Use of Mental Health Services After Hurricane Floyd in North Carolina

OBJECTIVE: The aim of this study was to examine the impact of a natural disaster, Hurricane Floyd, on the use of mental health services in a Medicaid population in North Carolina. METHODS: Difference-in-differences techniques were used to determine month-by-month and 12-month postevent average effects of the hurricane on the use of mental health services at the county level. The exposure group was drawn from 14 severely affected counties, and the control group was drawn from 56 unaffected counties. Data were analyzed from July 1998 (14 months before the hurricane) to September 2000 (12 months after the hurricane). RESULTS: The number of per-enrollee per-month outpatient visits to psychologists or licensed clinical social workers and the number of outpatient visits to non-mental health specialists showed a statistically significant increase over the 12-month postevent period, whereas the number of inpatient admissions for behavioral health reasons decreased. Dollars spent on antianxiety medication per enrollee per month showed a statistically significant decrease. CONCLUSIONS: The aftermath of Hurricane Floyd was associated with significantly greater use of mental health services in the Medicaid community in North Carolina for a few services. However, it is unclear whether changes in utilization patterns were due to the greater demand for services or to the availability of other services that may have served as substitutes. The results of this study underscore the importance of planning for service implementation and delivery after similar events in other states.