to deadly and disastrous consequences, unless we direct attention and resources into that Health segment.
The number of Mental Health facilities and the services these facilities provide it is just one aspect of the overall mental health outcome picture. I invite the readers to visit some work cited as well as https://www.mhanational.org/issues/ranking-states
Work cited:
(1) https://www.census.gov/data/tables/time-series/demo/popest/2010s-state-total.html#par_textimage
(2) Substance Abuse and Mental Health Services Administration, National Mental Health Services Survey (N-MHSS): 2019. Data on Mental Health Treatment Facilities. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2020.
(3) Anon (2020) Va.gov. Available at: https://www.va.gov/vetdata/docs/Demographics/New_Vetpop_Model/Vetpop_Infographic2020.pdf (Accessed: 26 August 2020).
(5) Seal, K. H. Seal, K. (2007) “Bringing the War Back Home”, Archives of Internal Medicine, 167(5), p. 476. doi: 10.1001/archinte.167.5.476.
(6) (2020) Mentalhealth.va.gov. Available at: https://www.mentalhealth.va.gov/docs/VA-Office-of-Mental-Health-and-Suicide-Prevention-Guidebook-June-2018-FINAL-508.pdf (Accessed: 26 August 2020).
(7) Ronal D. Hester Health Care Administration, Nicole Wertheim College of Nursing & Human Services, Florida International University, Miami, FL 33199 USA
Datasets utilized
- https://www.datafiles.samhsa.gov/sites/default/files/field-uploads-protected/studies/N-MHSS-2019/N-MHSS-2019-datasets/N-MHSS-2019-DS0001/N-MHSS-2019-DS0001-bundles-with-study-info/N-MHSS-2019-DS0001-bndl-data-tsv.zip
Shape (12472, 140) - https://raw.githubusercontent.com/urenajose/DS-Unit-1-Build/master/USApopestimate2019.csv
Shape (52, 6) - https://www2.census.gov/programs-surveys/popest/datasets/2010-2019/national/totals/nst-est2019-popchg2010_2019.csv?#
Shape(57, 67)