Community mental health service use by older adults in California

The objective of this research was to examine older Californians who used county mental health services between 1999 and 2002. We estimated treated prevalence rates, identified repeat service users, depicted service mix patterns and tested for differences among these service process outcomes. We observed 36,230 older Californians who used at least one service between 1999 and 2002. Logistic regressions estimated the effects of time, geographic region, age, diagnosis and insurance status on service process outcomes across 49 county mental health departments. The number of older adults who used services increased significantly during the observation period. Odds of accessing care were higher in the state's northern region, for those diagnosed with mood disorders and Medi-Cal beneficiaries. Repeat service use increased over time, and odds were higher for mood disorders and Medi-Cal beneficiaries. Odds of one-time service use were higher for persons with dementia and other psychiatric diagnoses; mood disorders and Medi-Cal beneficiaries had higher odds of consistent and continuous service use. The counties entered a period of diversification between 1999 and 2002, and varied significantly across treated prevalence rates, service continuity and service mix patterns. We considered how these differences may relate to administrative polices, service management practices, local market conditions and individual characteristics, and called for future research to determine how the public mental health system can assume a more critical role in providing care to older adults.