Community mental health agencies (CMHAs) provide most of the institutional outpatient treatment in the United States. A great deal of this care is given to clients at prices below the actual cost of the service. As the number of mental health providers increases, the question of how competition shapes the performance of CMHAs becomes more important. We use a two-stage least-squares model to examine how competition from other outpatient facilities, psychiatrists, and health maintenance organizations (HMOs), coupled with demographic, economic, and organizational factors affects subsidized care in CMHAs. Our analysis shows that competition from psychiatrists and HMOs reduces the number of subsidized visits that CMHAs provide and that agencies in urban areas and those initiated with federal funds provide more subsidized care. By restricting access to outpatient treatment, competition may have adverse long-term consequences for potential clients and for state mental health authorities.
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