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Section V.
National Service Statistics
Chapter 19
Highlights of Organized Mental Health Services
in 2002 and Major National and State Trends
Daniel J. Foley, M.S.
Ronald W. Manderscheid, Ph.D.
Joanne E. Atay, M.A.
Center for Mental Health Services
Substance Abuse and Mental Health Services Administration
James Maedke, M.A.
Jeffrey Sussman
Sean Cribbs, M.A.
Social and Scientific Systems, Inc.
During the 32 years leading up to 2002, significant changes occurred in the number, capacity, structure, and operation of organizations providing mental health services in the United States. This chapter describes some of the changes that have occurred nationally in the delivery system, analyzes some of the policy implications of these changes for future planning purposes, and presents some comparative data by State.
The source of most of the organizational data presented in this chapter is the periodic Survey of Mental Health Organizations and General Hospital Mental Health Services (SMHO; see appendix A) conducted by the Survey and Analysis Branch, Division of State and Community Systems Development, Center for Mental Health Services (CMHS), Substance Abuse and Mental Health Services Administration (SAMHSA). The SMHO is a complete enumeration of all specialty mental health organizations and separate psychiatric services of non-Federal general hospitals, together with a sample survey that collects descriptive information on the number and types of services, capacity (number of beds), volume of services (numbers of episodes, additions, and resident patients), staffing, expenditures, and sources of revenue.
The types of mental health organizations covered are State and county mental
hospitals, private psychiatric hospitals, non-Federal
general hospitals with separate psychiatric services, Department of Veterans
Affairs (VA) medical centers, residential treatment centers (RTCs) for emotionally
disturbed children, and "all other mental health organizations,"
which include multiservice mental health organizations, freestanding psychiatric
outpatient clinics, and partial care psychiatric organizations. Definitions
of these organization types are given in appendix A.
This chapter examines four organizational focuses of the specialty mental health care sector:
- Availability—the number of each type of organization and
the number of organizations providing mental health services in 24-hour
care (inpatient, including residential care) and in less than 24-hour
care (outpatient and partial care), as well as the capacity of these services
(number of 24-hour hospital
beds).
- Volume of Services—the actual level of services provided by each organization
type. Aggregate measures of service utilization are shown for 24-hour
hospital services, including residential treatment care, and for less than
24-hour services (number of
additions, number of resident patients, and average daily census).
- Staffing—the number of full-time
equivalent (FTE) personnel by staff discipline employed by each organization
type.
- Finances—the expenditures made by each organization type to provide
and administer services, and the amount and sources of the revenues received
by these organizations.
Availability of Services
Number of Organizations and Service Setting
The total number of mental health organizations in the United States1
increased between 1970 and 1998 from 3,005 to 5,722 (see table
19.1). However, there was a slight dip between 1992 and 1994, as well as
a decrease between 1998 and 2002, from 5,722 to 4,301 organizations. Almost
all the increase up to 1998 occurred as a result of gains in the number of separate
psychiatric services of non-Federal
general hospitals, RTCs, and "all other mental health organizations,"
because the number of State and county mental hospitals (hereafter referred
to as State mental hospitals) and the number of freestanding outpatient clinics
(included in the rubric "all other mental health organizations")
decreased, and the number of VA medical centers with psychiatric services remained
relatively unchanged. Although the number of private psychiatric hospitals in
1998 was still more than twice the number in 1970, this represented a substantial
decline from their 1992 peak. During the 4-year
period between 1998 and 2002, the number of private psychiatric hospitals continued
to decline by about 27 percent.
Although the number of mental health organizations increased overall leading up to 1998, the number of organizations providing 24-hour hospital and residential treatment services peaked in 1994 and has decreased by 21 percent since that time. For example, between 1970 and 1994, the number providing 24-hour hospital and residential treatment services nearly doubled from 1,734 to 3,827, but declined between 1994 and 2002 to 3,032. In contrast, the number providing less than 24-hour services rose consistently between 1970 and 1998, from 2,156 to 4,386. However, between 1998 and 2002, the number of mental health organizations providing less than 24-hour services decreased approximately 23 percent to 3,367.
