Wisconsin Department of Health Services January 2014 P-00522J Healthiest Wisconsin 2020 Baseline and Health Disparities Report Mental Health

MENTAL HEALTH Background Overview of Healthiest Wisconsin 2020 Baseline and Health Disparities Report Healthiest Wisconsin 2020 objectives and indicators Rationale Key points Data Mental health among adults Mental health among youth Access to services References Links to additional reports and resources Contacts Chapter Outline 2 Chapter outline

MENTAL HEALTH Report Overview This chapter is part of a larger report created by the Wisconsin Department of Health Services to track progress on the objectives of Healthiest Wisconsin 2020 (HW2020) and identify health disparities in the state. The full report is available at: The report is designed to address the Health Focus Areas in HW2020. Where direct measures exist, data are presented; where direct measures are not available, related information may be included. Information about populations experiencing health disparities is provided in the Health Focus Area chapters and is summarized in separate chapters devoted to specific populations. Technical notes are available at: Report overview 3

MENTAL HEALTH Report Format Full Report Format: PDF Intended use: reference document Chapters Format: Annotated PowerPoint slide set Intended uses: presentations to –Decision-makers –Service providers –Community leaders –The public Sample annotated slide Report overview 4

MENTAL HEALTH Report Outline Executive Summary Section 1: Introduction Section 2: Demographic overview Section 3: Health focus areas Section 4: Infrastructure focus areas Section 5: Data summaries by population Section 6: Technical notes Report overview 5

MENTAL HEALTH Report Outline: Detail Section 3: Health focus areas Alcohol and other drug use Chronic disease prevention and management Communicable diseases Environmental and occupational health Healthy growth and development Injury and violence Mental health Nutrition and healthy foods Oral health Physical activity Reproductive and sexual health Tobacco use and exposure Section 4: Infrastructure focus areas Access to health care Report overview 6

MENTAL HEALTH Report Outline: Detail Section 5: Data summaries by population  Racial/ethnic minority populations o American Indians o Asians o Blacks o Hispanics  People of lower socioeconomic status  People with disabilities  Lesbian, gay, bisexual, and transgender populations  Geography Report overview 7

MENTAL HEALTH Data notes Please refer to the Technical Notes chapter for a more detailed description of limitations and methods: The 95% confidence intervals are denoted by error bars. Where confidence intervals do not overlap, as shown in the example on the right, differences are statistically significant. Larger confidence intervals may indicate less reliable estimates that should be interpreted with caution. Population estimates that are considered unreliable are excluded. Misclassification of racial/ethnic groups may affect the accuracy of rates. Unless otherwise indicated, the Hispanic population may include people of various races; Whites, Blacks, Asians, and American Indians are non- Hispanic. Report overview 8

MENTAL HEALTH Factors that influence health Social determinants of health Source: University of Wisconsin Population Health Institute. County Health Rankings 2013, Report overview 9

MENTAL HEALTH Objective 1 By 2020, reduce smoking and obesity (which lead to chronic disease and premature death) among people with mental health disorders. Objective 1 Indicators Smoking and obesity rates among people with depression or serious psychological distress. Source: Wisconsin Department of Health Services, Healthiest Wisconsin 2020, Mental Health Focus Area Profile. Healthiest Wisconsin 2020 objectives and indicators 10 HW2020 objectives

MENTAL HEALTH Healthiest Wisconsin 2020 objectives and indicators Objective 2 By 2020, reduce disparities in suicide and mental health disorders for disproportionately affected populations, including those of differing races, ethnicities, sexual identities and orientations, gender identities, educational or economic status. Objective 2 Indicators Prevalence of mental health disorders in these population groups. Suicide rates in these populations. Mental health provider capacity indicating access to mental health services. Source: Wisconsin Department of Health Services, Healthiest Wisconsin 2020, Mental Health Focus Area Profile. 11 HW2020 objectives

MENTAL HEALTH Healthiest Wisconsin 2020 objectives and indicators Objective 3 By 2020, reduce the rate of depression, anxiety and emotional problems among children with special health care needs (CSHCN). Objective 3 Indicators Percent of children who have depression, anxiety or emotional problems. Percent of children who needed but did not receive mental health services in the previous year. Percent of CSHCN/non-CSHCN who received mental health treatment/counseling in the past year. Source: Wisconsin Department of Health Services, Healthiest Wisconsin 2020, Mental Health Focus Area Profile. 12 HW2020 objectives

