Assessing Access to Trauma-Informed Outpatient Mental Health Services for Adolescents: A Mystery Shopper Study

Psychiatr Serv. 2024 May 1;75(5):402-409. doi: 10.1176/ Epub 2023 Nov 29.


Objective: The authors aimed to examine how access to trauma-informed mental health services in safety-net health centers varies by insurance type and race-ethnicity of the care seeker.

Methods: In this mystery shopper study, three women (White, Latina, and Black voice actresses) called community mental health centers (CMHCs) and federally qualified health centers (FQHCs) (N=229) in Cook County, Illinois, posing as mothers requesting a mental health appointment for their traumatized adolescent child. Each health center was called twice-once in the spring and once in the summer of 2021-with alternating insurance types reported (Medicaid or private insurance). Ability to schedule an appointment, barriers to access, wait times, and availability of trauma-specific treatment were assessed.

Results: Callers could schedule an appointment in only 17% (N=78 of 451) of contacts. Reasons for appointment denial varied by organization type: the primary reasons for denial were capacity constraints (67%) at CMHCs and administrative requirements to switch to in-network primary care providers (62%) at FQHCs. Insurance and organization type did not predict successful appointment scheduling. Non-White callers were significantly less likely (incidence rate ratio=1.18) to be offered an appointment than the White caller (p=0.019). The average wait time was 12 days; CMHCs had significantly shorter wait times than FQHCs (p=0.019). Only 38% of schedulers reported that their health center offered trauma-informed therapy.

Conclusions: Fewer than one in five contacts resulted in a mental health appointment, and an apparent bias against non-White callers raises concern that racial discrimination may occur during scheduling. For equitable access to care, antidiscrimination policies should be implemented.

Keywords: Access to care; Adolescents; Childhood trauma; Community mental health services; Insurance; Racism.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Ambulatory Care
  • Appointments and Schedules
  • Black or African American
  • Community Mental Health Centers
  • Female
  • Health Services Accessibility*
  • Hispanic or Latino / statistics & numerical data
  • Humans
  • Illinois
  • Insurance, Health / statistics & numerical data
  • Male
  • Medicaid / statistics & numerical data
  • Mental Health Services / statistics & numerical data
  • Psychological Trauma / therapy
  • Safety-net Providers
  • United States
  • White
  • White People / statistics & numerical data