Geographic Barriers to Community-Based Psychiatric Treatment for Drug-Dependent Patients

The World Health Organization has urged governments worldwide to implement evidence-based treatment services for drug addiction and mental health disorders, but the role of geographic characteristics in influencing treatment continuity for this population has been largely understudied. Here, we employ logistic regression (N = 294) to investigate how accessibility and neighborhood socioeconomic context influenced treatment continuity for a sample of 294 drug-dependent patients who received acute inpatient psychiatric treatment at a large, inner-city hospital in Philadelphia, Pennsylvania, and who were then referred to outpatient care. Results indicate that longer travel time to treatment, a high crime rate in the patient's home neighborhood, and traveling from a relatively lower to a higher crime neighborhood for treatment suppress treatment continuity. These contextual influences are moderated by ethnicity, where whites are influenced more strongly by travel time to treatment. This likely reflects the locations of treatment programs relative to patterns of residential segregation. African Americans both reside and attend treatment within the very highest crime areas, and this appears to have a particularly negative impact on treatment continuity for African Americans. This research highlights the need for more careful consideration of geographic issues in psychiatric treatment planning.