MENTAL HEALTH Rationale “Mental health is a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully and is able to make a contribution to his or her community.” 6 Mental illness is the leading cause of disability in the United States; one out of five people will experience a mental health problem of some type during a one-year period. 7 Mental health disorders are associated with an increased risk of physical illness; more specifically, with increased rates of chronic health problems and risk factors such as smoking, physical inactivity, obesity, and substance abuse and dependence. Source: Wisconsin Department of Health Services, Healthiest Wisconsin 2020, Mental Health Focus Area Profile. 13 Rationale

MENTAL HEALTH Key points: Trends Adults o From 2000 to 2010, suicide rates in Wisconsin increased by 26% in males and by 21% in females. The greatest increases occurred among people ages Youth o From 2001 to 2011, the total number of Wisconsin high school students reporting suicidal ideation declined. The most significant decreases in suicidal ideation were among White and Hispanic youth. Children o From 2003 to 2012, the percentage of children at high risk of developmental, behavioral and social delays declined both in Wisconsin and nationally. o From 2007 to 2012, the percentage of children receiving medications for ADHD, emotions, concentration, or behavior significantly increased both in Wisconsin and nationally. 14 Key points

MENTAL HEALTH Key points: Adults The prevalence of factors related to mental health varies among Wisconsin adult populations. Frequent mental distress:* Females, Blacks, Hispanics, low-income people, Milwaukee County residents, people who are obese, and smokers, report higher rates of frequent mental distress. Adverse Childhood Experiences (ACEs): People with low household incomes and those with disabilities had significantly higher rates of experiencing four or more ACEs. Insufficient sleep and poor emotional support: Milwaukee County residents, people with low household incomes, people with a disability had higher rates of insufficient sleep and lack of emotional support. *Frequent mental distress is defined as 14 or more days of poor mental health in the past 30 days. 15 Key points

MENTAL HEALTH Key points: Youth The prevalence of factors related to mental health varies among Wisconsin high school students. Sexual minority youth, Black youth, and Asian youth had higher rates of depressive symptoms than their peers. Rates of suicidal ideation and behavior were higher among Black and American Indian youth and among sexual minority youth than other youth. Mental health protective factors were highest among White and sexual majority youth. 16 Key points

MENTAL HEALTH Key points: Children The prevalence of factors related to mental health varies among Wisconsin children. A higher percentage of Wisconsin children receive medications for ADHD, emotions, concentration, or behavior, compared to children nationwide. Adverse Childhood Experiences (ACEs): o The deeper the level of poverty, the greater the percentage of children who had experienced two or more ACEs. o Black children experienced two or more ACEs at a higher rate compared to White and Hispanic children. o Children with special health care needs experienced two or more ACEs at a higher rate compared to children with no special health care needs. 17 Key points

MENTAL HEALTH Mental health among adults 18

MENTAL HEALTH Frequent mental distress among Wisconsin adults, by sex, Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); landline-cellphone combined dataset. Mental health among adults 19

MENTAL HEALTH Frequent mental distress among Wisconsin adults, by age, Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); landline-cellphone combined dataset. Mental health among adults 20

MENTAL HEALTH Age-adjusted rate of frequent mental distress among Wisconsin adults, by race/ethnicity, Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); landline-only dataset. Note: Question asked in Estimates that are unreliable (based on Relative Standard Error or small sample size) are not shown; this means an estimate may not be presented for every population group. Mental health among adults 21

MENTAL HEALTH Age-adjusted rate of frequent mental distress among Wisconsin adults, by household income, Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); landline-only dataset. Note: Question asked in Mental health among adults 22

MENTAL HEALTH Age-adjusted rate of frequent mental distress among Wisconsin adults, by level of urbanization, Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); landline-only dataset. Note: Question asked in Mental health among adults 23

MENTAL HEALTH Frequent mental distress among Wisconsin adults ages 18-64, by disability status, Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); landline-only dataset. Note: Question asked in Mental health among adults 24

MENTAL HEALTH Frequent mental distress among Wisconsin adults, by sexual orientation, Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); landline-only dataset. Note: Question asked in Mental health among adults 25

MENTAL HEALTH Smoking and obesity among Wisconsin adults with and without frequent mental distress, Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); landline-cellphone combined dataset. Note: Days of poor mental health question asked in Mental health among adults 26

