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December 2019 (Volume 97)
Quarterly Article
Jonathan Purtle
Félice Lê-Scherban
Xi Wang
Paul T. Shattuck
Enola K. Proctor
Ross C. Brownson
Mental Health and Substance Use Challenges
September 2024
Back to The Milbank Quarterly
Policy Points:
Context: Comprehensive state behavioral health parity legislation (C‐SBHPL) is an evidence‐based policy that improves access and adherence to behavioral health treatments. However, adoption of C‐SBHPL by state legislators is low. Little is known about how C‐SBHPL evidence might be most effectively disseminated to legislators or how legislators’ fixed characteristics (eg, ideology), mutable characteristics (eg, beliefs about the policy’s impact), and state‐level contextual factors might influence their support for behavioral health policies. The purpose of our study is (1) to describe the associations between legislators’ fixed and mutable characteristics, state‐level contextual factors, and support for C‐SBHPL; and (2) to identify the mutable characteristics of legislators independently associated with C‐SBHPL support.
Methods: We conducted a multimodal (post mail, email, telephone) survey of US state legislators in 2017 (N = 475). The dependent variable was strong support for C‐SBHPL, and the independent variables included legislators’ fixed and mutable characteristics and state‐level contextual factors. We conducted multivariable, multilevel (legislator, state) logistic regression.
Findings: Thirty‐nine percent of the legislators strongly supported C‐SBHPL. After adjustment, the strongest predictors of C‐SBHPL support were beliefs that C‐SBHPL increases access to behavioral health treatments (aOR = 5.85; 95% CI = 2.41, 14.20) and does not increase insurance premiums (aOR = 2.70; 95% CI = 1.24, 5.90). Stigma toward people with mental illness was inversely associated with support (aOR = 0.86; 95% CI = 0.78, 0.95). After adjustment, ideology was the only fixed characteristic significantly associated with support for C‐SBHPL. State‐level contextual factors did not moderate associations between mutable characteristics and support for C‐SBHPL.
Conclusions: Legislators’ mutable characteristics are stronger predictors of C‐SBHPL support than are most of their fixed characteristics and all state‐level contextual factors, and thus should be targeted by dissemination efforts.
Keywords: Dissemination, legislators, behavioral health parity laws.
Read on Wiley Online Library
Published in 2019 DOI: 10.1111/1468-0009.12431