Maria Polyakova is a health economist, an assistant professor of health policy at the Stanford University School of Medicine and a member of the 2021 Tradeoffs Research Council. Her work examines how government spending affects markets for health insurance and health care.

Mental health problems afflict a staggering number of Americans, and the problem, by many accounts, has grown worse during the COVID-19 pandemic. Policymakers are concerned, and many believe the solution lies in large part in increasing the number of mental health care providers in the country. But is this the best way to get more people mental health treatment? 

In her new paper, Stanford PhD candidate Hui Ding uncovers evidence that suggests having enough providers is just one piece of the puzzle. Ding used the so-called “movers” strategy that has become a popular tool for researchers thinking about geographic variation in health care use. She looked at Medicare data on mental health diagnoses, care utilization and prescription drug use and then looked at what happened when people on Medicare moved to a place with a different level of average mental health care utilization. By looking at how the difference in area characteristics affect the utilization of care by people who move, Ding was able to estimate how much of mental health care use is about the person (which stays the same when people move) and how much is about the place (which changes when people move). 

She found that place-based factors accounted for 60% of the variation in utilization across areas. For example, her evidence suggests that people have a lower risk of ending up in an ER for self-harm when they move to a place with more utilization of mental health care. But surprisingly, she found only one-fifth of this “place” effect was about provider availability. Instead, she found much of it had to do with community attitudes about mental health. Ding used national survey responses and found that places where people believed less in the effectiveness of mental health treatment had lower rates of mental health care use and that moving from such places to those with more faith in mental health care had a significant impact on people’s likelihood of seeking care.

Ding notes that her analysis did not look at other place-specific factors like differences in how physicians diagnose or prescribe medications, and what’s true for the older people on Medicare may not be generalizable to other populations. But the takeaway, according to Ding, is that policies targeted to increasing the supply of mental health professionals in an area may not be effective at increasing mental health care on their own. Her results suggest that a marginal dollar may be more effectively invested in reducing stigma and increasing mental health literacy.

The paper concludes with an interesting thought – that telemedicine, which allows patients to get mental health care much more discreetly and which has grown tremendously during the pandemic, may provide an effective solution to both the supply and demand problems.