Number of Psychiatric Beds
Although the number of mental health organizations providing 24-hour
services (hospital inpatient and residential treatment) increased significantly
over the 32-year period, the number
of psychiatric beds provided by these organizations decreased by more than half,
from 524,878 in 1970 to 211,199 in 2002 (see table
19.2). The corresponding bed rates per 100,000 civilian population dropped
proportionately more in the same period, from 264 to 73. Beds in State mental
hospitals accounted for most of this precipitous drop, with their number representing
only 27 percent of all psychiatric beds in 2002, compared with almost 80 percent
in 1970 (see figure 19.1). Trends in bed rates
for specific organization types, shown in table 19.2
and figure 19.2, indicate that the rates for
private psychiatric hospitals, non-Federal
general hospitals with separate psychiatric services, RTCs, and "all other
mental health organizations" increased substantially between 1970 and
1990, with the greatest growth occurring between 1980 and 1990. Bed rates for
non-Federal general hospitals
remained stable throughout the 1990s, but declined substantially between 1998
and 2002. In addition, bed rates for private psychiatric hospitals declined,
although they remained above the rates for 1980 and earlier. The rate for RTCs
was nearly flat from 1970 to 2002, while the rate for State mental hospitals
and VA psychiatric organizations decreased substantially. The greatest increase
from 1970 to 1998—from less than one bed per 100,000 population to 23
beds—occurred in the "all other mental health organizations"
category, which includes the multiservice organizations (table
19.2). However, between 1998 and 2002, the bed rate for this category decreased
to 14 beds. In each of the years shown, the number of "scatter"
beds in non-Federal general hospitals
has been excluded. Scatter beds are those that are co-mingled with medical surgical
beds in non-Federal general hospitals,
as distinguished from those that are in the separate psychiatric units of these
hospitals.
Volume of Services
Additions to 24-Hour Hospital and Residential Services
The number of 24-hour hospital
and residential treatment additions increased steadily between 1969 and 1998,
from 1,282,698 to 2,299,959, with a slight decrease between 1998 and 2002 to
2,192,839. There was a corresponding increase in the addition rate, from 644
per 100,000 civilian population in 1969 to 875 in 1994. The addition rate decreased
between 1994 and 2002 to 762 (see table 19.3).
In 1969, three quarters of the 24-hour
hospital patients were about evenly divided between State mental hospitals and
the psychiatric services of non-Federal
general hospitals. A constant and precipitous decline in the number of additions
and the addition rate to State mental hospitals from 1969 to 1998, accompanied
by substantial increases in these measures for the 24-hour
services at non-Federal general
hospitals and private psychiatric hospitals, especially after 1979, shifted
the volume of patient additions to these latter two organization types. By 2002,
non-Federal general hospital separate
psychiatric services accounted for 50 percent and private psychiatric hospitals
for 22 percent of all 24-hour
additions, while the proportion of State mental hospital 24-hour
additions increased slightly, from 9 percent to 11 percent, from 1998 to 2002
(table 19.3). Among the other mental health organizations,
RTCs showed a more or less steady gain in addition rates between 1969 and 1990,
but they dipped in 1992, peaked in 1994, and then dipped slightly in both 1998
and 2000 before peaking at an all time high of 21 additions per 100,000 civilian
population in 2002 (see figure 19.3). From 1979
to 1998, VA 24-hour additions
as a proportion of all additions have been decreasing, from 12 percent to 7
percent (table 19.3). However, between 1998 and
2002 this category had a slight increase to 8 percent.
Additions to Less Than 24-Hour Care Services
From 1969 to 2002, the number of less than 24-hour
service additions to mental health organizations nearly tripled, from 1,202,098
to 3,574,832, and the corresponding addition rate per 100,000 civilian population
more than doubled, from 604 to 1,242 (see table 19.4).
Much of this increase occurred during the 1970s, when the number and rate of
less than 24-hour service additions
increased substantially in the "all other mental health organizations"
grouping, encompassing freestanding psychiatric outpatient clinics, federally
funded community mental health centers (CMHCs), and other multiservice mental
health organizations (see figure 19.4). Since
1979, the overall increase in additions to less than 24-hour
services has moderated, and, in fact, a slight decrease is noted between 1990
and 1992, generated mainly by a substantial decrease in outpatient additions
to non-Federal general hospital
psychiatric services. The number of additions to these facilities resumed its
increase in 1994, but decreased again between 2000 and 2002.
