Mental Health and Co-Occurring Disorders

Looking for a referral to, or more information about, mental health or substance use treatment services? The federal Substance Abuse and Mental Health Services Administration has a free, confidential National Helpline at 1-800-662-HELP (4357). "SAMHSA’s National Helpline, 1-800-662-HELP (4357), (also known as the Treatment Referral Routing Service) is a confidential, free, 24-hour-a-day, 365-day-a-year, information service, in English and Spanish, for individuals and family members facing mental and/or substance use disorders. This service provides referrals to local treatment facilities, support groups, and community-based organizations. Callers can also order free publications and other information."
SAMHSA's website also offers a free, confidential Behavioral Health Treatment Services Locator.

1. Mental Illness Among Adults in the US

"In 2016, an estimated 44.7 million adults aged 18 or older had AMI [Any Mental Illness] in the past year (Figure 54). This number represents 18.3 percent of adults in the United States. An estimated 10.4 million adults in the nation had SMI [Serious Mental Illness] in the past year, and 34.3 million adults had AMI excluding SMI in the past year. The number of adults with SMI represents 4.2 percent of adults in 2016, and the number of adults with AMI excluding SMI represents 14.0 percent of adults. Among adults with AMI in the past year, 23.2 percent had SMI, and 76.8 percent did not have SMI.41,42
"In 2016, the percentages of adults with AMI and adults who had AMI excluding SMI were similar to the percentages from 2008 to 2015 (Figures 55 and 57). The percentage of adults in 2016 with SMI was similar to the percentages from 2010 to 2015 but higher than the percentages in 2008 and 2009 (Figure 56)."

(Note: According to SAMHSA, "Adults with AMI were defined as having any mental, behavioral, or emotional disorder in the past year that met DSM-IV criteria (excluding developmental disorders and SUDs).30 Adults with AMI were defined as having SMI if they had any mental, behavioral, or emotional disorder that substantially interfered with or limited one or more major life activities. AMI and SMI are not mutually exclusive categories; adults with SMI are included in estimates of adults with AMI. Adults with AMI who do not meet the criteria for having SMI are categorized as having AMI excluding SMI. This section includes past year estimates of adults with AMI, SMI, and AMI excluding SMI.40")

Substance Abuse and Mental Health Services Administration. (2017). Key substance use and mental health indicators in the United States: Results from the 2016 National Survey on Drug Use and Health (HHS Publication No. SMA 17-5044, NSDUH Series H-52). Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration, p. 36. Retrieved from https://www.samhsa.gov/data/
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2. Demographic Characteristics of People in the US Receiving 24-Hour Hospital Inpatient Mental Health Treatment Services

"Of the 105,860 clients who received inpatient mental health treatment services on April 29, 2016, 32 percent were in general hospitals, 29 percent were in public psychiatric hospitals, and 28 percent were in private psychiatric hospitals."

"Gender"
"Despite some variation across facility type, 58 percent of clients who received inpatient mental health treatment services were male. Veterans Administration medical centers and public psychiatric hospitals accounted for the highest percentages of males who received inpatient services (83 and 69 percent, respectively).

"Age"
"• Sixteen percent of clients who received inpatient mental health treatment services were aged 17 or younger, while 68 percent were aged 18 to 64, and 16 percent were aged 65 and older.
"• Ninety-eight percent of clients who received inpatient services in RTCs for children were aged 17 or younger, and 2 percent were aged 18 to 64. (RTCs for children varied in how they defined children; some facilities included youth up to age 21. Reports of clients aged 65 and older who received inpatient mental health treatment services in RTCs for children likely constitute reporting errors.)
"• Private psychiatric hospitals served a greater proportion of children aged 17 and younger (25 percent) than general hospitals or public psychiatric hospitals (9 and 5 percent, respectively).
"• Eighty-five percent of clients served in public psychiatric hospitals were aged 18 to 64.
"• General hospitals and VA medical centers reported the largest proportions (24 percent each) of clients aged 65 and older who received inpatient mental health treatment services.

"Race"
"Race information was missing or reported as unknown for 51 percent of clients who received inpatient mental health treatment services on April 29, 2016. Of the clients for whom race information was reported, 31 percent of all those who received inpatient mental health treatment services were white;; 15 percent were Black or African American, and 1 percent each were Asian or two or more races.
"All types of facilities that provided inpatient mental health treatment services served a greater proportion of White clients than clients of any other racial group.
Of clients who received inpatient services in residential treatment centers (RTCs) for children, , 29 percent were Black or African American [Figure 3.2].

"Ethnicity"
"Ethnicity information was missing or reported as unknown for 49 percent of clients who received inpatient mental health treatment services. Forty-five percent were not Hispanic or Latino and 6 percent were Hispanic or Latino."

Substance Abuse and Mental Health Services Administration, National Mental Health Services Survey (N-MHSS): 2016. Data on Mental Health Treatment Facilities. BHSIS Series S-98, HHS Publication No. (SMA) 17-5049. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2017, pp. 23-24.
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3. Legal Status of People in the US Receiving 24-Hour Hospital Inpatient Mental Health Treatment Services

"Across all facility types, half of all clients who received inpatient mental health treatment services on April 29, 2016, were involuntarily admitted for care: 38 percent of clients were admitted with an involuntary non-forensic (non-criminal) legal status and 15 percent were admitted with an involuntary forensic (criminal) legal status.
Involuntary admissions were highest (91 percent) for clients who received inpatient mental health treatment services in RTCs for children and lowest (19 percent) for clients who received inpatient mental health treatment services in another type of residential treatment facility."

