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Benjamin G. Druss, MD, MPH, Thomas Bornemann, EdD, Yvonne W. Fry-Johnson, MD, Harriet G. McCombs, PhD, Robert M. Politzer, ScD and George Rust, MD, MPH

Benjamin Druss is with the Rollins School of Public Health, Emory University, Atlanta, Ga. Thomas Bornemann is with the Carter Center Mental Health Program, Atlanta. Yvonne Fry-Johnson and George Rust are with the National Center for Primary Care, Morehouse School of Medicine, Atlanta. Harriet McCombs is with the Health Resources and Services Administration, Bethesda, Md, as was Robert Politzer at the time the article was written.

Correspondence: Requests for reprints should be sent to Benjamin G. Druss, 1518 Clifton Rd, Atlanta, GA 30322 (e-mail: bdruss{at}emory.edu).

ABSTRACT

Objective. We examined trends in delivery of mental health and substance abuse services at the nation’s community health centers.

Methods. Analyses used data from the Health Resources and Services Administration (HRSA), Bureau of Primary Care’s (BPHC) 1998 and 2003 Uniform Data System, merged with county-level data.

Results. Between 1998 and 2003, the number of patients diagnosed with a mental health/substance abuse disorder in community health centers increased from 210 000 to 800 000. There was an increase in the number of patients per specialty mental health/substance abuse treatment provider and a decline in the mean number of patient visits, from 7.3 visits per patient to 3.5 by 2003. Although most community health centers had some on-site mental health/substance abuse services, centers without on-site services were more likely to be located in counties with fewer mental health/substance abuse clinicians, psychiatric emergency rooms, and inpatient hospitals.

Conclusions. Community health centers are playing an increasingly central role in providing mental health/substance abuse treatment services in the United States. It is critical both to ensure that these centers have adequate resources for providing mental health/substance abuse care and that they develop effective linkages with mental health/substance abuse clinicians in the communities they serve.