State-Level Changes in Youth Inpatient, Residential, and Outpatient Mental Health Services, 2010-2022

There are rising concerns over the availability of mental health services for children and youth. Recent evidence has shown reductions in the use of psychiatric inpatient, residential, and outpatient services among youths ages 0-17, with the COVID-19 pandemic and mental health workforce shortages identified as reasons for recent declines. The current study builds upon this evidence by exploring predictors of state-level changes in youth inpatient, residential, and outpatient service use from 2010 to 2022. This investigation involved secondary analysis of data collected from a Substance Abuse and Mental Health Services Administration (SAMHSA) annual survey of mental health treatment facilities across all 50 US states, D.C., and Puerto Rico, and publicly available data from the US Census Bureau and Kaiser Family Foundation. Results from longitudinal panel data models identified several state-level factors explaining variation in service use beyond reductions associated with COVID-19. Medicaid expansion, higher Federal Medical Assistance Percentage (FMAP), and more treatment facilities per capita were associated with higher utilization, and a greater percentage of youths from racial or ethnic minority backgrounds was associated with lower utilization. These findings suggest some actionable steps and service gaps needing further attention to help states improve service use in youth populations.