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Evaluation UCD Deliverable 2 SanDiego

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County Mental Health Tracking: San Diego County A Project of the Center for Reducing Health Disparities UC Davis School of Medicine Sponsored by the Mental Health Services Oversight and Accountability Commission (MHSOAC) Prepared by Estella M. Geraghty, MD, MS, MPH, GISP Assistant Professor of Clinical Internal Medicine UC Davis School of Medicine Sergio Aguilar-Gaxiola, MD, PhD Professor of Clinical Internal Medicine Director, Center for Reducing Health Disparities UC Davis School of Medicine Acknowledgement: Theresa Stinchfield for geocoding data, preparing choropleth maps and hot spot maps November 4, 2011 Table of Contents Measuring Access to Mental Health Care Services in San Diego Measuring Mental Health Care Services Utilization in San Diego Discussion of findings in San Diego County Appendix A. List of mental health diagnoses included in the county level analysis Atlas of Maps County Mental Health Tracking: San Diego 2 Measuring Access to Mental Health Care Services in San Diego In our previous county-level analyses, we used a penetration rate as the measure of access to mental health care services. While the measure was the same in San Diego County, the data sources were different. The prior work for Stanislaus and Santa Clara counties defined the penetration rate as follows: Numerator: The number of individuals with a mental health diagnosis (as listed in Appendix A in the prior report) who existed in the CSI database during 2008. Denominator: Includes the general population (or subpopulation of interest thereof) derived from 2008 population estimates from Geolytics, Inc. This methodology required adjustment for San Diego County for three reasons: first, they had a changeover in their database practices during 2008 and felt data for that year were less reliable than 2009; second, their CSI database did not have client addresses; third, they felt that getting the CSI data would be difficult and they could not do it in a timely fashion. For those reasons, the dataset provided to us for this research came from the MIS-Anasazi database. Notably, this database is not limited to only CSI reportable services and therefore also includes jail mental health services as well as long term care and hospital services. Therefore, the penetration rate generated for San Diego County was: Numerator: The number of individuals with a mental health diagnosis (as listed in Appendix A in this report) who existed in the MIS-Anasazi database during 2009. Denominator: Includes the general population (or subpopulation of interest thereof) derived from 2005-22009 population estimates from the American Community Survey by the U.S. Census Bureau. Please see the atlas for maps showing penetration rates by census tract in San Diego County as well as the clusters of high and low penetration in the hot spot maps. County Mental Health Tracking: San Diego 3 Measuring Mental Health Care Services Utilization in San Diego The utilization of mental health care services was analyzed using a measure of the number of mental health visits per MIS-Anasazi client by census tract. For this work, we used the presumed outpatient population. To do this we analyzed the service delivery types noted within the database and selected only those patients who had either a face-to-face type or telehealth type (this was inclusive of 85% of the total observations). Service Delivery Type 0% 1% 0% 2% 12% Correspondence Face to Face No Contact TTY Telehealth 85% Telephone Please see the atlas for maps showing utilization rates by census tract in San Diego County as well as the clusters of high and low utilization in the hot spot maps. Discussion of Findings in San Diego County We found San Diego County to be cooperative in providing us with their MIS- Anasazi data for this research. Still there were some issues with actually obtaining the data due to some administrative problems/communication, difficulties with the CSI data request (as noted above) and conflicting priorities with other data requests. When the data was delivered, we received a well-organized Microsoft Access database. Since San Diego County does not geocode its own data, we performed the geocoding ourselves. The address data provided was in excellent condition for geocoding. We had an essential 100% match rate for 42,936 records within San Diego County (only 1 unmatched address and approximately 100 ties). Some addresses led to a tie in the geocoding process and had to be manually matched. The most County Mental Health Tracking: San Diego 4 common reason for the tie was when the address did not include a North/South or East/West designation. For example, consider the address (a ‘false’ address is used as an example to protect patient privacy): 320 Mission Avenue, Escondido, CA 92025. Using Google Earth, we found that both a 320 East and 320 West Mission Avenue existed. By analyzing the satellite imagery, we could detect that one address represented apartment buildings (East) while the other was a commercial building (West), thus we matched to the residential address. This kind of error comprised a large portion of the tied records and we were able to resolve approximately half (our match rate was better than 99.88%). The population included in the analysis is described in Table 1 and is compared to demographic data from 2009. The number of individuals receiving county mental health care services is roughly 1.98% of the overall population. When comparing that percentage to the estimated prevalence of mental illness in California, this appears to indicate some level of service disparity. Table 1. San Diego County MIS-Anasazi database clients (2009) compared to demographic data from the U.S. Census American Community Survey (2005-2009). Total MIS- Anasazi U.S. Census N = Demographics 42,936 N=510,385 Gender Male 48.3% 48.9% Female 51.6% 51.1% Unknown 0.15% Age 12-19 22.0% 17.7% 20-24 8.3% 10.8% 25-44 34.0% 39.4% 45-54 21.4% 18.9% 55-64 14.3% 13.2% Race* White 48.5% 73.2% African-American 13.6% 5.4% Asian/Pacific Islander 7.2% 11.4% Am Indian/Alaskan Native 1.1% 0.8% Other 29.6% 9.2% Ethnicity** Hispanic 26.9% 31.1% Non-Hispanic 50.7% 52.8% Other 22.4% 16.0% County Mental Health Tracking: San Diego 5 *The MIS-Anasazi database includes several sub-populations of Asian and Pacific Islander. To create the category of ‘Asian/Pacific Islander’ we combined the following groups: Asian Indian, Cambodian, Chaldean, Chinese, Filipino, Guamanian, Hmong, Iranian, Iraqi, Japanese, Korean, Laotian, Other Asian, Other Pacific Islander, Samoan, and Vietnamese. **The ethnic categories in the MIS-Anasazi database include: Cuban, Dominican, Mexican American/Chicano, Other Hispanic/Latino, Puerto Rican, and Salvadoran which were combined to form the Hispanic category. When assessing the provision of services in San Diego County, it is helpful to begin at the state level (see Deliverable #1 and the statewide atlas) for context. The state-level trend for adult populations (> age 19) is toward high levels of access AND high levels of utilization of mental health care services with only a single exception – there is low access for the Native American population. This trend may imply an overuse of services in San Diego County on average as compared to the overall California population using Medi-Cal for their healthcare. Alternatively, one must consider the very real possibility that the statewide averages for access and utilization are inadequate and San Diego County is simply