摘要：Objective. We examined trends in delivery of mental health and substance abuse services at the nation’s community health centers. Methods. Analyses used data from the Health Resources and Services Administration (HRSA), Bureau of Primary Care’s (BPHC) 1998 and 2003 Uniform Data System, merged with county-level data. Results. Between 1998 and 2003, the number of patients diagnosed with a mental health/substance abuse disorder in community health centers increased from 210 000 to 800 000. There was an increase in the number of patients per specialty mental health/substance abuse treatment provider and a decline in the mean number of patient visits, from 7.3 visits per patient to 3.5 by 2003. Although most community health centers had some on-site mental health/substance abuse services, centers without on-site services were more likely to be located in counties with fewer mental health/substance abuse clinicians, psychiatric emergency rooms, and inpatient hospitals. Conclusions. Community health centers are playing an increasingly central role in providing mental health/substance abuse treatment services in the United States. It is critical both to ensure that these centers have adequate resources for providing mental health/substance abuse care and that they develop effective linkages with mental health/substance abuse clinicians in the communities they serve. For 40 years, community health centers have provided primary care and preventive services to some of the nation’s most vulnerable populations. As of 2003, community health centers provided health care to more than 12 million individuals, a majority of whom were persons of color, were poor, and either were uninsured or on Medicaid. 1 – 4 The 2002 Federal Health Center Growth Initiative, which has set a 60% expansion in the population served by community health centers by 2006 as its target, is likely to contribute to the role of community health centers in the nation’s safety net. 5 , 6 Recent reports from both primary care and mental health leaders have highlighted the potential importance of community health centers in caring for mental health and substance abuse disorders. 7 , 8 However, little information is available in the literature on mental health substance abuse services provided in these settings or how they may have evolved. A study of patients at 2 northeastern US community health centers found high rates of depressive, drug abuse, and alcohol disorders. 9 In a survey of directors of 20 community health centers, half reported that patients frequently required behavioral health services that are not provided on site, and cost was the major barrier to providing this needed care. 10 Finally, in a survey of medical directors of 89 community health centers in the southeastern United States, Rust et al. found that every respondent reported an inability to obtain at least 1 form of mental health/substance abuse service for their uninsured clients. 11 Taken together, these articles suggest both a great need for mental health/substance abuse care and a potential gap between that need and services available at community health centers. We sought to use existing data sources to provide a broad overview of mental health and addiction service delivery in the nation’s community health centers, both cross-sectionally and over time. We examined the rates of and trends for persons receiving mental health and addiction services at these centers, staffing and visit patterns, and the prevalence and correlates of on-site mental health and addiction services. We hope these results will shed light on this relatively hidden portion of the US behavioral health safety net.