MENTAL HEALTH Four or more Adverse Childhood Experiences (ACEs) among Wisconsin adults, by sex, 2010 and 2011 Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); landline-cellphone combined dataset. Note: Question asked in 2010 and Mental health among adults 27

MENTAL HEALTH Four or more Adverse Childhood Experiences (ACEs) among Wisconsin adults, by age, 2010 and 2011 Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); landline-cellphone combined dataset. Note: Question asked in 2010 and Mental health among adults 28

MENTAL HEALTH Age-adjusted rate of four or more Adverse Childhood Experiences (ACEs) among Wisconsin adults, by race/ethnicity, 2010 and 2011 Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); landline-only dataset Note: Question asked in 2010 and Estimates that are unreliable (based on Relative Standard Error or small sample size) are not shown; this means an estimate may not be presented for every population group. Mental health among adults 29

MENTAL HEALTH Age-adjusted rate of four or more Adverse Childhood Experiences (ACEs) among Wisconsin adults, by household income, 2010 and 2011 Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); landline-only dataset. Note: Question asked in 2010 and Mental health among adults 30

MENTAL HEALTH Age-adjusted rate of four or more Adverse Childhood Experiences (ACEs) among Wisconsin adults, by level of urbanization, 2010 and 2011 Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); landline-only dataset. Note: Question asked in 2010 and Mental health among adults 31

MENTAL HEALTH Four or more Adverse Childhood Experiences (ACEs) among Wisconsin adults, by disability status, 2010 and Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); land-line only dataset. Mental health among adults

MENTAL HEALTH Four or more Adverse Childhood Experiences (ACEs) among Wisconsin adults, by sexual orientation, 2010 and 2011 Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); landline-only dataset. Note: Question asked in 2010 and Mental health among adults 33

MENTAL HEALTH Insufficient sleep and poor emotional support among Wisconsin adults, by sex, Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); landline-cellphone combined dataset. Note: Questions were not asked in Mental health among adults 34

MENTAL HEALTH Insufficient sleep and poor emotional support among Wisconsin adults, by age, Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); landline-cellphone combined dataset. Note: Questions were not asked in Mental health among adults 35

MENTAL HEALTH Age-adjusted rate of insufficient sleep and rate of poor emotional support among Wisconsin adults by race/ethnicity, Mental health among adults Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); landline-only dataset. Note: Questions were not asked in Rates of insufficient sleep are age-adjusted; rates of poor emotional support are not age- adjusted. Estimates that are unreliable (based on Relative Standard Error or small sample size) are not shown; this means an estimate may not be presented for every population group. 36

MENTAL HEALTH Age-adjusted rate of insufficient sleep and rate of poor emotional support among Wisconsin adults, by level of urbanization, Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); landline-only dataset. Note: Questions were not asked in Rates of insufficient sleep are age-adjusted; rates of poor emotional support are not age- adjusted. Mental health among adults 37

MENTAL HEALTH Age-adjusted rate of insufficient sleep and rate of poor emotional support among Wisconsin adults, by household income, Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); landline-only dataset. Note: Questions were not asked in Rates of insufficient sleep are age-adjusted; rates of poor emotional support are not age- adjusted. Mental health among adults 38

MENTAL HEALTH Insufficient sleep and poor emotional support among Wisconsin adults ages 18-64, by disability status, Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); landline-only dataset. Note: Questions were not asked in Mental health among adults 39

MENTAL HEALTH Insufficient sleep and poor emotional support among Wisconsin adults, by sexual orientation, Mental health among adults Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); landline-only dataset. Note: Questions were not asked in

MENTAL HEALTH Suicide deaths, age-adjusted rate per 100,000, by race/ethnicity, Wisconsin, Source: Wisconsin Interactive Statistics on Health (WISH), Wisconsin resident death certificates.. Mental health among adults and youth 41

MENTAL HEALTH Suicide deaths, rate per 100,000, by sex and age, Wisconsin, Source: Wisconsin Interactive Statistics on Health (WISH), Wisconsin resident death certificates. Mental health among adults and youth Suicide rate 42

MENTAL HEALTH Injury and violence Suicide rates by county, age-adjusted rates per 100,000, Wisconsin, Source: Wisconsin Interactive Statistics on Health (WISH), Wisconsin resident death certificates. Statewide rate = 13 per 100, Mental health among adults and youth 43