doing better by comparison and may or may not be meeting the population need. For youth at the state level (ages 12-19), San Diego County showed high levels of access for all race, ethnicity and gender groups (excepting Native Americans). But for these younger patients, utilization was found to be low for Native Americans, Hispanics, Caucasians and women. One explanation for the lower level of utilization, particularly when combined with higher levels of access may be that these population subgroups in San Diego County have less serious mental health problems (so fewer visits per patient) or that there is some problem with follow up care. As we look at the county level maps, the following trends emerge: • Mental health access patterns are strikingly similar among many of the groups studied. The pattern shows increased access in the San Diego City area and decreased access along the coastal areas from Solana Beach to Del Mar and south to La Jolla. We see this in the following groups: all age groups, both genders, whites, and Hispanics (though Hispanics also have an area of high access around Escondido and in the eastern part of the county). • For the black population, high levels of access were seen around Escondido, Otay Lake and a small part of San Diego City. There was low access in the area around the Marine Corps Air Station at Miramar and east of Chula Vista. County Mental Health Tracking: San Diego 6 • The Asian population had no areas of low access but showed some higher access east of El Cajon between Granite Hills and Harbison Canyon. • There was high access for non-Hispanics in the eastern part of the county. • Utilization patterns varied widely among the subgroups studied, though one consistency was that lower levels of utilization were seen all along the coastal communities from Oceanside to San Diego City. In areas where both access and utilization were low along the coast (particularly between Solana Beach and San Diego) there is a potential need for more services. • High levels of utilization were seen most often in the southwestern part of the county around Chula Vista, National City and Imperial Beach. We also saw that men, blacks and Hispanics had higher levels of utilization in the Poway area near Miramar air station. In these areas, where access was equivalent to the county mean, it appears that patients are receiving high levels of follow up care for their mental health conditions. • There was no clustering seen in hot spot maps for Native Americans (both access and utilization) and Asian populations (utilization only). This may be a ‘real’ effect – meaning that mental health services for these populations are provided uniformly over the San Diego County geography OR it may mean, especially in the case of Native Americans, that the population was too small to analyze successfully. County Mental Health Tracking: San Diego 7 Appendix A List of mental health diagnoses included in the county level analysis (x indicates all existing subgroups for that code) Disorder ICD 9 code Psychotic disorder with delusions in conditions classified elsewhere (transient, organic, paranoid) 293.81 Psychotic disorder with delusions in conditions classified elsewhere (transient, organic, hallucinatory) 293.82 Schizophrenic disorders 295.xx Bipolar I disorder, single manic episode 296.00 Manic disorder, recurrent episode 295.10 Major depressive disorder, single episode 296.20 Major depressive disorder, recurrent episode 296.30 Bipolar I disorder, most recent episode (or current) manic 296.40 Major depressive disorder, circular type, if previous attack was of manic type 296.50 Bipolar I disorder, most recent episode (or current) depressed 296.50 Bipolar I disorder, most recent episode (or current) mixed 296.60 Bipolar I disorder, most recent episode (or current) unspecified 296.70 Bipolar disorder, unspecified 296.8x Unspecified episodic mood disorder 296.9x Paranoid state, simple 297.xx Major depressive disorder, psychotic 298.xx Autistic disorder 299.xx Anxiety state, unspecified 300.00 Panic disorder without agoraphobia 300.01 Generalized anxiety disorder 300.02 Hysteria 300.1x Phobia, unspecified 300.20 Agoraphobia with panic disorder 300.21 Agoraphobia without mention of panic attacks 300.22 Social phobia 300.23 Other isolated specific phobias 300.29 Obsessive-compulsive disorders 300.30 Dysthymic disorder 300.40 Neurasthenia 300.50 Depersonalization disorder 300.60 Hypochondriasis 300.70 Somatization disorder 300.8x Unspecified neuropsychotic mental disorder 300.90 Affective personality disorder 301.1x Obsessive-compulsive personality disorder 301.40 Antisocial personality disorder 301.70 Borderline personality disorder 301.83 Alcohol dependence syndrome 303.xx Opioid type dependence 304.xx Nondependent use of drugs 305.xx Special symptoms or syndromes, not elsewhere classified 307.xx Acute reaction to stress 308.00 Adjustment disorder 309.xx County Mental Health Tracking: San Diego 8 Posttraumatic stress disorder 309.81 Depressive disorder, not elsewhere classified 311.00 Conduct disorder 312.xx Overanxious disorder 313.xx Attention deficit disorder 314.00 Attention deficit disorder with hyperactivity 314.01 Hyperkinetic conduct disorder 314.20 County Mental Health Tracking: San Diego 9 Atlas of Mental Health Care Access and Utilization for San Diego County List of Maps Access to Mental Health Care Services: Distribution Maps All Patients (ages 12-64), 2009 Age 12-19, 2009 Age 20-24, 2009 Age 25-44, 2009 Age 45-54, 2009 Age 55-64, 2009 Men, 2009 Women, 2009 White Population, 2009 Black Population, 2009 Asian and Pacific Islander Population , 2009 Native American Population, 2009 Other Race Population, 2009 Hispanic Population, 2009 Non-Hispanic Population, 2009 Hot Spot Maps All Patients (ages 12-64), 2009 Age 12-19, 2009 Age 20-24, 2009 Age 25-44, 2009 Age 45-54, 2009 Age 55-64, 2009 Men, 2009 Women, 2009 White Population, 2009 Black Population, 2009 Asian and Pacific Islander Population , 2009 Native American Population, 2009 - NO MAP - NO CLUSTERING PRESENT Other Race Population, 2009 Hispanic Population, 2009 Non-Hispanic Population, 2009 Utilization of Mental Health Care Services: Distribution Maps All Patients (ages 12-64), 2009 Age 12-19, 2009 Age 20-24, 2009 Age 25-44, 2009 Age 45-54, 2009 Age 55-64, 2009 Men, 2009 Women, 2009 White Population, 2009 Black Population, 2009 Asian Pacific Islander Population , 2009 Native American Population, 2009 Other Race Population, 2009 Hispanic Population, 2009 Non-Hispanic Population, 2009 Hot Spot Maps All Patients (ages 12-64), 2009 Age 12-19, 2009 Age 20-24, 2009 Age 25-44, 2009 Age 45-54, 2009 Age 55-64, 2009 Men, 2009 Women, 2009 White Population, 2009 Black Population, 2009 Asian Pacific Islander Population , 2009 - NO MAP - NO CLUSTERING PRESENT Native American Population, 2009 - NO MAP - NO CLUSTERING PRESENT Other Race Population, 2009 Hispanic Population, 2009 Non-Hispanic Population, 2009 San Diego County Clark Lake §¨¦ £¤ 15 79 £¤ 76 Lake Henshaw §¨¦ 5 Oceanside Vista !( !( £¤ Carlsbad !( San Marcos Sutherland 78 !( !( Lake Escondido £¤ 78 Encinitas !( Solana Beach Lake !( Poway £¤ San Vicente Cuyamaca Del Mar !( 67 !( Reservoir £¤ §¨¦ 79 5 §¨¦ 15 El Capitan Reservoir Santee §¨¦ !( §¨¦ 805 8 El Cajon !( !( La Mesa !( Major City Pop > 100,000 San Diego !( Lemon Grove §¨¦ !( City !( 8 Interstate Freeway !( !( S R w e e s e e tw rv a o t i e r r Major Highway Coronado National City £¤ !( 94 Chula Vista Lake Lower Otay Reservoir Census Tract Boundary Imperial Beach !