The purpose of this study is to examine the relationship between service accessibility and outcomes for seriously mentally ill (SMI) persons who use the Mississippi public mental health system. SMI subjects in our study will be predominantly rural and African-American. The aims of the study are:

(1) to describe and quantify the availability and accessibility of services (e.g., case management, crisis intervention) for the ten CMHC catchment areas associated with the Mississippi State Hospital (MSH). We define accessibility as the operational characteristics of a service that enable patients to use the service.

(2) to examine the relationship between accessibility and four outcomes while controlling for geographic access and patient characteristics. We chose four outcomes that our previous research found to be especially significant in this population in that they indicate treatment adherence (CMHC utilization, medication compliance), are extraordinarily adverse (jail detention), or are very costly (rehospitalization).

(3) to develop a conceptual framework for future studies on service accessibility of rural and minority SMI persons with the aid of an advisory panel of experts in the Mississippi mental health care system.

This study will involve collecting survey data on program characteristics from Mississippi providers, quantifying the accessibility of these services, and creating detailed individual-level geographic access measures. This information will be linked with a rich clinical and service-use dataset previously collected in the Mississippi Recidivism Study (n=210) and will be supplemented by MSH administrative data on SMI individuals who were hospitalized at MSH over an eight-year period (n=5000).

R01MH049199

1992-04-01

1995-03-31