Degree Name

DrPH (Doctor of Public Health)

Program

Public Health

Date of Award

12-2026

Committee Chair or Co-Chairs

Kate Beatty

Committee Members

Casey Balio, Qian Huang

Abstract

Introduction: Access to mental health has seen changes over the past decade, but little research and attention have been given to access to inpatient psychiatric facilities. Inpatient psychiatric care is crucial for patients experiencing mental health emergencies who need immediate access to care. Gaps in spatial accessibility, affordability, and the access and assessment process were identified due to a lack of available information in the field.

Methods: Secondary data from the Tennessee Department of Health were used to assess financial accessibility through payer source charges and patient encounters, as well as through mapping of inpatient psychiatric facilities and conducting drive time and coverage area analyses. Primary data were collected through interviews with clinicians located in Northeastern Tennessee to gain insight into the assessment process and gather their perceptions of inpatient care.

Results: Longitudinal descriptive reviews on the financial accessibility among Tennessee Inpatient Facilities. This showed increased variability among facilities when stratified by region, ownership, and type of operation. Spatial accessibility in ArcGIS showed 82% of counties were not covered within a 30-minute radius of inpatient facilities. Analysis showed that Middle Tennessee had significantly less coverage from inpatient facilities and raised concerns about spatial-social determinants in rural areas outside this coverage area. Reflexive thematic analysis was conducted to analyze the interview transcripts. Five overarching themes related to assessment procedures, barriers, disparities impacting access, and recommendations for improving access to inpatient care were identified.

Discussion: Overall findings reflected a movement towards increased research on access to inpatient care. Findings show a need for additional research around payer source interaction with inpatient facilities to investigate payer source variability. Findings also show an increased need for research focused on county-level accessibility to facilities with spatial and mental health concerns. Findings from interviews highlighted the interconnectedness of disparities to one's ability to access care and highlighted the continued need to hear from clinicians within the field.

Document Type

Dissertation - unrestricted

Copyright

Copyright by the authors.

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