( §¨¦ 5 UCDavis 0 5 10 20 Notes: Projection is North American Datum 1983, Center for Reducing Health Disparities Miles California Teale Albers. Access* to Mental Health Care Services San Diego County, 2009 - Ages 12 through 64 Oceanside I-15 Escondido San Diego I-5 Chula Vista Interstate Penetration Rate (%) Less than 2.1 2.1 4.0 to 4.1 6.0 to 6.1 8.0 to 8.1 10.0 to 10.1 to 11.0 Greater than 11.0 I-805 Mean Penetration Rate: 2.2% I-8 Standard Deviation: 4.1% *Notes: I-5 The penetration rate is defined as the number of individuals in this group receiving a mental health diagnosis divided by the total population in that group, aggregated by census tract in 2009. White areas have no data. Coordinate System: North American Datum 1983 Projection: California Teale Albers Mental Health data are from San Diego County's MIS-Anasazi Database. Census data are from 0 7.5 15 Miles American Community Survey 2005-2009 estimates. Access* to Mental Health Care Services San Diego County, 2009 - Ages 12 through 19 Oceanside I-15 Escondido San Diego I-5 Chula Vista Interstate Penetration Rate (%) Less than 2.1 2.1 4.0 to 4.1 6.0 to 6.1 8.0 to 8.1 10.0 to 10.1 to 11.0 Greater than 11.0 I-805 Mean Penetration Rate: 3.3% I-8 Standard Deviation: 6.2% *Notes: I-5 The penetration rate is defined as the number of individuals in this group receiving a mental health diagnosis divided by the total population in that group, aggregated by census tract in 2009. White areas have no data. Coordinate System: North American Datum 1983 Projection: California Teale Albers Mental Health data are from San Diego County's MIS-Anasazi Database. Census data are from 0 7.5 15 Miles American Community Survey 2005-2009 estimates. Access* to Mental Health Care Services San Diego County, 2009 - Ages 20 through 24 Oceanside I-15 Escondido San Diego I-5 Chula Vista Interstate Penetration Rate (%) Less than 2.1 2.1 4.0 to 4.1 6.0 to 6.1 8.0 to 8.1 10.0 to 10.1 to 11.0 Greater than 11.0 I-805 Mean Penetration Rate: 2.2% I-8 Standard Deviation: 3.6% *Notes: I-5 The penetration rate is defined as the number of individuals in this group receiving a mental health diagnosis divided by the total population in that group, aggregated by census tract in 2009. White areas have no data. Coordinate System: North American Datum 1983 Projection: California Teale Albers Mental Health data are from San Diego County's MIS-Anasazi Database. Census data are from 0 7.5 15 Miles American Community Survey 2005-2009 estimates. Access* to Mental Health Care Services San Diego County, 2009 - Ages 25 through 44 Oceanside I-15 Escondido San Diego I-5 Chula Vista Interstate Penetration Rate (%) Less than 2.1 2.1 4.0 to 4.1 6.0 to 6.1 8.0 to 8.1 10.0 to 10.1 to 11.0 Greater than 11.0 I-805 Mean Penetration Rate: 1.9% I-8 Standard Deviation: 3.7% *Notes: I-5 The penetration rate is defined as the number of individuals in this group receiving a mental health diagnosis divided by the total population in that group, aggregated by census tract in 2009. White areas have no data. Coordinate System: North American Datum 1983 Projection: California Teale Albers Mental Health data are from San Diego County's MIS-Anasazi Database. Census data are from 0 7.5 15 Miles American Community Survey 2005-2009 estimates. Access* to Mental Health Care Services San Diego County, 2009 - Ages 45 through 54 Oceanside I-15 Escondido San Diego I-5 Chula Vista Interstate Penetration Rate (%) Less than 2.1 2.1 4.0 to 4.1 6.0 to 6.1 8.0 to 8.1 10.0 to 10.1 to 11.0 Greater than 11.0 I-805 Mean Penetration Rate: 2.7% I-8 Standard Deviation: 5.2% *Notes: I-5 The penetration rate is defined as the number of individuals in this group receiving a mental health diagnosis divided by the total population in that group, aggregated by census tract in 2009. White areas have no data. Coordinate System: North American Datum 1983 Projection: California Teale Albers Mental Health data are from San Diego County's MIS-Anasazi Database. Census data are from 0 7.5 15 Miles American Community Survey 2005-2009 estimates. Access* to Mental Health Care Services San Diego County, 2009 - Ages 55 through 64 Oceanside I-15 Escondido San Diego I-5 Chula Vista Interstate Penetration Rate (%) Less than 2.1 2.1 4.0 to 4.1 6.0 to 6.1 8.0 to 8.1 10.0 to 10.1 to 11.0 Greater than 11.0 I-805 Mean Penetration Rate: 2.4% I-8 Standard Deviation: 4.4% *Notes: I-5 The penetration rate is defined as the number of individuals in this group receiving a mental health diagnosis divided by the total population in that group, aggregated by census tract in 2009. White areas have no data. Coordinate System: North American Datum 1983 Projection: California Teale Albers Mental Health data are from San Diego County's MIS-Anasazi Database. Census data are from 0 7.5 15 Miles American Community Survey 2005-2009 estimates. Access* to Mental Health Care Services San Diego County, 2009 - Men Oceanside I-15 Escondido San Diego I-5 Chula Vista Interstate Penetration Rate (%) Less than 2.1 2.1 4.0 to 4.1 6.0 to 6.1 8.0 to 8.1 10.0 to 10.1 to 11.0 Greater than 11.0 I-805 Mean Penetration Rate: 2.2% I-8 Standard Deviation: 4.2% *Notes: I-5 The penetration rate is defined as the number of individuals in this group receiving a mental health diagnosis divided by the total population in that group, aggregated by census tract in 2009. White areas have no data. Coordinate System: North American Datum 1983 Projection: California Teale Albers Mental Health data are from San Diego County's MIS-Anasazi Database. Census data are from 0 7.5 15 Miles American Community Survey 2005-2009 estimates. Access* to Mental Health Care Services San Diego County, 2009 - Women Oceanside I-15 Escondido San Diego I-5 Chula Vista Interstate Penetration Rate (%) Less than 2.1 2.1 4.0 to 4.1 6.0 to 6.1 8.0 to 8.1 10.0 to 10.1 to 11.0 Greater than 11.0 I-805 Mean Penetration Rate: 2.2% I-8 Standard Deviation: 3.8% *Notes: I-5 The penetration rate is defined as the number of individuals in this group receiving a mental health diagnosis divided by the total population in that group, aggregated by census tract in 2009. White areas have no data. Coordinate System: North American Datum 1983 Projection: California Teale Albers Mental Health data are from San Diego County's MIS-Anasazi Database. Census data are from 0 7.5 15 Miles American Community Survey 2005-2009 estimates. Access* to Mental Health Care Services San Diego County, 2009 - White Oceanside I-15 Escondido San Diego I-5 Chula Vista Interstate Penetration Rate (%) Less than 2.1 2.1 4.0 to 4.1 6.0 to 6.1 8.0 to 8.1 10.0 to 10.1 to 11.0 Greater than 11.0 I-805 Mean Penetration Rate: 1.5% I-8 Standard Deviation: 3.1% *Notes: I-5 The penetration rate is defined as the number of individuals in this group receiving a mental health diagnosis divided by the total population in that group, aggregated by census tract in 2009. White areas have no data. Coordinate System: North American Datum 1983 Projection: California Teale Albers Mental Health data are from San Diego County's MIS-Anasazi Database. Census data are from 0 7.5 15 Miles American Community Survey 2005-2009 estimates. Access* to Mental Health Care Services San Diego County, 2009 - Black Oceanside I-15 Escondido San Diego I-5 Chula Vista Interstate Penetration Rate (%) Less than 2.1 2.1 4.0 to 4.1 6.0 to 6.1 8.0 to 8.1 10.0 to 10.1 to 11.0 Greater than 11.0 I-805 Mean Penetration Rate: 7.5% I-8 Standard Deviation: 13.3% *Notes: I-5 The penetration rate is defined as the number of individuals in this group receiving a mental health diagnosis divided by the total population in that group, aggregated by census tract in 2009. White areas have no data. Coordinate System: North American