Substance Abuse and Mental Health Services Administration, National Mental Health Services Survey (N-MHSS): 2016. Data on Mental Health Treatment Facilities. BHSIS Series S-98, HHS Publication No. (SMA) 17-5049. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2017, p. 25.
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4. Demographic Characteristics of People in the US Receiving 24-Hour Residential Mental Health Treatment Services

"Of the 65,324 clients who received residential mental health treatment services on April 29, 2016, 35 percent received services in RTCs for children and 27 percent received services in RTCs for adults.

"Gender"
"A greater proportion of clients who received residential mental health treatment services on April 29, 2016, were male (61 percent) than female. This finding is consistent with the gender composition of clients who received inpatient mental health treatment services.
"VA medical centers and public psychiatric hospitals had the highest proportions of males who received residential mental health treatment services (87 and 69 percent, respectively).

"Age"
"As shown in Table 3.2a-b, clients between 18 and 64 years old accounted for 49 percent of all clients who received residential mental health treatment services on April 29, 2016, while 45 percent were age 17 or younger, and 5 percent were 65 years or older.

"Race"
"Race information was missing or reported as unknown for 40 percent of clients who received residential mental health treatment services on April 29, 2016. White clients accounted for 37 percent of all those who received residential mental health treatment services, while 17 percent were Black or African American, 3 percent were two or more races, and clients who identified as Asian or as American Indian/Alaska Native comprised 1 percent each.
"As shown in Figure 3.4, all types of facilities provided residential mental health treatment services to higher percentages of White clients than Black or African American clients, except for partial hospitalization/day treatment facilities.

"Ethnicity"
Ethnicity information was missing or reported as unknown for 36 percent of clients who received residential mental health treatment services. Clients who identified as Hispanic or Latino accounted for 8 percent of clients, while 56 percent did not identify as Hispanic or Latino."

Substance Abuse and Mental Health Services Administration, National Mental Health Services Survey (N-MHSS): 2016. Data on Mental Health Treatment Facilities. BHSIS Series S-98, HHS Publication No. (SMA) 17-5049. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2017, pp. 26-28.
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5. Legal Status of People in the US Receiving 24-Hour Residential Mental Health Treatment Services

"Overall, 71 percent of all clients who received residential mental health treatment services on April 29, 2016, were voluntarily admitted for care, and the remaining 29 percent were admitted with an involuntary legal status."

Substance Abuse and Mental Health Services Administration, National Mental Health Services Survey (N-MHSS): 2016. Data on Mental Health Treatment Facilities. BHSIS Series S-98, HHS Publication No. (SMA) 17-5049. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2017, p. 28.
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6. Demographic Characteristics of People in the US Receiving Less Than 24-Hour Outpatient Mental Health Treatment Services

"Of the 4,161,697 clients who received outpatient mental health treatment services at least once in April 2016 and were still enrolled in treatment on April 29, 2016, 46 percent received services in outpatient mental health facilities and 32 percent received services in community mental health centers. VA medical centers accounted for 9 percent of clients served in less than 24-hour outpatient settings, while multi-setting mental health facilities and general hospitals accounted for 4 percent each.

"Gender"
"Unlike the gender distribution of clients who received inpatient and residential mental health treatment services, the proportion of males and females receiving outpatient mental health treatment services was similar: 51 percent were male and 49 percent were female. A notable exception was VA medical centers, which predominantly served males (77 percent).

"Age"
"Children aged 17 or younger accounted for 27 percent of clients who received outpatient mental health treatment services; 60 percent of clients were adults aged 18 to 64, and 13 percent were seniors aged 65 and older.
"As shown in Figure 3.5, RTCs for children served children in higher proportions than all other facility types. Adults aged 18 to 64 received outpatient services in higher proportion than other age groups in other types of residential treatment facilities (76 percent), VA medical centers (68 percent), and public psychiatric hospitals (67 percent). Clients aged 65 and older accounted for about a quarter of those who received outpatient services in both private psychiatric hospitals and VA medical centers (28 and 23 percent, respectively).

"Race"
"Race information was missing or reported as unknown for 46 percent of clients who received outpatient mental health treatment services. According to the reported race information, 35 percent of clients who received outpatient services were White, 12 percent were Black or African American, 5 percent were two or more races, and 1 percent each were Asian or American Indian/Alaska Native.
"Figure 3.6 compares the proportions of White and Black or African American clients receiving outpatient mental health treatment services by facility type. As with residential settings, all facilities served a greater proportion of White than Black or African American clients.

"Ethnicity"
"Ethnicity information was missing or reported as unknown for 41 percent of clients who received outpatient services. Clients who identified as Hispanic or Latino accounted for 11 percent of those served as outpatients, while 48 percent did not identify as Hispanic or Latino."

Substance Abuse and Mental Health Services Administration, National Mental Health Services Survey (N-MHSS): 2016. Data on Mental Health Treatment Facilities. BHSIS Series S-98, HHS Publication No. (SMA) 17-5049. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2017, pp. 28-29.
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7. Legal Status of People in the US Receiving Less Than 24-Hour Outpatient Mental Health Treatment Services

"Overall, 92 percent of clients who received outpatient services received care voluntarily, while the other 8 percent received care involuntarily."

Substance Abuse and Mental Health Services Administration, National Mental Health Services Survey (N-MHSS): 2016. Data on Mental Health Treatment Facilities. BHSIS Series S-98, HHS Publication No. (SMA) 17-5049. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2017, p. 29.
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