Growing inequities in mental health crisis services offered to indigent patients in Puerto Rico versus the US states before and after Hurricanes Maria and Irma

Abstract

Objective: To assess changes in the availability of mental health crisis services in Puerto Rico relative to US states before and after Hurricanes Maria and Irma.

Data sources/study setting: National Mental Health Services Surveys conducted in 2016 and 2020.

Study design: Repeated cross-sectional design. The independent variable was mental health facility location in Puerto Rico or a US state. Dependent variables were the availability of three mental health crisis services (psychiatric emergency walk-in services, suicide prevention services, and crisis intervention team services).

Data collection/extraction methods: The proportion and per 100,000 population rate of facilities offering crisis services were calculated.

Principal findings: The availability of crisis services at mental health facilities in Puerto Rico remained stable between 2016 and 2020. These services were offered less at indigent care facilities in Puerto Rico than US states (e.g., 38.2% vs. 49.5% for suicide prevention, p = 0.06) and the magnitude of difference increased following Hurricane Maria.

Conclusions: There are disparities between Puerto Rico and US states in the availability of mental health crisis services for indigent patients.

Keywords: health care disparities; health care organizations and systems; indigent care; mental health; psychiatry; uninsured/safety net providers.