Datum 1983 Projection: California Teale Albers Mental Health data are from San Diego County's MIS-Anasazi Database. Census data are from 0 7.5 15 Miles American Community Survey 2005-2009 estimates. Access* to Mental Health Care Services San Diego County, 2009 - Asian and Pacific Islander Oceanside I-15 Escondido San Diego I-5 Chula Vista Interstate Penetration Rate (%) Less than 2.1 2.1 4.0 to 4.1 6.0 to 6.1 8.0 to 8.1 10.0 to 10.1 to 11.0 Greater than 11.0 I-805 Mean Penetration Rate: 2.2% I-8 Standard Deviation: 7.2% *Notes: I-5 The penetration rate is defined as the number of individuals in this group receiving a mental health diagnosis divided by the total population in that group, aggregated by census tract in 2009. White areas have no data. Coordinate System: North American Datum 1983 Projection: California Teale Albers Mental Health data are from San Diego County's MIS-Anasazi Database. Census data are from 0 7.5 15 Miles American Community Survey 2005-2009 estimates. Access* to Mental Health Care Services San Diego County, 2009 - Native American Oceanside I-15 Escondido San Diego I-5 Chula Vista Interstate Penetration Rate (%) Less than 2.1 2.1 4.0 to 4.1 6.0 to 6.1 8.0 to 8.1 10.0 to 10.1 to 11.0 Greater than 11.0 I-805 Mean Penetration Rate: 3.5% I-8 Standard Deviation: 7.8% *Notes: I-5 The penetration rate is defined as the number of individuals in this group receiving a mental health diagnosis divided by the total population in that group, aggregated by census tract in 2009. White areas have no data. Coordinate System: North American Datum 1983 Projection: California Teale Albers Mental Health data are from San Diego County's MIS-Anasazi Database. Census data are from 0 7.5 15 Miles American Community Survey 2005-2009 estimates. Access* to Mental Health Care Services San Diego County, 2009 - Other Oceanside I-15 Escondido San Diego I-5 Chula Vista Interstate Penetration Rate (%) Less than 2.1 2.1 4.0 to 4.1 6.0 to 6.1 8.0 to 8.1 10.0 to 10.1 to 11.0 Greater than 11.0 I-805 Mean Penetration Rate: 10.1% I-8 Standard Deviation: 14.0% *Notes: I-5 The penetration rate is defined as the number of individuals in this group receiving a mental health diagnosis divided by the total population in that group, aggregated by census tract in 2009. White areas have no data. Coordinate System: North American Datum 1983 Projection: California Teale Albers Mental Health data are from San Diego County's MIS-Anasazi Database. Census data are from 0 7.5 15 Miles American Community Survey 2005-2009 estimates. Access* to Mental Health Care Services San Diego County, 2009 - Hispanic Oceanside I-15 Escondido San Diego I-5 Chula Vista Interstate Penetration Rate (%) Less than 2.1 2.1 4.0 to 4.1 6.0 to 6.1 8.0 to 8.1 10.0 to 10.1 to 11.0 Greater than 11.0 I-805 Mean Penetration Rate: 1.8% I-8 Standard Deviation: 2.6% *Notes: I-5 The penetration rate is defined as the number of individuals in this group receiving a mental health diagnosis divided by the total population in that group, aggregated by census tract in 2009. White areas have no data. Coordinate System: North American Datum 1983 Projection: California Teale Albers Mental Health data are from San Diego County's MIS-Anasazi Database. Census data are from 0 7.5 15 Miles American Community Survey 2005-2009 estimates. Access* to Mental Health Care Services San Diego County, 2009 - Not Hispanic Oceanside I-15 Escondido San Diego I-5 Chula Vista Interstate Penetration Rate (%) Less than 2.1 2.1 4.0 to 4.1 6.0 to 6.1 8.0 to 8.1 10.0 to 10.1 to 11.0 Greater than 11.0 I-805 Mean Penetration Rate: 4.8% I-8 Standard Deviation: 11.7% *Notes: I-5 The penetration rate is defined as the number of individuals in this group receiving a mental health diagnosis divided by the total population in that group, aggregated by census tract in 2009. White areas have no data. Coordinate System: North American Datum 1983 Projection: California Teale Albers Mental Health data are from San Diego County's MIS-Anasazi Database. Census data are from 0 7.5 15 Miles American Community Survey 2005-2009 estimates. Access* to Mental Health Care Services San Diego County, 2009 - Ages 12-64 I-15 Oceanside Escondido I-5 San Diego Chula Vista Interstate High and Low Clusters of Access to Mental Health Care Services Much less access (p<0.01) Less access (p<0.05) Equivalent to the county mean More access (p<0.05) Much more access (p<0.01) I-805 Distance Band: 6.2 miles I-8 *Notes: I-5 The penetration rate is defined as the number of individuals in this group receiving a mental health diagnosis divided by the total population in that group, aggregated by census tract in 2009. This penetration rate is then used in hotspot analysis such that statistically significant clusters of access are shown. White areas have no data. A fixed distance as shown above was used with a two neighbor requirement in the hotspot analysis. 0 7.5 15 Miles Coordinate System: North American Datum 1983 Projection: California Teale Albers Access* to Mental Health Care Services San Diego County, 2009 - Ages 12-19 I-15 Oceanside Escondido I-5 San Diego Chula Vista Interstate High and Low Clusters of Access to Mental Health Care Services Much less access (p<0.01) Less access (p<0.05) Equivalent to the county mean More access (p<0.05) Much more access (p<0.01) I-805 Distance Band: 5.9 miles I-8 *Notes: I-5 The penetration rate is defined as the number of individuals in this group receiving a mental health diagnosis divided by the total population in that group, aggregated by census tract in 2009. This penetration rate is then used in hotspot analysis such that statistically significant clusters of access are shown. White areas have no data. A fixed distance as shown above was used with a two neighbor requirement in the hotspot analysis. 0 7.5 15 Miles Coordinate System: North American Datum 1983 Projection: California Teale Albers Access* to Mental Health Care Services San Diego County, 2009 - Ages 20-24 I-15 Oceanside Escondido I-5 San Diego Chula Vista Interstate High and Low Clusters of Access to Mental Health Care Services Much less access (p<0.01) Less access (p<0.05) Equivalent to the county mean More access (p<0.05) Much more access (p<0.01) I-805 Distance Band: 6.5 miles I-8 *Notes: I-5 The penetration rate is defined as the number of individuals in this group receiving a mental health diagnosis divided by the total population in that group, aggregated by census tract in 2009. This penetration rate is then used in hotspot analysis such that statistically significant clusters of access are shown. White areas have no data. A fixed distance as shown above was used with a two neighbor requirement in the hotspot analysis. 0 7.5 15 Miles Coordinate System: North American Datum 1983 Projection: California Teale Albers Access* to Mental Health Care Services San Diego County, 2009 - Ages 25-44 I-15 Oceanside Escondido I-5 San Diego Chula Vista Interstate High and Low Clusters of Access to Mental Health Care Services Much less access (p<0.01) Less access (p<0.05) Equivalent to the county mean More access (p<0.05) Much more access (p<0.01) I-805 Distance Band: 6.2 miles I-8 *Notes: I-5 The penetration rate is defined as the number of individuals in this group receiving a mental health diagnosis divided by the total population in that group, aggregated by census tract in 2009. This penetration rate is then used in hotspot analysis such that statistically significant clusters of access are shown. White areas have no data. A fixed distance as shown above was used with a two neighbor requirement in the hotspot analysis. 