This Web site is a component of the SAMHSA Health Information Network

This Site Mental Health at HHS All Mental Health

Children's Mental Health Consumer/Survivor National Strategy for Suicide Prevention School Violence Prevention Managing Anxiety Surgeon General's Reports What's New Mental Health at The Department of Health and Human Services Funding Information Calendar of Events Mental Health Links Mental Health Dictionary Español

printer friendly page e-mail this page bookmark this page shopping cart  current or new account

This Web site is a component of the SAMHSA Health Information Network.

Healthy People 2010—Conference Edition

Chapter 18 Mental Health and Mental Disorders

Treatment Expansion

18-6. (Developmental) Increase the number of persons seen in primary health care who receive mental health screening and assessment.

Potential data source: Primary Care Data System/Federally Qualified Health Centers, HRSA.

The general medical/primary care sector consists of health care professionals such as internists, pediatricians, and nurse practitioners in office-based practice, clinics, acute medical/surgical hospitals, and nursing homes. Close to 6 percent of the adult U.S. population use the general medical sector for mental health care, with an average of about 4 mental health visits per year—far lower than the average of 14 visits per year found in the specialty medical sector. ^{3, 4} The general medical sector has long been identified as the initial point of contact for many adults with mental disorders; for some, these providers may be their only source of mental health services. This attention to mental state in primary care can promote early detection and intervention for mental health problems.

18-7. (Developmental) Increase the proportion of children with mental health problems who receive treatment.

Potential data source: National Household Survey on Drug Abuse (NHSDA), SAMHSA, OAS.

For many children aged 18 years and under, life-long mental disorders may start in childhood or adolescence. For many other children, normal development is disrupted by biological, environmental, and psychosocial factors, which impair their mental health, interfere with education and social interactions, and keep them from realizing their full potential as adults.

Expanding effective services for children, particularly for those with serious emotional disturbance, depends on promoting effective collaboration across critical areas of support: families, social services, health, mental health, juvenile justice, and schools. Better services and collaboration for children with serious emotional disturbance and their families will result in greater school retention, decreased contact with the juvenile justice system, increased stability of living arrangements, and improved educational, emotional, and behavioral development.^{64, 65}

18-8. Developmental) Increase the proportion of juvenile justice facilities that screen new admissions for mental health problems.

Potential data source: Inventory of Mental Health Services in Juvenile Justice Facilities, SAMHSA.

Each year, over 100,000 youths are placed in juvenile justice facilities.⁶⁶ Although exact numbers of youths with mental disorders among those entering this system are not available, the proportion is considerably higher than in the general population. Not surprisingly, problems of suicide, self-injurious behavior, and other disorders are significant among youths in the juvenile justice system.^{67, 68} Screening activities, including parent or caregiver interviews, should be conducted by qualified mental health personnel.⁶⁷ This approach can help ensure that all youths entering the juvenile justice system who also have a treatable mental health problem are identified and receive appropriate treatment.

18-9. Increase the proportion of adults with mental disorders who receive treatment.

Target and baseline:

Target setting method: 17 percent improvement.

Data sources: Epidemiologic Catchment Area (ECA) Program, NIH, NIMH;
National Household Survey on Drug Abuse (NHSDA), SAMHSA, OAS; Mental Health U.S., 1996, SAMHSA, CMHS.

DNA = Data have not been analyzed. DNC = Data are not collected. DSU = Data are statistically unreliable.

Serious mental illness. Untreated mental illnesses have human and economic costs associated with them. ^{68, 69, 70} Lost productivity due to illness, premature death, criminal justice interaction process, and property loss are all part of these costs. Ninety percent of those who complete suicide have a diagnosed mental illness.³ Helping persons with mental illnesses access appropriate scientifically based treatments is essential.

