(PS2-66) Administrative Burdens as Hidden Barriers to Accessing Mental Health Services in Federally Qualified Health Centers: A Mixed-methods Assessment

Increasingly, adolescents are struggling with poor mental health outcomes, making it essential to improve access to high-quality mental health services. Federally Qualified Health Centers (FQHCs) are federally-funded safety-net health centers that provide integrated physical and mental healthcare to individuals regardless of insurance status. This study examines how administrative burdens, i.e., challenges citizens face when interacting with a government agency, may act as barriers to accessing mental health services, especially for marginalized individuals. This exploratory sequential mixed-methods study uses data from semi-structured interviews with hospital- and community-based social workers (n=12), and from a mystery shopper study conducted during the COVID-19 pandemic with FQHCs in a large metropolitan county in the United States (n=119 FQHCs). It addresses three questions: 1) what kinds of administrative burdens exist in accessing mental health care? 2) how do parents of adolescent clients experience these burdens? 3) how do these burdens act as distinct barriers to accessing mental health services within safety-net health centers? Findings reveal that FQHCs implement a variety of administrative burdens on prospective clients, such as a requirement to designate their primary care physician into the FQHCs network through their insurance prior to scheduling, difficult-to-navigate phone trees, unanswered voicemails, and rude or discriminatory interactions with schedulers. These burdens result in extensive learning, compliance, and psychological costs for clients, leading to a catch-22 situation where the most marginalized individuals, such as adolescents with mental health disorders who are enrolled in Medicaid, become the most likely to disengage from the process of accessing mental healthcare. Although FQHCs have been lauded as a key mechanism to improve access to care for Medicaid populations, this study finds that administrative burdens may act as hidden barriers to accessing mental healthcare. Recommendations to reduce administrative burdens at the organizational and system levels are discussed.