0 7.5 15 Miles Coordinate System: North American Datum 1983 Projection: California Teale Albers Access* to Mental Health Care Services San Diego County, 2009 - Ages 45-54 I-15 Oceanside Escondido I-5 San Diego Chula Vista Interstate High and Low Clusters of Access to Mental Health Care Services Much less access (p<0.01) Less access (p<0.05) Equivalent to the county mean More access (p<0.05) Much more access (p<0.01) I-805 Distance Band: 7.1 miles I-8 *Notes: I-5 The penetration rate is defined as the number of individuals in this group receiving a mental health diagnosis divided by the total population in that group, aggregated by census tract in 2009. This penetration rate is then used in hotspot analysis such that statistically significant clusters of access are shown. White areas have no data. A fixed distance as shown above was used with a two neighbor requirement in the hotspot analysis. 0 7.5 15 Miles Coordinate System: North American Datum 1983 Projection: California Teale Albers Access* to Mental Health Care Services San Diego County, 2009 - Ages 55-64 I-15 Oceanside Escondido I-5 San Diego Chula Vista Interstate High and Low Clusters of Access to Mental Health Care Services Much less access (p<0.01) Less access (p<0.05) Equivalent to the county mean More access (p<0.05) Much more access (p<0.01) I-805 Distance Band: 6.2 miles I-8 *Notes: I-5 The penetration rate is defined as the number of individuals in this group receiving a mental health diagnosis divided by the total population in that group, aggregated by census tract in 2009. This penetration rate is then used in hotspot analysis such that statistically significant clusters of access are shown. White areas have no data. A fixed distance as shown above was used with a two neighbor requirement in the hotspot analysis. 0 7.5 15 Miles Coordinate System: North American Datum 1983 Projection: California Teale Albers Access* to Mental Health Care Services San Diego County, 2009 - Men I-15 Oceanside Escondido I-5 San Diego Chula Vista Interstate High and Low Clusters of Access to Mental Health Care Services Much less access (p<0.01) Less access (p<0.05) Equivalent to the county mean More access (p<0.05) Much more access (p<0.01) I-805 Distance Band: 6.2 miles I-8 *Notes: The penetration rate is defined as the number of I-5 individuals in this group receiving a mental health diagnosis divided by the total population in that group, aggregated by census tract in 2009. This penetration rate is then used in hotspot analysis such that statistically significant clusters of access are shown. White areas have no data. A fixed distance as shown above was used with a two neighbor requirement in the hotspot analysis. 0 7.5 15 Miles Coordinate System: North American Datum 1983 Projection: California Teale Albers Access* to Mental Health Care Services San Diego County, 2009 - Women I-15 Oceanside Escondido I-5 San Diego Chula Vista Interstate High and Low Clusters of Access to Mental Health Care Services Much less access (p<0.01) Less access (p<0.05) Equivalent to the county mean More access (p<0.05) Much more access (p<0.01) I-805 Distance Band: 6.2 miles I-8 *Notes: I-5 The penetration rate is defined as the number of individuals in this group receiving a mental health diagnosis divided by the total population in that group, aggregated by census tract in 2009. This penetration rate is then used in hotspot analysis such that statistically significant clusters of access are shown. White areas have no data. A fixed distance as shown above was used with a two neighbor requirement in the hotspot analysis. 0 7.5 15 Miles Coordinate System: North American Datum 1983 Projection: California Teale Albers Access* to Mental Health Care Services San Diego County, 2009 - White I-15 Oceanside Escondido I-5 San Diego Chula Vista Interstate High and Low Clusters of Access to Mental Health Care Services Much less access (p<0.01) Less access (p<0.05) Equivalent to the county mean More access (p<0.05) Much more access (p<0.01) I-805 Distance Band: 6.5 miles I-8 *Notes: I-5 The penetration rate is defined as the number of individuals in this group receiving a mental health diagnosis divided by the total population in that group, aggregated by census tract in 2009. This penetration rate is then used in hotspot analysis such that statistically significant clusters of access are shown. White areas have no data. A fixed distance as shown above was used with a two neighbor requirement in the hotspot analysis. 0 7.5 15 Miles Coordinate System: North American Datum 1983 Projection: California Teale Albers Access* to Mental Health Care Services San Diego County, 2009 - Black I-15 Oceanside Escondido I-5 San Diego Chula Vista Interstate High and Low Clusters of Access to Mental Health Care Services Much less access (p<0.01) Less access (p<0.05) Equivalent to the county mean More access (p<0.05) Much more access (p<0.01) I-805 Distance Band: 5.0 miles I-8 *Notes: The penetration rate is defined as the number of I-5 individuals in this group receiving a mental health diagnosis divided by the total population in that group, aggregated by census tract in 2009. This penetration rate is then used in hotspot analysis such that statistically significant clusters of access are shown. White areas have no data. A fixed distance as shown above was used with a two neighbor requirement in the hotspot analysis. 0 7.5 15 Miles Coordinate System: North American Datum 1983 Projection: California Teale Albers Access* to Mental Health Care Services I-15 Oceanside Escondido I-5 San Diego Chula Vista Interstate High and Low Clusters of Access to Mental Health Care Services Much less access (p<0.01) Less access (p<0.05) Equivalent to the county mean More access (p<0.05) Much more access (p<0.01) I-805 Distance Band: 5.3 miles I-8 *Notes: The penetration rate is defined as the number of I-5 individuals in this group receiving a mental health diagnosis divided by the total population in that group, aggregated by census tract in 2009. This penetration rate is then used in hotspot analysis such that statistically significant clusters of access are shown. White areas have no data. A fixed distance as shown above was used with a two neighbor requirement in the hotspot analysis. 0 7.5 15 Miles Coordinate System: North American Datum 1983 Projection: California Teale Albers San Diego County, 2009 - Asian And Pacific Islander Access* to Mental Health Care Services San Diego County, 2009 - Other I-15 Oceanside Escondido I-5 San Diego Chula Vista Interstate High and Low Clusters of Access to Mental Health Care Services Much less access (p<0.01) Less access (p<0.05) Equivalent to the county mean More access (p<0.05) Much more access (p<0.01) I-805 Distance Band: 6.2 miles I-8 *Notes: I-5 The penetration rate is defined as the number of individuals in this group receiving a mental health diagnosis divided by the total population in that group, aggregated by census tract in 2009. This penetration rate is then used in hotspot analysis such that statistically significant clusters of access are shown. White areas have no data. A fixed distance as shown above was used with a two neighbor requirement in the hotspot analysis. 