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

Other %

Retention by Ethnicity - Statewide

Distribution of Retention Rates by Ethnicity - Statewide

Statewide Prevalence, Penetration and Retention Rates by Gender

Statewide Prevalence, Penetration and Retention Rates by Age Groupings

Age Group Penetration - Statewide

Age Group Distribution - Statewide

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.