MENTAL HEALTH Suicide deaths by underlying cause of injury, Wisconsin, Source: Wisconsin Interactive Statistics on Health (WISH), Wisconsin resident death certificates. Mental health among adults and youth 44

MENTAL HEALTH Mental health among youth 45

MENTAL HEALTH Depression among Wisconsin high school students by race/ethnicity, Source: Wisconsin Department of Public Instruction, Youth Risk Behavior Survey (YRBS); 2007, 2009, 2011 combined dataset. Mental health among youth 46

MENTAL HEALTH Depression among Wisconsin high school students by sexual minority status, Source: Wisconsin Department of Public Instruction, Youth Risk Behavior Survey (YRBS); 2007, 2009, 2011 combined dataset. Mental health among youth 47

MENTAL HEALTH Suicide risk during past 12 months among Wisconsin high school students by race/ethnicity, Source: Wisconsin Department of Public Instruction, Youth Risk Behavior Survey (YRBS); 2007, 2009, 2011 combined dataset. Note: Estimates that are unreliable (based on Relative Standard Error or small sample size) are not shown; this means an estimate may not be presented for every population group. Mental health among youth 48

MENTAL HEALTH Suicide risk during past 12 months among Wisconsin high school students by sexual minority status, Source: Wisconsin Department of Public Instruction, Youth Risk Behavior Survey (YRBS); 2007, 2009, 2011 combined dataset. Mental health among youth 49

MENTAL HEALTH Protective factors among Wisconsin high school students by race/ethnicity, Source: Wisconsin Department of Public Instruction, Youth Risk Behavior Survey (YRBS); 2007, 2009, 2011 combined dataset. Mental health among youth 50

MENTAL HEALTH Protective factors among Wisconsin high school students by sexual minority status, Source: Wisconsin Department of Public Instruction, Youth Risk Behavior Survey (YRBS); 2007, 2009, 2011 combined dataset. Mental health among youth 51

MENTAL HEALTH High risk of developmental, behavioral, or social delays among children ages 4 months to 5 years, Wisconsin and United States, Source: National Survey of Children’s Health. Mental health among youth 52

MENTAL HEALTH Prevalence of medication use for ADHD, emotions, concentration, or behavior among children ages 2-17, Wisconsin and United States, Source: National Survey of Children’s Health. Mental health among youth 53

MENTAL HEALTH Percentage of children ages 2-17 who needed but not did not receive mental health services, Wisconsin and United States, Source: National Survey of Children’s Health. Mental health among youth 54

MENTAL HEALTH Percentage of children who have experienced two or more adverse childhood experiences (ACEs), Wisconsin and United States, Source: National Survey of Children’s Health. Mental health among youth 55

MENTAL HEALTH Percentage of children who have experienced two or more adverse childhood experiences (ACEs), by race/ethnicity, Source: National Survey of Children’s Health. Estimates that are unreliable (based on Relative Standard Error or small sample size) are not shown; this means an estimate may not be presented for every population group. Mental health among youth 56

MENTAL HEALTH Percentage of children who have experienced two or more adverse childhood experiences (ACEs), by federal poverty level (FPL), Source: National Survey of Children’s Health. Mental health among youth 57

MENTAL HEALTH Percentage of children who have experienced two or more adverse childhood experiences (ACEs), by disability status, Wisconsin, Source: National Survey of Children’s Health. Mental health among youth 58

MENTAL HEALTH Access to services 59

MENTAL HEALTH Number of full-time equivalent psychiatrists needed to remove significant shortages for the resident population, by county, 2011 Source: Wisconsin Department of Health Services, Primary Care Office, Shortage Designation Program. Access to services 60

MENTAL HEALTH References 1.University of Wisconsin Population Health Institute. County Health Rankings, Center for Urban Population Health. Milwaukee Health Report, LaVeist TA, Gaskin DA, Richard P (2009). The Economic Burden of Health Inequalities in the United States. Joint Center for Political and Economic Studies. 20Burden%20of%20Health%20Inequalities%20in%20the%20United%20States.pdf 20Burden%20of%20Health%20Inequalities%20in%20the%20United%20States.pdf 4.Thomas JC, Sage M, Dillenberg J, Guillory VJ (2002). A Code of Ethics for Public Health. Am Journal of Public Health. 92(7):1057– Wisconsin Department of Health Services (DHS). Healthiest Wisconsin World Health Organization. Fact Sheet No. 220, Mental health: strengthening our response. 7.Substance Abuse and Mental Health Services Administration. Results from the 2011 National Survey on Drug Use and Health: Mental Health Findings References