0 7.5 15 Miles Coordinate System: North American Datum 1983 Projection: California Teale Albers Access* to Mental Health Care Services San Diego County, 2009 - Hispanic I-15 Oceanside Escondido I-5 San Diego Chula Vista Interstate High and Low Clusters of Access to Mental Health Care Services Much less access (p<0.01) Less access (p<0.05) Equivalent to the county mean More access (p<0.05) Much more access (p<0.01) I-805 Distance Band: 5.9 miles I-8 *Notes: I-5 The penetration rate is defined as the number of individuals in this group receiving a mental health diagnosis divided by the total population in that group, aggregated by census tract in 2009. This penetration rate is then used in hotspot analysis such that statistically significant clusters of access are shown. White areas have no data. A fixed distance as shown above was used with a two neighbor requirement in the hotspot analysis. 0 7.5 15 Miles Coordinate System: North American Datum 1983 Projection: California Teale Albers Access* to Mental Health Care Services San Diego County, 2009 - Not Hispanic I-15 Oceanside Escondido I-5 San Diego Chula Vista Interstate High and Low Clusters of Access to Mental Health Care Services Much less access (p<0.01) Less access (p<0.05) Equivalent to the county mean More access (p<0.05) Much more access (p<0.01) I-805 I-8 Distance Band: 5.9 miles *Notes: I-5 The penetration rate is defined as the number of individuals in this group receiving a mental health diagnosis divided by the total population in that group, aggregated by census tract in 2009. This penetration rate is then used in hotspot analysis such that statistically significant clusters of access are shown. White areas have no data. A fixed distance as shown above was used with a two neighbor requirement in the hotspot analysis. 0 7.5 15 Miles Coordinate System: North American Datum 1983 Projection: California Teale Albers Utilization Rate* of Mental Health Care Services San Diego County, 2009 - Ages 12-64 I-15 Oceanside Escondido I-5 San Diego Chula Vista Interstate Annualized Utilization Rates by Census Tract Less than 2.0 2.1 4.0 to 4.1 6.0 to 6.1 12.0 to I-805 12.1 to 18.0 I-8 18.1 to 24.0 Greater than 24.0 I-5 *Notes: The utilization rate is calculated as the number of mental health care visits divided by the number of mental health clients. White areas have no data. Coordinate System: North American Datum 1983 Projection: California Teale Albers Mental Health data are from San Diego County's 0 7.5 15 Miles MIS-Anasazi Database. Utilization Rate* of Mental Health Care Services San Diego County, 2009 - Ages 12-19 I-15 Oceanside Escondido I-5 San Diego Chula Vista Interstate Annualized Utilization Rates by Census Tract Less than 2.0 2.1 4.0 to 4.1 6.0 to 6.1 12.0 to I-805 12.1 to 18.0 I-8 18.1 to 24.0 Greater than 24.0 I-5 *Notes: The utilization rate is calculated as the number of mental health care visits divided by the number of mental health clients. White areas have no data. Coordinate System: North American Datum 1983 Projection: California Teale Albers Mental Health data are from San Diego County's 0 7.5 15 Miles MIS-Anasazi Database. Utilization Rate* of Mental Health Care Services San Diego County, 2009 - Ages 20-24 I-15 Oceanside Escondido I-5 San Diego Chula Vista Interstate Annualized Utilization Rates by Census Tract Less than 2.0 2.1 4.0 to 4.1 6.0 to 6.1 12.0 to I-805 12.1 to 18.0 I-8 18.1 to 24.0 Greater than 24.0 I-5 *Notes: The utilization rate is calculated as the number of mental health care visits divided by the number of mental health clients. White areas have no data. Coordinate System: North American Datum 1983 Projection: California Teale Albers Mental Health data are from San Diego County's 0 7.5 15 Miles MIS-Anasazi Database. Utilization Rate* of Mental Health Care Services San Diego County, 2009 - Ages 25-44 I-15 Oceanside Escondido I-5 San Diego Chula Vista Interstate Annualized Utilization Rates by Census Tract Less than 2.0 2.1 4.0 to 4.1 6.0 to 6.1 12.0 to I-805 12.1 to 18.0 I-8 18.1 to 24.0 Greater than 24.0 I-5 *Notes: The utilization rate is calculated as the number of mental health care visits divided by the number of mental health clients. White areas have no data. Coordinate System: North American Datum 1983 Projection: California Teale Albers Mental Health data are from San Diego County's 0 7.5 15 Miles MIS-Anasazi Database. Utilization Rate* of Mental Health Care Services San Diego County, 2009 - Ages 45-54 I-15 Oceanside Escondido I-5 San Diego Chula Vista Interstate Annualized Utilization Rates by Census Tract Less than 2.0 2.1 4.0 to 4.1 6.0 to 6.1 12.0 to I-805 12.1 to 18.0 I-8 18.1 to 24.0 Greater than 24.0 I-5 *Notes: The utilization rate is calculated as the number of mental health care visits divided by the number of mental health clients. White areas have no data. Coordinate System: North American Datum 1983 Projection: California Teale Albers Mental Health data are from San Diego County's 0 7.5 15 Miles MIS-Anasazi Database. Utilization Rate* of Mental Health Care Services San Diego County, 2009 - Ages 55-64 I-15 Oceanside Escondido I-5 San Diego Chula Vista Interstate Annualized Utilization Rates by Census Tract Less than 2.0 2.1 4.0 to 4.1 6.0 to 6.1 12.0 to I-805 12.1 to 18.0 I-8 18.1 to 24.0 Greater than 24.0 I-5 *Notes: The utilization rate is calculated as the number of mental health care visits divided by the number of mental health clients. White areas have no data. Coordinate System: North American Datum 1983 Projection: California Teale Albers Mental Health data are from San Diego County's 0 7.5 15 Miles MIS-Anasazi Database. Utilization Rate* of Mental Health Care Services San Diego County, 2009 - Men I-15 Oceanside Escondido I-5 San Diego Chula Vista Interstate Annualized Utilization Rates by Census Tract Less than 2.0 2.1 4.0 to 4.1 6.0 to 6.1 12.0 to I-805 12.1 to 18.0 I-8 18.1 to 24.0 Greater than 24.0 I-5 *Notes: The utilization rate is calculated as the number of mental health care visits divided by the number of mental health clients. White areas have no data. Coordinate System: North American Datum 1983 Projection: California Teale Albers Mental Health data are from San Diego County's 0 7.5 15 Miles MIS-Anasazi Database. Utilization Rate* of Mental Health Care Services San Diego County, 2009 - Women I-15 Oceanside Escondido I-5 San Diego Chula Vista Interstate Annualized Utilization Rates by Census Tract Less than 2.0 2.1 4.0 to 4.1 6.0 to 6.1 12.0 to I-805 12.1 to 18.0 I-8 18.1 to 24.0 Greater than 24.0 I-5 *Notes: The utilization rate is calculated as the number of mental health care visits divided by the number of mental health clients. White areas have no data. Coordinate System: North American Datum 1983 Projection: California Teale Albers Mental Health data are from San Diego County's 0 7.5 15 Miles MIS-Anasazi Database. Utilization Rate* of Mental Health Care Services San Diego County, 2009 - White I-15 Oceanside Escondido I-5 San Diego Chula Vista Interstate Annualized Utilization Rates by Census Tract Less than 2.0 2.1 4.0 to 4.1 6.0 to 6.1 12.0 to I-805 12.1 to 18.0 I-8 18.1 to 24.0 Greater than 24.0 I-5 *Notes: The utilization rate is calculated as the number of mental health care visits divided by the number of mental health clients. White areas have no data. Coordinate System: North American Datum 1983 Projection: California Teale Albers Mental Health data are from San Diego County's 0 7.5 15 Miles MIS-Anasazi Database. Utilization Rate* of Mental Health Care Services San Diego County, 2009 - Black I-15 Oceanside Escondido I-5 San Diego Chula Vista Interstate Annualized Utilization Rates by Census Tract Less than 2.0 2.1 4.0 to 4.1 6.0 to 6.1 12.0 to I-805 12.1 to 18.0 I-8 18.1 to 24.0 Greater than 24.0 I-5 *Notes: The utilization rate is calculated as the number of mental health care visits divided by the number of mental health clients. White areas have no data. Coordinate System: North American Datum 1983 Projection: California Teale Albers Mental Health data are from San Diego County's 0 7.5 