measuring access to community- based mental health services in california a presentation to the...
TRANSCRIPT
Measuring Access to Community-Based Mental Health Services in California
A Presentation to the California Mental Health Planning Council
April 16th, 2009
Prevalence, Penetration and Retention
Prevalence, Penetration and Retention Defined
These Prevalence Rates represent the number of people California with Serious Mental Illness or Serious Emotional Disturbance across various demographic characteristics such as Age, Gender and Race/Ethnicity
Penetration rates tell us how many people we are serving compared to how many people are in need of services. These rates are calculated by dividing the number of individuals estimated to have SMI/SED by the number of people who actually receive public mental health services.
Retention rates provide us with information about disparities in service quality across Age, Gender and Race/Ethnicity
All of the information combined provides us with some indication of how the public mental health system fairs in regards to meeting the needs of individuals across various demographic characteristics.
Statewide Prevalence, Penetration and Retention Rates by Race/Ethnicity
Comparison of Total Clients Served to (Holzer) Targets By Ethnicity/Race
StatewideFiscal Year 06/07
537,168
96,40060,07077,164
23,788
265,250
8,342
84,306
33,318
146,499
4,636
218,252
0
100,000
200,000
300,000
400,000
500,000
600,000
White Hispanic African American Asian/Pacific Islander Native American Other
Ethnicity/Race
Num
ber o
f Clie
nts
Target Served
Other
305.25%
Comparison of Total Clients Served to (Holzer) Targets Percent Difference from Target By Ethnicity/Race
StatewideFiscal Year 06/07
White-17.72%
Hispanic-72.73%
African American9.26%
Asian/Pacific Islander-44.53%
Native American-44.43%
Other305.25%
-100%
-75%
-50%
-25%
0%
25%
50%
75%
100%
Ethnicity/Race
Pe
rce
nt
Dif
fere
nt
Fro
m T
arg
et
305.25%
StatewideClients Served by Days of Service
By Ethnicity/RaceFiscal Year 06/07
0
50000
100000
150000
200000
250000
CS
I Clie
nts
Greater Than 15 Days of Service 66193 43857 23939 9962 1449 26207
5-15 Days of Service 66364 45594 25172 13110 1452 30634
2-4 Days of Service 44253 29546 18373 6079 930 20947
Only 1 Day Outpatient 39637 26810 16315 4027 778 17930
White Hispanic African AmericanAsian/Pacific
IslanderNative American Other
Retention by Ethnicity - Statewide
Distribution of Retention Rates by Ethnicity - Statewide
Percent Distribution of Clients Served by Days of Service By Ethnicity/Race
StatewideFiscal Year 06/07
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
Per
cent
of T
otal
Clie
nts
Ser
ved
Greater Than 15 Days of Service 30.6% 30.1% 28.6% 30.0% 31.4% 27.4%
5-15 Days of Service 30.7% 31.3% 30.0% 39.5% 31.5% 32.0%
2-4 Days of Service 20.4% 20.3% 21.9% 18.3% 20.2% 21.9%
Only 1 Day Outpatient 18.3% 18.4% 19.5% 12.1% 16.9% 18.7%
White Hispanic African AmericanAsian/Pacific
IslanderNative American Other
Statewide Prevalence, Penetration and Retention Rates by Gender
Comparison of Total Clients Served to (Holzer) TargetsBy GenderStatewide
Fiscal Year 06/07
557,546
414,235
285,599 294,154
0
100,000
200,000
300,000
400,000
500,000
600,000
Female Male
Gender
Num
ber o
f Clie
nts
Target Served
Comparison of Total Clients Served to (Holzer) Targets Percent Difference from Target By Gender
StatewideFiscal Year 06/07
Female-48.78%
Male-28.99%
-100%
-75%
-50%
-25%
0%
25%
50%
75%
100%
Gender
Perc
ent D
iffer
ent F
rom
Tar
get
Total Clients Served by Days of Service By GenderStatewide
Fiscal Year 06/07
0
50000
100000
150000
200000
250000
300000
CSI
Clie
nts
Greater Than 15 Days of Service 81937 89242 428
5-15 Days of Service 93486 86828 2012
2-4 Days of Service 58895 60498 735
Only 1 Day Outpatient 49665 55358 474
Female Male Unavailable
Percent Distribution of Clients Served by Days of Service By GenderStatewide
Fiscal Year 06/07
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
Gender
Perc
ent o
f Tot
al C
lient
s Se
rved
Greater Than 15 Days of Service 28.9% 30.6% 11.7%