"All other mental health organizations" now includes the freestanding
outpatient and partial care clinics as well as the multiservice organizations.
In 2002, this category had nearly 2.3 million outpatient additions, down from
about 2.9 million in 1998. The less than 24-hour
additions in the non-Federal general
hospital psychiatric services were second, with more than 500,000 additions
in 2002, down from 1.1 million in 2000. Private psychiatric hospitals, RTCs,
and the VA medical centers combined comprised more than 700,000 additions. Additions
in State mental hospitals in 2002 numbered more than 52,000. By category, the
changes in number of less than 24-hour
care additions since 2000 were mixed. State mental hospitals, Private psychiatric
hospitals, and RTCs showed increases, while non-Federal
general hospital psychiatric services, VA medical centers, and "all other mental
health organizations" showed decreases.
Patients in 24-Hour Hospital and Residential Services
The number of 24-hour hospital
and residential patients generally decreased from 1969 to 2002, with increases
since the previous survey in 1986, 1994, and 2002 (see table
19.5). The 1994 increase was due entirely to the inclusion of residential
supportive patients, who had been excluded in previous years. Thus, the decline
from 1994 to 2002 continued a trend that had begun after 1986. In 1969, 24-hour
hospital and residential patients numbered 471,451, but by 1992 the number had
declined to 214,714. The number in 2002 was 180,543. The rate per 100,000 civilian
population decreased from 237 in 1969 to 63 in 2002. Much of the decrease occurred
before 1979, when substantial reductions occurred in the number of resident
patients in State mental hospitals and in VA medical center psychiatric inpatient
services. The total resident patient count has continued to decline as decreases
in the State mental hospital, VA medical center, and private psychiatric hospital
resident patient populations have not been offset by the relatively stable numbers
through 2002 in non-Federal general
hospital psychiatric services and the increases in the number of RTCs and other
organizations. VA medical center resident patient counts peaked in 1969, while
private psychiatric hospital resident patient counts peaked in 1990; both categories
continued to decrease throughout the 1990s and accounted for 5 percent and 10
percent of patient counts, respectively, in 2002. In 1969, State mental hospitals
accounted for the largest percentage of residents of psychiatric organizations,
more than three quarters. Their percentage of residents declined steadily, but
they continued to treat more residential patients than any other type of treatment
facility through 2002, when they were treating nearly 30 percent of residential
patients.
Patient Care Episodes
Patient care episodes, unlike the other volume measures, provide an estimate of the number of persons under care throughout the year. They are defined as the number of persons receiving services at the beginning of the year in the 24-hour hospital and residential treatment care services and less than 24-hour care services of mental health organizations plus the number of additions to these services throughout the year. They are a duplicated count in that persons can be admitted to more than one type of service or can be admitted to the same service more than once during the year.
The National Institute of Mental Health (NIMH) and CMHS have tracked patient
care episodes since 1955. Over the ensuing 45 years, the locus of mental health
care in the United States shifted from inpatient to ambulatory services, as
measured by the number of patient care episodes. Of the 1.7 million episodes
in 1955, 77 percent were in 24-hour
hospital and residential treatment services, and 23 percent were in less than
24-hour services; by 1971, there
were 4.2 million episodes, of which 42 percent were in 24-hour
hospital and residential treatment services, and 58 percent were in less than
24-hour hospital services; by
2002, of 9.5 million episodes, 24 percent were in 24-hour
hospital and residential treatment services, and 76 percent were in less than
24-hour hospital services, almost
exactly the reverse of the 1955 distribution (see table
19.6 and figure 19.5).
Along with the shift of patient care episodes from 24-hour
hospital and residential treatment care to less than 24-hour
services, a shift also occurred across organization types within these two services
(Redick, Witkin, Atay, & Manderscheid, 1994). For example, State mental hospitals
accounted for 63 percent of hospital and residential treatment episodes in 1955,
compared with only 13 percent in 2002. Also in 2002, the majority of hospital
and residential treatment care episodes were in private psychiatric hospitals
(22 percent) and non-Federal general
hospitals (48 percent; see figure 19.6). Compared
with 2002, State mental hospitals and VA medical centers in 1955 saw a larger
proportion of less than 24-hour
care episodes. For example, State mental hospitals accounted for 9 percent of
less than 24-hour care episodes
in 1955 and 2 percent in 2002. VA medical centers accounted for 11 percent of
these episodes in 1955 and 3 percent in 2002. The proportion of "all other mental
health organizations" providing less than 24-hour
care was higher in 1955 (80 percent) than in 2002 (69 percent; see figure
19.7).
