Behavioral Health United States: 2012

2013·5.9 MB·English

Behavioral Health,
United States, 2012
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Behavioral Health,
United States,
2012
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
Substance Abuse and Mental Health Services Administration
www.samhsa.gov
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ACKNOWLEDGMENTS
This report was prepared for the Substance Abuse and Mental Health Services Administration
(SAMHSA) by RTI International under contract numbers HHSS283200700002I/
HHSS28342003T with SAMHSA, U.S. Department of Health and Human Services (HHS).
Judith Teich of SAMHSA’s Center for Behavioral Health Statistics and Quality served as the
Government Project Officer.
Disclaimer
The views, opinions, and content of this publication are those of the authors and do not
necessarily reflect the views, opinions, or policies of SAMHSA or HHS.
Public Domain Notice
All material appearing in this report is in the public domain and may be reproduced,
downloaded, or copied without permission from SAMHSA. Citation of the source is
appreciated. However, this publication may not be reproduced or distributed for a fee without
the specific, written authorization of the Office of Communications, SAMHSA, HHS.
Electronic Access and Printed Copies
This publication may be downloaded or ordered at http://store.samhsa.gov/home. Or call
SAMHSA at 1-877-SAMHSA-7 (1-877-726-4727).
Recommended Citation
Substance Abuse and Mental Health Services Administration. (2013). Behavioral Health,
United States, 2012. HHS Publication No. (SMA) 13-4797. Rockville, MD: Substance Abuse
and Mental Health Services Administration.
Originating Office
Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health
Services Administration, 1 Choke Cherry Road, Rockville, MD 20857. HHS Publication No.
(SMA) 13-4797. Printed 2013.
Behavioral Health, United States, 2012 iii
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CONTENTS
Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .iii
Executive Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .xxiii
Section 1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Section 2 Behavioral Health Disorders across the Life Span . . . . . . . . . . . . . . . . . . . . 7
Section 3 Mental Health and Substance Use Disorders:
Impairment in Functioning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Section 4 Mental Health and Substance Use Disorders: Treatment Landscape . . 21
Section 5 Tables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .33
5 .1 Behavioral Health of the Population . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
5 .2 Behavioral Health Service Utilization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91
5 .3 Behavioral Health Treatment Capacity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 191
5 .4 Payers and Payment Mechanisms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 253
5 .5 Table References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .343
Appendix A Data Tables for Figures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .347
Appendix B Data Source Descriptions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .361
Appendix C Glossary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .369
Appendix D Selected Source Tables as Originally Published . . . . . . . . . . . . . . . . . . . . 375
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .383
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DETAILED CONTENTS
Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . iii
Executive Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .xxiii
Section 1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
1 .1 About This Volume . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
1 .2 Additions to Data in This Volume . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
1.2.1 Children ............................................................2
1.2.2 Vulnerable Populations ................................................2
1.2.3 Military Personnel, Veterans, and Military Families ..........................2
1.2.4 Medicaid Beneficiaries ................................................2
1.2.5 Treatment Workforce .................................................2
1 .3 How Data in This Volume Improve Understanding of the Impact of
Health Care Reform on Behavioral Health Treatment . . . . . . . . . . . . . . . . . . . . . . . 3
1.3.1 Helping Ensure Parity in Coverage between Behavioral Health Conditions and
Other Medical Conditions ..............................................3
1.3.2 Covering More People through Medicaid .................................3
1.3.3 Reducing Barriers for People with Pre-Existing Conditions ....................4
1.3.4 Improving Access to Prescription Medication for Treatment of Behavioral
Health Conditions ....................................................4
1 .4 Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
1 .5 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Section 2 Behavioral Health Disorders across the Life Span . . . . . . . . . . . . . . . . . . . . 7
2 .1 Onset and Prevalence of Mental Health Disorders . . . . . . . . . . . . . . . . . . . . . . . . . 7
2 .2 Onset and Prevalence of Substance Use Disorders . . . . . . . . . . . . . . . . . . . . . . . . 9
2 .3 Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
2 .4 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Behavioral Health, United States, 2012 vii
Section 3 Mental Health and Substance Use Disorders:
Impairment in Functioning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
3 .1 Adults . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
3.1.1 Serious Mental Illness and Levels of Impairment in Functioning ...............13
3.1.2 Co-Occurring Mental Health and Substance Use Disorders ..................16
3.1.3 Co-Occurring Disorders and Levels of Impairment in Functioning ..............16
3 .2 Children and Adolescents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
3.2.1 Serious Emotional Disturbance and Levels of Impairment in Functioning ........16
3 .3 Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
3 .4 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Section 4 Mental Health and Substance Use Disorders: Treatment Landscape . .21
4 .1 Adults . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
4.1.1 Mental Health Treatment .............................................22
4.1.2 Substance Abuse Treatment ...........................................22
4.1.3 Amount and Adequacy of Treatment ....................................23
4.1.4 Special Populations ..................................................25
4 .2 Adolescents and Children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
4.2.1 Mental Health and Substance Abuse Treatment ...........................25
4 .2 .1 .1 Treatment for Adolescents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25
4 .2 .1 .2 Treatment for Children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .26
4 .2 .1 .3 Types and Locations of Treatment Received . . . . . . . . . . . . . . . . . . . . . . . . .26
4.2.2 Adequacy of Treatment ...............................................28
4.2.3 Special Populations ..................................................29
4 .3 Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
4 .4 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
viii Behavioral Health, United States, 2012