Mental and Behavioral Health Services Chapter 10 Mental and Behavioral Health Services

Mental Illness Mental illness refers to all diagnosable mental disorders. Mental disorders are health conditions characterized by variations in thinking, mood, or behavior and are associated with distress and impaired functioning.

Selected Mental Disorder Table 8.1. Prevalence rates for selected mental disorders among adults, past 12 months, National Health Interview Survey, 1999. Selected Mental Disorder Characteristic Major Depression Generalized Anxiety Panic Attack Total 6.3 2.8 2.7 Age 18-24 6.5 2.9 25-44 6.6 3.1 3.2 45-64 7.2 65+ 3.7 1.5 .9

Selected Mental Disorder Table 8.1. Prevalence rates for selected mental disorders among adults, past 12 months, National Health Interview Survey, 1999. Selected Mental Disorder Characteristic Major Depression Generalized Anxiety Panic Attack Sex Male 4.5 1.9 1.7 Female 8.0 3.6 Race/Ethnicity White 6.6 2.8 Black 6.2 2.6 2.9 Hispanic 4.8 2.0

Table 8.1. Prevalence rates for selected mental disorders among adults, past 12 months, National Health Interview Survey, 1999. Selected Mental Disorder Characteristic Major Depression Generalized Anxiety Panic Attack Family Income $20,000 or more 5.6 2.2 2.4 Less than $20,000 9.5 5.1 3.9 Education Less than high school 7.0 3.8 2.9 High school or some college 6.9 3.1 College graduate 4.1 1.5 1.7

Table 8.1. Prevalence rates for selected mental disorders among adults, past 12 months, National Health Interview Survey, 1999. Selected Mental Disorder Characteristic Major Depression Generalized Anxiety Panic Attack Marital Status Married 4.7 2.2 2.1 Divorced/Separated/Widowed 10.2 4.4 3.7 Unmarried/Single 7.3 3.1 3.4

Reference Table 8.1 In any given year, approximately 18.8 million American adults have a depressive disorder. Nearly twice as many women when compared to men are affected by depressive disorders each year.

Reference Table 8.1 The prevalence of major depression and generalized anxiety is much greater for families with incomes below $20,000. The prevalence of major depression is much greater for individuals who are divorced, separated, or widowed.

The Scope of Mental Illness Approximately one in five Americans experience a mental disorder over the course of one year. The process of developing preventive interventions has been slow due to an insufficient understanding of the etiology of mental disorders.

The Scope of Mental Illness Gaps exist between optimally effective treatments and treatments actually administered. Specific demographic and economic groups are more likely than others to experience mental health problems.

Structure of the U.S. Mental and Behavioral Health Service System U.S. mental and behavioral health service system is comprised of four components: General medical/primary care, human services, and the public and private sectors. Also includes a specialty mental health sector.

Structure of the U.S. Mental and Behavioral Health Service System The general medical/primary care sector consists of practitioners in office-based settings, clinics, hospitals, and nursing homes. The human services sector includes social services, school-based counseling, rehabilitation services, and religious counselors.

Structure of the U.S. Mental and Behavioral Health Service System The public sector includes all services directly operated and financed by governmental agencies. The private sector includes all services operated and financed by the private sector.

Structure of the U.S. Mental and Behavioral Health Service System The specialty mental health sector consists of mental health professionals trained specifically to treat people with mental illnesses.

Table 8.3. Mental Health Organizations and Beds for 24-hour hospital and residential treatment: United States, 1986 and 1998 Type of Organization 1986 1998 Number of Mental Health Organizations State and County mental hospitals 285 229 Private psychiatric hospitals 314 348 Non-federal general hospital psychiatric services 1,351 1,707

Table 8.3. Mental Health Organizations and Beds for 24-hour hospital and residential treatment: United States, 1986 and 1998 Type of Organization 1986 1998 Number of Mental Health Organizations Department of Veteran Affairs medical center 139 145 Residential treatment centers for emotionally disturbed children 437 461 All other organizations* 2,221 2,832 * Includes freestanding psychiatric outpatient clinics, partial care organizations, and multi-service mental health organizations.

Table 8.3. Mental Health Organizations and Beds for 24-hour hospital and residential treatment: United States, 1986 and 1998 Type of Organization 1986 1998 Number of Beds State and County mental hospitals 119,033 63,769 Private psychiatric hospitals 30,201 34,154 Non-federal general hospital psychiatric services 45,808 55,145

Table 8.3. Mental Health Organizations and Beds for 24-hour hospital and residential treatment: United States, 1986 and 1998 Type of Organization 1986 1998 Number of Beds Department of Veterans Affairs medical centers 26,874 13,742 Residential treatment centers for emotionally disturbed children 24,547 33,997 All other organizations* 21,150 65,922

Reference Table 8.3 The number of state and county mental hospitals and beds has significantly decreased. The number of residential treatment center beds for emotionally disturbed children has dramatically increased.

Reference Table 8.3 The number of freestanding psychiatric outpatient clinics, partial care organizations, and multi-service mental health organizations has significantly increased.

Patterns of Use Approximately 15 percent of the adult population receive mental health services in any given year. Approximately 6 percent of this population use specialty mental health care. Five percent of the adult population receive mental health services from general medical or human service providers.

Patterns of Use Three to four percent of the adult population receive services from self-help groups or other human service professionals. The school system is the largest provider of mental health care for children and adolescents.

Mental Health Financing Approximately 53 percent of the funding for treatment comes from the public sector. Private insurance accounts for more than 50 percent of private sector funding. The remainder of mental health expenditures is financed through out-of-pocket payments.

Health Insurance Health insurance is a critical determinant in accessing mental health services. Health insurance determines the range of benefits and the facilities used for treatment. Insurance companies often set lower annual or lifetime limits to protect themselves against costly claims.

Mental Health and Managed Care Managed care controls utilization and costs at the provider level through case management. Recently, HMOs have found it cost effective to carve out mental health care for administration by an MBHO.

Mental Health and Managed Care Plans with payer carve-outs have patients enroll with separate vendors for mental health care. Plans with health plan subcontracts arrange to have mental health care managed by an MBHO so that patients do not have to select separate coverage options for care.

Parity in Mental Health Parity refers to the effort to treat mental health financing on the same basis as financing for general health services. A parity mandate requires all insurers to provide the same coverage equal to the coverage for all other disorders.

The Mental Health Parity Act of 1996 The Parity Act focused solely on catastrophic benefits in mental health insurance coverage. It prohibited the use of different lifetime and annual limits on coverage for mental and somatic illnesses.

Limitations of the Mental Health Parity Act Organizations that did not offer mental health benefits or had fewer than 50 employees were exempt. The provisions did not apply to other forms of benefit limits or substance abuse treatments.

Limitations of the Mental Health Parity Act Insurers who experienced more than a 1 percent increase in premiums resulting from the Parity Act were eligible for exemption.

Challenges Facing Mental Health Services Delivery systems lack integrated community-based services, continuity of providers and treatments, family support services, and culturally sensitive services. The supply of well-trained mental health professionals is inadequate, particularly in rural areas.

Challenges Facing Mental Health Services Diagnosis and treatment will need to be tailored to individual circumstances. Financial obstacles that discourage utilization and prevent patients from seeking treatment will need to be eliminated or minimized.