Staffing of Mental Health Organizations
This section has been updated since the publication of Mental Health, United
States, 2002 with sample survey data from 2000.
Concomitant with increases in the number of mental health organizations and
patients served by these organizations, the number of FTE staff employed by
such organizations generally increased between 1972 and 2000, from 375,984 to
569,187 (see table 19.7).
In 1972, professional patient care staff comprised about 27 percent of all
FTE staff, compared with 43 percent of all FTE staff in 2000 (see figure
19.8). Among the professional patient care staff disciplines, the largest
gains over the 28-year period
were noted for psychiatrists, psychologists, social workers, registered nurses,
and other mental health professionals (table 19.7). By contrast, the number
of other workers (with less than a B.A. degree) employed in mental health organizations
showed a variable pattern of increases and decreases between 1972 and 2000,
with a larger number reported in 2000 (182,566) than in 1972 (140,379). The
number of FTE administrative, clerical, and maintenance staff increased slightly
from 134,719 to 142,627 in that period (table 19.7).
As a percentage of all FTE staff, other mental health workers dropped from
37 percent in 1972 to 32 percent in 2000. The administrative and support staff
declined from 36 percent in 1972 to 25 percent in 2000 (table
19.7). The mental health organization types that showed the largest proportional
increases in number between 1972 and 2000 were private psychiatric hospitals,
non-Federal general hospitals
with separate psychiatric services, RTCs, and "all other mental health
organizations," which accounted for all of the increases in total FTE
staff among mental health organizations during this period (tables
19.7a, 19.7b, 19.7c,
19.7d, 19.7e,
19.7f).
Financing of Services
This section has been updated since the publication of Mental Health, United States, 2002 with inventory data on revenues and expenditures since 1998.
Expenditures
Total expenditures by mental health organizations in the United States, as
measured in current dollars, increased more than elevenfold between 1969 and
1998, from $3.3 billion to $38.5 billion. However, between 1998 and 2002, total
expenditures declined to slightly more than $34 billion. Additionally, when
adjustments were made for inflation, that is, when expenditures were expressed
in constant dollars (1969 = 100), total expenditures rose from $3.3 billion
in 1969, peaked at slightly more than $5.5 billion in 1990, remained at over
$5 billion until 2000, and declined to slightly less than $4 billion in 2002.
This increase was not a monotonic increase over the period (see figure
19.9, table 19.8a, and table
19.8b). Only $619 million, or 2 percent of the $31 billion increase in current
dollar expenditures between 1969 and 2002, represented an increase in purchasing
power; the remaining 98 percent was due to inflation.
All the specific organization types registered increases in current dollar
expenditures between 1969 and 2002, but private psychiatric hospitals declined
in 1992, 1998, and 2000; State mental hospitals declined after 1992 followed
by increases for 2000 and 2002; VA medical centers showed declines in 1994,
peaked in 1998, declined again in 2000, and rose slightly in 2002; and all other
mental health organizations have continued to decline since peaking in 1998
(table 19.8a). (However, the per capita rates
also show a decline between 1998 and 2002 for all types of organizations except
RTCs; see table 19.8a and figure 19.10). Although
several organization types showed gains in 1998, when measured in constant dollars,
only RTCs showed gains between 1998 and 2002 (see figure
19.11). As a result, the proportionate share of total expenditures changed
significantly between 1969 and 2002 for some of the organization types. For
example, State mental hospitals and VA medical centers comprised only 22 and
3 percent of total expenditures, respectively, in 2002, compared with 55 and
14 percent, respectively, in 1969; private psychiatric hospitals, separate psychiatric
services of non-Federal general
hospitals, and "all other mental health organizations" comprised 12, 15, and 35
percent, respectively, in 2002, compared with 7, 9, and 7 percent, respectively,
in 1969 (see table 19.8b and figure
19.12).
