The influence of state mental health perceptions and spending on an individual’s use of mental health services

To explore the possible contextual effects of state-level mental health perceptions and public spending for mental health
treatment on an individual’s use of mental health services, independent of the individual’s own perceptions.

Cross-sectional data from the 2007 Behavioral Risk Factor Surveillance System were used. A total of 216,514 participants from
35 states and the District of Columbia were included in the study. Logistic regression and multilevel modeling were used to
estimate the effects of individual-level characteristics and three state-level factors—per capita spending on community mental
health services, aggregated perceptions of the effectiveness of mental health treatment and the stigma of mental illness—on
the individual’s current use of mental health services.

Adjusting for the individual’s perceptions and characteristics, state-level perception of treatment effectiveness was positively
associated with the use of mental health services [odds ratio (OR) for 5 % increase in the percentage perceiving effectiveness = 1.08;
95 % confidence interval (CI): 1.01, 1.16]. This association was strongest for individuals who experienced 1–4 days of mental
distress in the past 30 days (OR = 1.17; 95 % CI 1.06, 1.29). State-level public spending on community mental health services
was also positively associated with an individual’s use of mental health services (OR for a $40 increase in spending = 1.09;
95 % CI 1.01, 1.17); however, state-level perceptions of mental-illness stigma was not.

Our findings suggest there may be contextual effects of state-level perceptions of treatment effectiveness and state spending
on community mental health services on the use of mental health services.