MENTAL HEALTH 8.Centers for Disease Control and Prevention (CDC). Self-Reported Frequent Mental Distress Among Adults --- United States, 1993— Institute of Medicine (2011).The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding. Transgender-People.aspx Transgender-People.aspx 10.U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Prevention. Top Health Issues for LGBT Populations Information & Resource Kit Substance Abuse and Mental Health Services Administration (SAMHSA). Smoking rate among adults with serious psychological distress remains high McClave AK, Dube SR, Strine TW, Mokdad AH (2009). Associations between health- related quality of life and smoking status among a large sample of U.S. adults. Preventive Medicine, 48 (2), References

MENTAL HEALTH 13.CDC. Health Related Quality of Life CDC. About BMI for Adults CDC. Adverse Childhood Experiences Study O’Connor C, Finkbiner C, & Watson L. (2012). Adverse Childhood Experiences in Wisconsin: Findings from the 2010 Behavioral Risk Factor Survey. Madison, Wisconsin: Wisconsin Children’s Trust Fund and Child Abuse Prevention Fund of Children’s Hospital & Health System Brown DW, Anda RF, Tiemeier H, Felitti VJ, Edwards VJ, Croft JB, Giles WH (2009). Adverse childhood experiences and the risk of premature mortality. American Journal of Preventive Medicine CDC. The state of mental health in aging America CDC. Insufficient sleep is a public health epidemic CDC. Health-related quality of life: Well-being concepts References

MENTAL HEALTH 21.Wisconsin Department of Health Services; Injury Research Center at the Medical College of Wisconsin; Mental Health America of Wisconsin; Wisconsin Suicide Prevention Initiative (2008). The Burden of Suicide in Wisconsin CDC. Youth Risk Behavior Surveillance System Office of Adolescent Health. Mental Health. health-topics/mental-health/home.htmlhttp:// health-topics/mental-health/home.html 24.Keenan-Miller D, Hammen CL, Brennan PA. Health outcomes related to early adolescent depression. Journal of Adolescent Health CDC. Mortality Among Teenagers Aged Years: United States, Husky M, Olfson M, He J, Nock M, Swanson S, Merikangas K. Twelve-month suicidal symptoms and use of services among adolescents: results from the National Comorbidity Survey. Psychiatric Services in Advance Birkett M, Espelage DL, Koenig B. LGB and questioning students in schools: The moderating effects of homophobic bullying and school climate on negative outcomes. J Youth Adolescence References

MENTAL HEALTH 28.CDC. School Connectedness: Strategies for Increasing Protective Factors Among Youth Data Resource Center for Child and Adolescent Health (DRC); National Survey of Children's Health CDC. Visser SN, Blumberg SJ, Danielson ML, Bitsko RH, Kogan MD. State-Based and Demographic Variation in Parent-Reported Medication Rates for Attention- Deficit/Hyperactivity Disorder, 2007– Felitti VJ, Anda RF, Nordenberg D, Williamson DF, Spitz AM, Edwards V, Koss MP, Marks JS (1998). Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults: American Journal of Preventive Medicine Wisconsin Department of Health Services (DHS). Wisconsin Health Facts: Poverty and Health, 2010 Results from the Wisconsin Family Health Survey Wisconsin Department of Health Services (DHS), Wisconsin Primary Care Office. Number of Psychiatrist FTEs Needed to Reduce Significant Shortages for the Resident Population: 65 References

MENTAL HEALTH Links to additional reports and resources Adverse Childhood Experiences in Wisconsin: Findings from the 2010 Behavioral Risk Factor Survey. Linking Mental and Physical Health: Results from the Wisconsin Behavioral Risk Factor Survey. Prevent Suicide Wisconsin: Centers for Disease Control and Prevention (CDC). Mental health Links

MENTAL HEALTH Contact Julianne Dwyer Mental Health Promotion and Prevention Coordinator Bureau of Prevention, Treatment and Recovery Division of Mental Health and Substance Abuse Services Wisconsin Department of Health Services 67 Contacts