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Title: Safety-net Primary Care Clinics and Psychiatric Emergency Department Visits

Abstract: In this paper, I examine whether expanding access to safety-net primary care
clinics (SNPCCs) has an impact on psychiatric emergency department (ED) utilization – defined as mental illness and substance use disorders, in California. Primary care physicians have assumed an increasingly important role in outpatient
behavioral healthcare through screening, diagnosing, and prescribing medications.
I leverage variation in travel distance to the nearest clinic in a zipcode area over
the period 2005 to 2015 in a two-way fixed-effects regression. I find that one additional mile increase in travel distance leads to an increase of 0.13% in the number
of psychiatric ED visits and the effects are primarily driven by female patients. My
findings imply that delivering behavioral healthcare in SNPCCs can be a strategy
to reduce unmet needs for behavioral healthcare among low-income groups. Policies designed to increase investments in safety-net primary care settings may have
unintended benefits in reducing psychiatric ED utilization.