Trends in per capita expenditures (the amount of expenditures per person in
the civilian population of the United States) followed patterns similar to
those noted above for the absolute expenditures among the various types of
mental health organizations between 1969 and 2002. Only non-Federal
general hospitals, RTCs, and "all other mental health organizations" showed
consistent per capita expenditure increases throughout the period from 1969
to 1998. However, both non-Federal general hospitals
and "all other mental health organizations" declined between 1998 and 2002.
State mental hospitals and private psychiatric hospitals had declining per
capita expenditures after 1994, and VA medical centers had a decline after
1998 (see
table 19.8a). When expressed in constant dollars,
total per capita expenditures had an inconsistent net decline of $2.97 between
1969 and 2002, from $16.53 to $13.56. Patterns for the individual types of
organizations were mixed: State mental hospitals and VA medical centers largely
decreased, while "all other mental health organizations" had the largest increase,
peaking in 1998, but declining through 2002 (table
19.8b).
Revenues by Source
In 2002, revenues of mental health organizations in the United States totaled
$37.3 billion, a decrease of $4.3 billion over 2000. Of the 2002 total revenues,
31 percent came from State mental health agencies and other State government
funds, 15 percent from client fees, 39 percent from Federal Government sources
(including Medicare and Medicaid), 10
percent from local governments, 2 percent from contracts, and 3 percent from
all other sources (see table 19.9a). The distribution
of revenues by source for 2002 was similar to 2000 in that the highest percentage
of funds (more than two-thirds)
came from Federal and State government funding.
Looking at the revenues received by the different types of mental health organizations,
figure 19.13 shows that the largest proportion
of revenues, 33 percent, went to "all other mental health organizations."
State and county organizations were next with 25 percent, followed by non-Federal
general hospitals with 17 percent. The highest revenue increase, 16 percent
over 2000, was for RTCs, whereas the largest revenue decrease, 20 percent
from 2000, occurred in non-Federal
general hospitals.
Major revenue sources also varied among the different mental health organization
types in 2002. As would be expected, State mental hospitals obtained most
of their funding (72 percent) from State mental health agencies and other
State government sources, an increase from 69 percent in 2000 (table
19.9a). While almost half (44 percent) of the funding for private psychiatric
hospitals came from Medicare and Medicaid, a similar amount (43 percent)
came from client fees. Medicaid was the largest source of revenue for RTCs
(29 percent). Medicaid also provided the largest amount of funding for "all
other mental health organizations," at 37 percent.
Policy Implications
This chapter provides data that allow for the analysis and planning of mental
health service delivery.2 Time series data make it possible to map
the trends and the evolution of services for mental health treatment. In addition,
recent data, particularly those collected in 2000 and in 2002, provide insight
into the large scale transformations in health care service beginning in the
1990s that emphasized a major shift from inpatient to outpatient care. Analysts
of health policy are faced with new challenges following the reform of health
care and social service programs, and this is especially true for mental health
policy.
Number of Beds
The substantial increase in the number of private psychiatric hospitals and non-Federal general hospital psychiatric inpatient and residential services during the 1980s has generated mergers, consolidations, downsizing, and closings of some of these hospitals. During the 1990s, the number of general hospitals with inpatient psychiatric services fluctuated slightly and then decreased substantially in 2000 concurrent with the supply of inpatient beds. Since 1992, the number of private psychiatric hospitals has declined resulting in a declining number of beds.
The 2002 data for State and county mental hospitals also showed a continued trend for a decline in these services. These facilities show a continued decline in their year end resident patients and number of inpatient and residential beds as many State governments struggle to reduce their budgets by eliminating costly hospital and residential programs, stressing community care, and preventing admission to psychiatric beds when possible. This situation is becoming even more critical as responsibilities continue to shift to States. The shift to non-residential care is shown by the increases in additions to less than 24-hour care since 1969 that only recently declined from 4 million in 2000 to 3.5 million in 2002.
Another factor in the decline in the number of psychiatric inpatient and residential beds may be the increased use of managed care and other cost saving mechanisms, including the substitution of less than 24-hour services for inpatient and residential care to further reduce the length of hospital stays, thereby reducing the cost of employee care to businesses and insurance companies. Indications are that the number of psychiatric beds may continue to decline in the foreseeable future (President's New Freedom Commission on Mental Health, 2004).
