Working Papers
In this paper, I examine whether expanding access to safety-net primary care clinics (SNPCCs) has an impact on psychiatric emergency department utilization in California. Primary care physicians have assumed an increasingly important role in outpatient mental healthcare and substance use treatment through screening, diagnosing, and prescribing medications. I leverage variation in travel distance from a small area to the nearest clinics over the period 2005 to 2015 in a two-way fixed-effects model. I find that one additional mile increase in travel distance leads to an increase of 0.13% in the number of psychiatric emergency department 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 need for psychiatric care among low-income groups. Policies designed to increase investments in safety-net primary care settings may have unintended benefits in reducing psychiatric emergency department utilization.
In this paper, I study the role of payday loan restrictions on suicide and overdose deaths. Payday lenders offer ``quick cash'' and charge high fees relative to the principle loan amounts. Concerns about payday loans trapping borrowers in debt have led 21 U.S. states and the District of Columbia to prohibit or severely restrict payday lending by the end of 2021. Having access to costly credit could lead poorly informed individuals to a cycle of repeated borrowing and result in negative heath consequences, such as suicides. Moreover, numerous studies have documented the link between disposable income and negative heath events related to substance use, such as hospitalization and mortality, even when the income is anticipated. Given this relationship, state laws that limit access to credit, such as payday loans, may have unintended consequences related to health outcomes. Using the National Center for Health Statistics Multiple Cause of Death Files from 1999-2018 and estimating event-study models using procedures by Sun & Abraham (2021), my estimates show that suicides and overdoses decline post payday lending restriction. I additionally show that payday loan usage and binge drinking decline as access to payday loans is restricted. My findings suggest that restricting access to payday loans can have unintended benefits in reducing suicides and deaths linked to substance misuse.
We study the effect of community access to behavioral health (mental health and substance use disorders) treatment on police officer safety, which we proxy with on-duty assaults on officers. Combining agency-level data on police officer on-duty assaults and county-level data on the number of treatment centers within the community that offer behavioral health treatment, we estimate two-way fixed-effects regressions and find that that an additional four centers per county (average increase) leads to a 1.3% reduction per police agency in on-duty assaults against police officers. Previously established benefits of access to treatment on behavioral health extend to the work environment of police officers.