# Slides — Mental Health Access Gap V1 · Trellison Institute Briefing Deck
**Audience**: policy briefing · academic seminar · journalism brief
**Length**: 10 slides + title + closer = 12 total
**Speaker notes**: ~30 seconds per slide; deck designed for 8-minute briefing or 20-minute deep-read
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## SLIDE 0 — Title
**The Mental Health Access Gap is Two Problems, Not One**
A working paper from Trellison Institute · May 2026 (v1.0 draft)
*Methodology rating: pending · Evidence-chain certificate: pending*
Speaker note: This is the first published application of the Need-vs-Access Framework v1.
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## SLIDE 1 — The 41 million
> 41,100,000 American adults · ≥14 days per month of frequent mental distress
>
> Source: CDC PLACES (BRFSS small-area estimates) · 78,815 census tracts · 244.5M adults covered
Speaker note: This is the floor — peer-reviewed federal small-area estimate, population-weighted to a 16.80% national prevalence.
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## SLIDE 2 — The map and the surprise
[Visual: animated drive-time chloropleth v1.1 — CONUS + AK + HI]
> **91.3%** of U.S. adults live within 30 minutes of a licensed mental-health provider.
>
> **2.6% (6.3M)** live over 60 minutes from any provider.
Speaker note: The headline drive-time number is *not* what most listeners expect. Take a beat.
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## SLIDE 3 — Two problems, not one
| Population | Drive time | Problem | Lever |
|---|---|---|---|
| 6.3M (2.6%) | > 60 min | Geographic | Telehealth, HPSA, mobile crisis, NHSC loan repayment |
| 238M (97%) | < 60 min | Capacity | BHWET workforce, CCBHC payment, network adequacy, MHPAEA parity |
Speaker note: Conflating these has stalled the policy conversation. Separating them clarifies which lever applies.
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## SLIDE 4 — Problem 1: the 6.3M
[Visual: zoomed map of Texas-Mexico border, interior Alaska, rural Mountain West]
- Brewster County, TX: **321 min** drive to nearest provider
- Presidio County, TX: 285 min
- Kusilvak Census Area, AK: 270 min
- Fremont County, WY (Wind River Reservation): 274 min
Distance is the problem. The lever is telehealth + HPSA + mobile crisis.
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## SLIDE 5 — Problem 2: the college-town signal
[Visual: animated residual reveal v1.1]
Top positive outliers (gap is worse than insurance predicts):
| County | College | mhlth% | Drive | z |
|---|---|---|---|---|
| Cabell WV | Marshall | 36.9% | 0.7 min | +7.16 |
| Lafayette MS | Ole Miss | 26.3% | 1.0 min | +6.17 |
| Forrest MS | Southern Miss | 29.1% | 0.3 min | +6.10 |
| Strafford NH | UNH | 28.7% | 4.4 min | +6.07 |
Provider 0.7 min away · 36.9% prevalence · the gap is the appointment, not the distance.
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## SLIDE 6 — What's working (negative outliers)
| County | Policy stack | z |
|---|---|---|
| Wayne MI (Detroit) | Medicaid expansion + CCBHC | -7.35 |
| Kent MI (Grand Rapids) | Medicaid expansion + CCBHC | -7.16 |
| Jackson MO (Kansas City) | Medicaid expansion (2021) + CCBHC | -6.66 |
| Fairfax VA | High-coverage + integrated care | -6.40 |
The replication template: **state Medicaid expansion + CCBHC payment model + network adequacy enforcement**.
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## SLIDE 7 — The methodology
[Visual: dartboard pulse animation v1.1]
The Need-vs-Access Framework v1:
1. Tract-level pop-weighted national prevalence
2. Drive-time proxy: haversine × 1.4 / urban-rural speed split
3. Gap ratio = need × 1000 / state-supply per 100K
4. Within-state OLS: log gap_ratio ~ uninsured rate
5. Residual z-score classification at ±1.5σ
6. Pop-weighted dartboard sample (4 per class × 3 classes)
Open-source. Reusable. 11 other access domains queued.
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## SLIDE 8 — The dartboard (proof)
12 tracts. Pre-specified. Stratified. Population-weighted.
[Visual: dartboard pulse animation pause-frame]
Each dot is one of 12 case-study tracts whose stories check out against the public record. Stories include the policy stack (Detroit, Grand Rapids, Kansas City), the supply-saturation signature (Los Angeles), and the structural undercount (Colorado Springs military, Ocean NJ retirees). See per-tract narratives in `mh_gap_v1_dartboard_narratives.md`.
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## SLIDE 9 — What's next
| Audit gate | Status |
|---|---|
| Trellison methodology rating | pending |
| LedgerWell evidence-chain certificate | pending |
| DOI registration | pending (Zenodo) |
| Public release | gated on above |
Then: 11 other access domains. Same framework. Different bindings.
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## SLIDE 10 — The arsenal
Published content arsenal at **https://trellison.com/research/mental-health-supply-demand-gap**:
- Working paper (10 sections, ~6,500 words)
- Methodology supplement
- Executive brief (2 pages)
- Data dictionary / codebook (27 fields)
- 12 dartboard tract narratives
- Press release + Q&A
- Replication package
- 3 animated visualization clips (YouTube, CONUS + AK + HI)
- Long-form data-story video (forthcoming)
- Interactive heatmap (forthcoming)
- Slides (this deck)
The audit is the product. The framework is the proof.
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## SLIDE 11 — Q&A / Discussion
Anticipated questions cataloged in `mh_gap_v1_press_qa.md` (12 Q&A entries).
Contact:
- [email protected]
- [email protected]
- [email protected]
*Thank you.*