Patient Care Episodes
Policy implications evident from the trend data on patient care episodes involve four main issues: (1) the future role of State mental hospitals, (2) the balance between community-based and State mental hospital services, (3) the balance between hospital and residential and ambulatory services, and (4) the contracting by State mental health agencies for the provision of services through the private sector.
As the number of hospital and residential episodes in State mental hospitals continues to decline, policy makers are confronted with momentous decisions. Of particular importance is the question of whether these facilities should be expanded or closed. Some argue that these hospitals have contracted in size to such an extent that persons with severe mental illness are being denied admission, so that further downsizing is unwise. Others argue that all persons, regardless of the severity of their mental illness, can be cared for in the community and that State mental hospitals should be phased out entirely. Confounding the options of the policy makers are economic pressures brought by communities and labor unions to keep the State mental hospitals open and to increase their size.
State mental health agencies favor the expansion of community-based services at the expense of State mental hospital services. Federal legislation promotes community-based services to the exclusion of State mental hospital services in the distribution of community mental health service block grant funds to the States. Furthermore, between 1955 and 2002, aftercare services shifted from the State mental hospitals to community-based facilities. Despite these facts, State mental hospitals still received 70 percent of their revenue from State mental health agencies in 2002, up from 66 percent in 2000 (see table 19.9). In light of this situation, one of the major issues facing the mental health community today is how to strike a balance between the services of community-based mental health agencies and those of State mental hospitals.
The proper balance of hospital and residential with ambulatory services needs to be examined for treatment efficacy as well as for cost benefit. Although the percentage of less than 24-hour care is now much greater than it was between 1955 and 1971, the proportion has remained almost the same since 1975. Decisions will have to be made about the role of ambulatory versus hospital and residential services and, in particular, about whether ambulatory services should be increased at the expense of hospital and residential services.
The President's New Freedom Commission on Mental Health called for fully integrating people with mental illness into the community by enabling them to live, work, study, and participate in all activities.
Staffing
Accompanying trends in the number of mental health organizations and their caseloads since 1970 has been trends in the number of FTE staff these organizations employ. Increases occurred among the professional patient care staff, notably in the number of psychiatrists, psychologists, social workers, registered nurses, and other mental health professionals. The number of professional staff has more than doubled compared with a 6 percent increase in administrative, clerical, and maintenance (support) staff and a 30 percent increase in other mental health workers (paraprofessional) staff. This can be attributed in large part to the expansion of community-based mental health care services during this period, which has led to a greater emphasis on short-term hospital and residential as well as less than 24-hour care and partial care services, with the primary goal of keeping clients functioning in their own communities.
A feature of the contemporary evolution of health care service has been the replacement of higher cost professionals, particularly physicians, with other staff in less expensive labor categories, such as registered nurses. While the overall number of FTE staff in all mental health organizations increased in the 28 years between 1972 and 2000, the number of psychiatrists serving these mental health institutions increased at a slower rate than other professional staff. Between 1972 and 2000, the number of psychiatrists increased by 56 percent and the number of other physicians decreased by 26 percent. In contrast, the number of psychologists doubled, and the number of social workers nearly tripled.
As the trends in the number and rates per population associated with hospital and residential care (e.g., decreases in resident patients and psychiatric beds) appear to be leveling off and policies regarding the effectiveness of long-term hospital and residential care versus short-term hospital and residential and ambulatory care come under review, the future human resource needs of mental health organizations must be assessed, particularly whether the supply of paraprofessional and professional mental health care workers needs to be augmented or selectively reduced. Consideration must also be given to the substitutability of staff disciplines in certain situations.
Managed Care
In 1998, 66 percent of all mental health organizations were part of one or
more managed care networks, compared with 40 percent in 1994. Non-Federal
general hospitals with separate psychiatric services and private psychiatric
hospitals had the largest percentage of managed care participants—92 and 81 percent,
respectively. The next largest percentages were all others (56 percent), RTCs
(46 percent), and VA medical centers (48 percent). The organizations least likely
to be part of managed care networks were State mental hospitals (14 percent).