15 Miles MIS-Anasazi Database. Utilization Rate* of Mental Health Care Services San Diego County, 2009 - Asian Pacific Islander I-15 Oceanside Escondido I-5 San Diego Chula Vista Interstate Annualized Utilization Rates by Census Tract Less than 2.0 2.1 4.0 to 4.1 6.0 to 6.1 12.0 to I-805 12.1 to 18.0 I-8 18.1 to 24.0 Greater than 24.0 I-5 *Notes: The utilization rate is calculated as the number of mental health care visits divided by the number of mental health clients. White areas have no data. Coordinate System: North American Datum 1983 Projection: California Teale Albers Mental Health data are from San Diego County's 0 7.5 15 Miles MIS-Anasazi Database. Utilization Rate* of Mental Health Care Services San Diego County, 2009 - Native American I-15 Oceanside Escondido I-5 San Diego Chula Vista Interstate Annualized Utilization Rates by Census Tract Less than 2.0 2.1 4.0 to 4.1 6.0 to 6.1 12.0 to I-805 12.1 to 18.0 I-8 18.1 to 24.0 Greater than 24.0 I-5 *Notes: The utilization rate is calculated as the number of mental health care visits divided by the number of mental health clients. White areas have no data. Coordinate System: North American Datum 1983 Projection: California Teale Albers Mental Health data are from San Diego County's 0 7.5 15 Miles MIS-Anasazi Database. Utilization Rate* of Mental Health Care Services San Diego County, 2009 - Other I-15 Oceanside Escondido I-5 San Diego Chula Vista Interstate Annualized Utilization Rates by Census Tract Less than 2.0 2.1 4.0 to 4.1 6.0 to 6.1 12.0 to I-805 12.1 to 18.0 I-8 18.1 to 24.0 Greater than 24.0 I-5 *Notes: The utilization rate is calculated as the number of mental health care visits divided by the number of mental health clients. White areas have no data. Coordinate System: North American Datum 1983 Projection: California Teale Albers Mental Health data are from San Diego County's 0 7.5 15 Miles MIS-Anasazi Database. Utilization Rate* of Mental Health Care Services San Diego County, 2009 - Hispanic I-15 Oceanside Escondido I-5 San Diego Chula Vista Interstate Annualized Utilization Rates by Census Tract Less than 2.0 2.1 4.0 to 4.1 6.0 to 6.1 12.0 to I-805 12.1 to 18.0 I-8 18.1 to 24.0 Greater than 24.0 I-5 *Notes: The utilization rate is calculated as the number of mental health care visits divided by the number of mental health clients. White areas have no data. Coordinate System: North American Datum 1983 Projection: California Teale Albers Mental Health data are from San Diego County's 0 7.5 15 Miles MIS-Anasazi Database. Utilization Rate* of Mental Health Care Services San Diego County, 2009 - Not Hispanic I-15 Oceanside Escondido I-5 San Diego Chula Vista Interstate Annualized Utilization Rates by Census Tract Less than 2.0 2.1 4.0 to 4.1 6.0 to 6.1 12.0 to I-805 12.1 to 18.0 I-8 18.1 to 24.0 Greater than 24.0 I-5 *Notes: The utilization rate is calculated as the number of mental health care visits divided by the number of mental health clients. White areas have no data. Coordinate System: North American Datum 1983 Projection: California Teale Albers Mental Health data are from San Diego County's 0 7.5 15 Miles MIS-Anasazi Database. Utilization* of Mental Health Care Services San Diego County, 2009 - Ages 12-64 Oceanside I-15 Escondido San Diego I-5 Chula Vista Interstate High and Low Clusters of Utilization of Mental Health Care Services Much less utilization (p<0.01) Less utilization (p<0.05) Equivalent to the county mean More utilization (p<0.05) Much more utilization (p<0.01) I-805 Distance Band: 5.0 miles I-8 *Notes: The utilization rate is analyzed as the number of mental I-5 health visits divided by the number of mental health care clients. The utilization rate is then used in hot spot analysis such that statistically significant clusters of access are shown. White areas have no data. A fixed distance as shown above was used with a two neighbor requirement in the hotspot analysis. Coordinate System: North American Datum 1983 Projection: California Teale Albers 0 7.5 15 Miles Mental Health data are from San Diego County's MIS- Anasazi Database. Utilization* of Mental Health Care Services San Diego County, 2009 - Ages 12-19 Oceanside I-15 Escondido San Diego I-5 Chula Vista Interstate High and Low Clusters of Utilization of Mental Health Care Services Much less utilization (p<0.01) Less utilization (p<0.05) Equivalent to the county mean More utilization (p<0.05) Much more utilization (p<0.01) I-805 Distance Band: 5.6 miles I-8 *Notes: The utilization rate is analyzed as the number of mental I-5 health visits divided by the number of mental health care clients. The utilization rate is then used in hot spot analysis such that statistically significant clusters of access are shown. White areas have no data. A fixed distance as shown above was used with a two neighbor requirement in the hotspot analysis. Coordinate System: North American Datum 1983 Projection: California Teale Albers 0 7.5 15 Miles Mental Health data are from San Diego County's MIS- Anasazi Database. Utilization* of Mental Health Care Services San Diego County, 2009 - Ages 20-24 Oceanside I-15 Escondido San Diego I-5 Chula Vista Interstate High and Low Clusters of Utilization of Mental Health Care Services Much less utilization (p<0.01) Less utilization (p<0.05) Equivalent to the county mean More utilization (p<0.05) Much more utilization (p<0.01) I-805 Distance Band: 5.0 miles I-8 *Notes: The utilization rate is analyzed as the number of mental I-5 health visits divided by the number of mental health care clients. The utilization rate is then used in hot spot analysis such that statistically significant clusters of access are shown. White areas have no data. A fixed distance as shown above was used with a two neighbor requirement in the hotspot analysis. Coordinate System: North American Datum 1983 Projection: California Teale Albers 0 7.5 15 Miles Mental Health data are from San Diego County's MIS- Anasazi Database. Utilization* of Mental Health Care Services San Diego County, 2009 - Ages 25-44 Oceanside I-15 Escondido San Diego I-5 Chula Vista Interstate High and Low Clusters of Utilization of Mental Health Care Services Much less utilization (p<0.01) Less utilization (p<0.05) Equivalent to the county mean More utilization (p<0.05) Much more utilization (p<0.01) I-805 Distance Band: 5.6 miles I-8 *Notes: The utilization rate is analyzed as the number of mental I-5 health visits divided by the number of mental health care clients. The utilization rate is then used in hot spot analysis such that statistically significant clusters of access are shown. White areas have no data. A fixed distance as shown above was used with a two neighbor requirement in the hotspot analysis. Coordinate System: North American Datum 1983 Projection: California Teale Albers 0 7.5 15 Miles Mental Health data are from San Diego County's MIS- Anasazi Database. Utilization* of Mental Health Care Services San Diego County, 2009 - Ages 45-54 Oceanside I-15 Escondido San Diego I-5 Chula Vista Interstate High and Low Clusters of Utilization of Mental Health Care Services Much less utilization (p<0.01) Less utilization (p<0.05) Equivalent to the county mean More utilization (p<0.05) Much more utilization (p<0.01) I-805 Distance Band: 5.6 miles I-8 *Notes: The utilization rate is analyzed as the number of mental I-5 health visits divided by the number of mental health care clients. The utilization rate is then used in hot spot analysis such that statistically significant clusters of access are shown. White areas have no data. A fixed distance as shown above was used with a two neighbor requirement in