Depression. At some time or another, virtually all adults will experience a tragic or unexpected loss or a serious setback and times of profound sadness, grief, or distress. Major depressive disorder, however, differs both quantitatively and qualitatively from normal sadness or grief, which is typically less pervasive and generally more time-limited. Moreover, some of the symptoms of severe depression, such as anhedonia (the inability to experience pleasure), hopelessness, and loss of mood reactivity (the ability to feel a mood uplift in response to something positive) only rarely accompany normal sadness. Suicidal thoughts and psychotic symptoms such as delusions or hallucinations virtually always signify a pathological state. Depression disrupts the lives of depressed persons and their families and reduces economic productivity. Depression also can result in suicide and has an especially severe impact on women.^{12, 24} Treatment can alleviate each of these problems. Available medications and psychological treatments, alone or in combination, can help 80 percent of those with depression.⁷²

Depression also has a deleterious impact on the economy, costing the United States over $40 billion each year, both in diminished productivity and in use of health care resources. In the workplace, depression is a leading cause of absenteeism and diminished productivity.⁷³ Although only a minority seek professional help to relieve a mood disorder, depressed people are significantly more likely than others to visit a physician for some other reason.⁴

Schizophrenia is characterized by profound disruption in cognition and emotion, affecting the most fundamental human attributes: language, thought, perception, affect, and sense of self. Symptoms frequently include hearing internal voices or experiencing other sensations not connected to an obvious source (hallucinations) and assigning unusual significance or meaning to normal events or holding fixed false beliefs. No single symptom is definitive for diagnosis; rather, the diagnosis encompasses a pattern of signs and symptoms, in conjunction with impaired occupational or social functioning. The disorder affects 0.5 to 1 percent of the population over the course of a lifetime. Onset generally occurs during young adulthood (mid-20s for men, late-20s for women), although earlier and later onset do occur.⁷⁵

Anxiety disorders are not only common in the United States, but they are ubiquitous across human cultures.^{3, 4, 76} Twenty-four percent of the population will experience an anxiety disorder, many with overlapping substance abuse disorders.^{19, 77, 78} The longitudinal course of anxiety disorders is characterized by relatively early ages of onset, chronicity, relapsing or recurrent episodes of illness, and periods of disability.^{79, 80, 81, 82} Panic disorder and agoraphobia are associated with increased risks of attempted and completed suicide. ^{25, 83}

18-10. (Developmental) Increase the proportion of persons with co-occurring substance abuse and mental disorders who receive treatment for both disorders.

Potential data sources: National Health Interview Survey (NHIS), CDC, NCHS; National Household Survey on Drug Abuse (NHSDA), SAMHSA, OAS; Replication of National Comorbidity Survey, NIH, NIMH.

Co-occurring mental and addictive disorders are more common than previously recognized. In general, 19 percent of the adult U.S. population have a mental disorder alone (in 1 year); 3 percent have both mental and addictive disorders; and 6 percent have addictive disorders alone. Consequently, about 28 to 30 percent of the population have either a mental or addictive disorder.^{3, 4} The lifetime rates of co-occurrence of mental disorders and addictive disorders are strikingly high. About one in five Americans experience a mental disorder in the course of a year. Nearly one in three adults who have a mental disorder in their lifetime also experiences a co-occurring substance abuse (alcohol or other drugs) disorder, which complicates treatment. Individuals with co-occurring disorders are more likely to experience a chronic course and to use services than are those with either type of disorder alone. Clinicians, program developers, and policymakers need to be aware of these high rates of comorbidity. While an integrated approach may be indicated for persons with serious mental illness and co-occurring addictive disorders, how public health service systems can best address issues of treating the full range of persons with co-occurring mental and substance-related disorders remains a challenge. Treatment protocols continue to be refined as research findings and promising practices are disseminated to programs and practitioners.

18-11. (Developmental) Increase the proportion of local governments with community-based jail diversion programs for adults with serious mental illnesses.

Potential data source: National Survey of Jail Mental Health Diversion Programs, SAMHSA.

Nearly 700,000 persons with active symptoms of severe mental illness are admitted to jails each year. They constitute about 7 percent of the jail population.⁸⁴ Individuals with SMI were over-represented in jails compared to their numbers in the general population. Some people arrested for nonviolent crimes could be better served if diverted from the jail system to a community-based mental health treatment program.⁸⁵ Key components of a model diversion program are: (1) identifying specific program elements for diversion with accompanying resources and identified staff, (2) a specific target population, (3) a goal of avoiding or decreasing the time of incarceration, and (4) a way to link target population members with community-based mental health services. ⁸⁵

Table of Contents | Previous | Next