5-15 Days of Service 32.9% 29.7% 55.1%
2-4 Days of Service 20.7% 20.7% 20.1%
Only 1 Day Outpatient 17.5% 19.0% 13.0%
Female Male Unavailable
Statewide Prevalence, Penetration and Retention Rates by Age Groupings
Comparison of Total Clients Served to (Holzer) Targets By Age Group
StatewideFiscal Year 06/07
342,019
125,674
110,168120,422
114,414
79,20148,961
30,923
18,356
95,503114,033
18,857
167,567
63,931 54,582 50,351
0
50,000
100,000
150,000
200,000
250,000
300,000
350,000
400,000
00-05 06-11 12-17 18-24 25-44 45-54 55-64 65+
Age Group
Num
ber o
f Clie
nts
Target Served
Comparison of Total Clients Served to (Holzer) Targets Percent Difference from Target By Age Group
StatewideFiscal Year 06/07
00-05-85.00%
06-11-46.91%
12-17-0.33%
18-24-31.08% 25-44
-51.01%
45-54-13.31%
55-642.84%
65+-40.64%
-100%
-75%
-50%
-25%
0%
25%
50%
75%
100%
Age Group
Perc
ent D
iffer
ent F
rom
Tar
get
Age Group Penetration - Statewide
Total Clients Served by Days of Service By Age Group
StatewideFiscal Year 06/07
0
20000
40000
60000
80000
100000
120000
140000
160000
180000
CS
I Clie
nts
Greater Than 15 Days of Service 5913 27185 41877 10684 39990 27393 14386 4162 17
5-15 Days of Service 5590 19372 31426 14377 52388 33172 19687 6268 46
2-4 Days of Service 3762 10762 20788 14041 38856 18730 9083 4053 53
Only 1 Day Outpatient 3579 6554 19738 14961 34807 15381 6732 3630 115
00-05 06-11 12-17 18-24 25-44 45-54 55-64 65+ Unknown
Age Group Distribution - Statewide
Percent Distribution of Clients Served by Days of Service By Age Group
Statewide Fiscal Year 06/07
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
Per
cent
of T
otal
Clie
nts
Ser
ved
Greater Than 15 Days of Service 31.4% 42.6% 36.8% 19.8% 24.1% 28.9% 28.8% 23.0% 7.4%
5-15 Days of Service 29.7% 30.3% 27.6% 26.6% 31.6% 35.0% 39.5% 34.6% 19.9%
2-4 Days of Service 20.0% 16.8% 18.3% 26.0% 23.4% 19.8% 18.2% 22.4% 22.9%
Only 1 Day Outpatient 19.0% 10.3% 17.3% 27.7% 21.0% 16.2% 13.5% 20.0% 49.8%
00-05 06-11 12-17 18-24 25-44 45-54 55-64 65+ Unknow n
Considerations and Caveats
Although there are other prevalence estimates available, we chose to use Holzer’s prevalence estimates because they are available by county and because his estimates provide sufficient granularity that we can manipulate them to create alternate categories (such as what we created for the Planning Council for Age).
While Holzer’s estimates are fall in the lower end of the range of prevalence estimates, they are within generally accepted limits and very useful for comparison purposes.
The accuracy of Penetration rates can be impacted by: inconsistently reported diagnoses within our system inconsistency in definitions for Serious Mental Illness or Serious
Emotional Disturbance across experts in the field over or under-estimates of population updates based on 10 year old
Census data As penetration rates are estimated at the county level, potential for over
or under estimation becomes more likely due to small cohort sizes
Example of a Penetration Rate that would merit further consideration County A has an estimated Prevalence rate of SMI for
Native Americans of 40, and 80 people with SMI receive services in a given year
Using the calculation of penetration: 80/40 = a penetration rate of 200% (?) Question: Does this mean that County A over-served Native
Americans? Not necessarily...
Further investigation at the local level may reveal… There is an underestimated prevalence of SMI for Native Americans The diagnoses reported for some Native American individuals is
inaccurate, which is impacting the number of people identified as SMI
From Here
The previous slides represent a collaborative effort between DMH and the Planning Council to begin to look at disparities across various groups at the local level.
The Planning Council is in the process of developing workbooks for each county that will contain similar information. These workbooks will be shared at the local level and will be used to investigate and develop plans to address disparities across race/ethnicity, age and gender.