the hotspot analysis. Coordinate System: North American Datum 1983 Projection: California Teale Albers 0 7.5 15 Miles Mental Health data are from San Diego County's MIS- Anasazi Database. Utilization* of Mental Health Care Services San Diego County, 2009 - Ages 55-64 Oceanside I-15 Escondido San Diego I-5 Chula Vista Interstate High and Low Clusters of Utilization of Mental Health Care Services Much less utilization (p<0.01) Less utilization (p<0.05) Equivalent to the county mean More utilization (p<0.05) Much more utilization (p<0.01) I-805 Distance Band: 5.0 miles I-8 *Notes: The utilization rate is analyzed as the number of mental I-5 health visits divided by the number of mental health care clients. The utilization rate is then used in hot spot analysis such that statistically significant clusters of access are shown. White areas have no data. A fixed distance as shown above was used with a two neighbor requirement in the hotspot analysis. Coordinate System: North American Datum 1983 Projection: California Teale Albers 0 7.5 15 Miles Mental Health data are from San Diego County's MIS- Anasazi Database. Utilization* of Mental Health Care Services San Diego County, 2009 - Men Oceanside I-15 Escondido San Diego I-5 Chula Vista Interstate High and Low Clusters of Utilization of Mental Health Care Services Much less utilization (p<0.01) Less utilization (p<0.05) Equivalent to the county mean More utilization (p<0.05) Much more utilization (p<0.01) I-805 Distance Band: 4.3 miles I-8 *Notes: The utilization rate is analyzed as the number of mental I-5 health visits divided by the number of mental health care clients. The utilization rate is then used in hot spot analysis such that statistically significant clusters of access are shown. White areas have no data. A fixed distance as shown above was used with a two neighbor requirement in the hotspot analysis. Coordinate System: North American Datum 1983 Projection: California Teale Albers 0 7.5 15 Miles Mental Health data are from San Diego County's MIS- Anasazi Database. Utilization* of Mental Health Care Services San Diego County, 2009 - Women Oceanside I-15 Escondido San Diego I-5 Chula Vista Interstate High and Low Clusters of Utilization of Mental Health Care Services Much less utilization (p<0.01) Less utilization (p<0.05) Equivalent to the county mean More utilization (p<0.05) Much more utilization (p<0.01) I-805 Distance Band: 6.2 miles I-8 *Notes: The utilization rate is analyzed as the number of mental I-5 health visits divided by the number of mental health care clients. The utilization rate is then used in hot spot analysis such that statistically significant clusters of access are shown. White areas have no data. A fixed distance as shown above was used with a two neighbor requirement in the hotspot analysis. Coordinate System: North American Datum 1983 Projection: California Teale Albers 0 7.5 15 Miles Mental Health data are from San Diego County's MIS- Anasazi Database. Utilization* of Mental Health Care Services San Diego County, 2009 - White Oceanside I-15 Escondido San Diego I-5 Chula Vista Interstate High and Low Clusters of Utilization of Mental Health Care Services Much less utilization (p<0.01) Less utilization (p<0.05) Equivalent to the county mean More utilization (p<0.05) Much more utilization (p<0.01) I-805 Distance Band: 5.6 miles I-8 *Notes: The utilization rate is analyzed as the number of mental I-5 health visits divided by the number of mental health care clients. The utilization rate is then used in hot spot analysis such that statistically significant clusters of access are shown. White areas have no data. A fixed distance as shown above was used with a two neighbor requirement in the hotspot analysis. Coordinate System: North American Datum 1983 Projection: California Teale Albers 0 7.5 15 Miles Mental Health data are from San Diego County's MIS- Anasazi Database. Utilization* of Mental Health Care Services San Diego County, 2009 - Black Oceanside I-15 Escondido San Diego I-5 Chula Vista Interstate High and Low Clusters of Utilization of Mental Health Care Services Much less utilization (p<0.01) Less utilization (p<0.05) Equivalent to the county mean More utilization (p<0.05) Much more utilization (p<0.01) I-805 Distance Band: 9.3 miles I-8 *Notes: The utilization rate is analyzed as the number of mental I-5 health visits divided by the number of mental health care clients. The utilization rate is then used in hot spot analysis such that statistically significant clusters of access are shown. White areas have no data. A fixed distance as shown above was used with a two neighbor requirement in the hotspot analysis. Coordinate System: North American Datum 1983 Projection: California Teale Albers 0 7.5 15 Miles Mental Health data are from San Diego County's MIS- Anasazi Database. Utilization* of Mental Health Care Services San Diego County, 2009 - Other Oceanside I-15 Escondido San Diego I-5 Chula Vista Interstate High and Low Clusters of Utilization of Mental Health Care Services Much less utilization (p<0.01) Less utilization (p<0.05) Equivalent to the county mean More utilization (p<0.05) Much more utilization (p<0.01) I-805 Distance Band: 5.3 miles I-8 *Notes: The utilization rate is analyzed as the number of mental I-5 health visits divided by the number of mental health care clients. The utilization rate is then used in hot spot analysis such that statistically significant clusters of access are shown. White areas have no data. A fixed distance as shown above was used with a two neighbor requirement in the hotspot analysis. Coordinate System: North American Datum 1983 Projection: California Teale Albers 0 7.5 15 Miles Mental Health data are from San Diego County's MIS- Anasazi Database. Utilization* of Mental Health Care Services San Diego County, 2009 - Hispanic Oceanside I-15 Escondido San Diego I-5 Chula Vista Interstate High and Low Clusters of Utilization of Mental Health Care Services Much less utilization (p<0.01) Less utilization (p<0.05) Equivalent to the county mean More utilization (p<0.05) Much more utilization (p<0.01) I-805 Distance Band: 5.3 miles I-8 *Notes: The utilization rate is analyzed as the number of mental I-5 health visits divided by the number of mental health care clients. The utilization rate is then used in hot spot analysis such that statistically significant clusters of access are shown. White areas have no data. A fixed distance as shown above was used with a two neighbor requirement in the hotspot analysis. Coordinate System: North American Datum 1983 Projection: California Teale Albers 0 7.5 15 Miles Mental Health data are from San Diego County's MIS- Anasazi Database. Utilization* of Mental Health Care Services San Diego County, 2009 - Not Hispanic Oceanside I-15 Escondido San Diego I-5 Chula Vista Interstate High and Low Clusters of Utilization of Mental Health Care Services Much less utilization (p<0.01) Less utilization (p<0.05) Equivalent to the county mean More utilization (p<0.05) Much more utilization (p<0.01) I-805 Distance Band: 5.0 miles I-8 *Notes: The utilization rate is analyzed as the number of mental I-5 health visits divided by the number of mental health care clients. The utilization rate is then used in hot spot analysis such that statistically significant clusters of access are shown. White areas have no data. A fixed distance as shown above was used with a two neighbor requirement in the hotspot analysis. Coordinate System: North American Datum 1983 Projection: California Teale Albers 0 7.5 15 Miles Mental Health data are from San Diego County's MIS- Anasazi Database.