Expenditures
With the advent of health care reform, much interest has developed in the
role of inflation in the increase of expenditures by mental health organizations.
Both the number of private psychiatric hospitals and their expenditures increased
dramatically between 1969 and 2002, but declines were seen in both current
and constant expenditures between 1994 and 2002. Non-Federal general hospitals
with psychiatric services showed constant increases in expenditures and per
capita between 1969 and 2000 as measured in current dollars, but they showed
a constant decrease between 1990 and 2002 if measured in constant dollars.
Yet their 24-hour care population continued to increase up to 1998. VA medical
centers, RTCs, and "all other mental health organizations" showed increased
expenditures in both current and constant dollars and in per capita through
1998. However, since 1998, only RTCs have shown increased expenditures in both
current and constant dollars and in per capita; VA medical centers and "all
other mental health organizations" have exhibited marked declines during the
same period.
Mental Health Services Data by State
In conjunction with the preparation of national data for this chapter, CMHS tabulated the 2002 inventory data by State. In recent years, these State data have become increasingly important for managers of State mental health agencies, enabling them to compare their program statistics with those of other States and with national totals. In addition, State legislators, budget officers, and planners of mental health services frequently ask program administrators to furnish comparable statistical information from other States. Although State populations, programs, services, and funding patterns differ somewhat, State mental health program directors have usually identified enough similarities between their State and one or several others to make statistical comparisons. Among the most important factors in selecting other States for comparison is the need for States to have similarly organized services as well as somewhat similar populations. Geographical proximity may also be a relevant factor.
Tables 19.10, 19.10a,
and 19.10b show the number of facilities in
each State in each of the six facility types. Table
19.10 lists the number of facilities offering any services; table
19.10a lists the number providing 24-hour
hospital inpatient and residential care; and table
19.10b lists the number in each State providing outpatient care. All three
tables compare the number of facilities in 2002 with the numbers in 1992, 1994,
1998, and 2000.
Figures 19.14, 19.15,
and 19.16 show three key variables by State:
(1) inpatient and residential treatment beds, (2) inpatient and residential
treatment additions, and (3) outpatient additions. All three maps display rates
per 100,000 civilian population on July 1, 2002. Psychiatric inpatient and residential
treatment beds (figure 19.14) were least common
in the western States and most common in the Northeast. Wyoming had an unusually
high rate of inpatient and residential beds for a western State, whereas much
of the Southeast has low bed rates..
Inpatient and residential treatment additions (figure
19.15) displayed a similar regional pattern, being less frequent in the
western States. A band of high admission rates was seen throughout a number
of midwestern States, including Wisconsin, Iowa, Missouri, and Oklahoma, and
many of the adjacent States also had relatively high addition rates. In the
East, only Florida had a low addition rate.
High outpatient addition rates were found in Wyoming and Wisconsin (figure
19.16) in addition to a cluster of New England States—Massachusetts, Connecticut,
New Hampshire, and Maine. The areas with the lowest rates were again the West
and also the Southeast.
Data from the 2002 SMHO, similar to those presented in the figures, are available
in unpublished form from CMHS. Comparative State data for 1983, 1986, and 1988
can be found in Mental Health, United States, 1992; for 1986, 1988,
and 1990 in Mental Health, United States, 1994; for 1986, 1990, and
1992 in Mental Health, United States, 1996; for 1990, 1992, and 1994
in Mental Health, United States, 1998; for 1992, 1994, and 1998 in
Mental Health, United States, 2000; and for 1992, 1994, 1998, and 2000
in Mental Health, United States, 2002.
References
President's New Freedom Commission on Mental Health (2004). Subcommittee on acute care: Background paper. DHHS Pub. No. SMA-04-3876. Rockville, MD: U.S. Department of Health and Human Services.
Redick, R. W., Witkin, M. J., Atay, J. E., & Manderscheid, R. W. (1994). The evolution and expansion of mental health care in the United States between 1955 and 1990. Rockville, MD: Center for Mental Health Services.
Witkin, M. J., Atay, J. E., & Manderscheid, R. W. (1994). The effect of inflation on expenditures by mental health organizations between 1969 and 1990. Rockville, MD: Center for Mental Health Services.
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