The Effect of CSB Services on Hospitalization Rates

In Virginia, Community Service Boards (CSBs) serve as a single point of entry into publicly funded mental health, mental retardation, and substance abuse services. CSBs are part of a move toward an integrated system of care, which focuses on establishing community services and making more efficient and effective use of state facilities. Today there are 40 CSBs throughout Virginia offering varying combinations of nine core services: emergency, local inpatient care, outpatient care, case management, day support, employment, residential, prevention and early intervention, and limited other services. Only emergency services and, subject to the availability of funds appropriated, case management services are mandated by the Code of Virginia. While the type and quantity of services at each CSB vary significantly, how this variation influences the health of the population is unclear. Our study outlines some of the major differences among CSBs and, using an instrumental variable (IV) approach, estimates how the availability and use of outpatient mental health services affects hospitalization rates among Medicaid recipients. The results are consistent with 1) individuals obtaining more outpatient services in localities that offers more services and 2) higher levels of outpatient services reducing the number of nights spent in a hospital. Understanding how the extensiveness of outpatient services provided to individuals with mentally illness influences hospitalization rates has important implications for health, as well as for the state’s budget and the criminal justice system.