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Patterns of Mental Health Service Utilization and Substance Use Among Adults, 2000 and 2001 |
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With the shift toward deinstitutionalization and the increase in managed care, community-based services have become the primary source of treatment for mental illness. However, shrinking public expenditures for such services have meant that those without private health insurance or those who exhaust their private insurance coverage are often unable to get the services they need (Leslie & Rosenheck, 1999; National Council on Disability, 2002). The use of outpatient services is associated with individual characteristics, such as gender, education, marital status, race/ethnicity, and income (Howard et al., 1996). For example, studies have found that blacks and Hispanics were less likely than whites to use outpatient services (Alvidrez, 1999; Padgett, Patrick, Burns, & Schlesinger, 1994b). Vessey and Howard (1993) found a linear relationship between level of education and mental health treatment and indicated that women were more than men likely to make a visit to a mental health professional. Other studies have found that nonelderly persons, those with lowest family incomes, and those with public insurance had greater outpatient mental health and substance service use than their counterparts (Alvidrez, 1999; Zuvekas, 2001).
The National Household Survey on Drug Abuse (NHSDA) permits a more comprehensive assessment of outpatient services utilization than previous studies. Outpatient treatment in the NHSDA refers to treatment or counseling for problems with emotions, nerves, or mental health in any outpatient setting. Outpatient estimates in the present study may include a visit to a doctor's office, an outpatient mental health clinic or medical clinic, a partial day hospital or day treatment program, or some other place, as well as any visit to a psychologist, psychiatrist, social worker, or counselor.
Using data from the 2000 and 2001 NHSDA, this chapter examines the full range of socioeconomic and demographic characteristics of persons who received mental health outpatient services in the year prior to the interview, including where they received services, how many visits they made, and the sources of payment.
Approximately 12 million adults received outpatient mental health treatment in the year prior to the interview (Table 4.1). The majority of these (57.1 percent) were seen in private therapists' offices1 (Figure 4.1 and Table 4.2). This was true for all demographic and socioeconomic groups except for those with less than high school education and those receiving government assistance, who were as likely to be seen in outpatient mental health centers as in private therapists' offices. The overall proportion of adults receiving treatment at mental health centers was equal to the proportion seen in doctors' offices (19.4 percent). About 12 percent of persons receiving outpatient treatment reported receiving treatment at some place other than private therapists' offices, outpatient mental health centers, and doctors' offices.2
Note: Mental health treatment or counseling is defined as having received inpatient care, outpatient care, or using prescription medication for mental or emotional problems. Outpatient care includes one or more visits for outpatient care at an outpatient mental health clinic or center, the office of a private therapist, psychologist, psychiatrist, social worker, or counselor, a doctor's office, or some other place. "Other" place includes outpatient medical clinics, partial day hospitals or day treatment programs, or some other place.
Source: SAMHSA, Office of Applied Studies, National Household Survey on Drug Abuse, 2000 and 2001.
Adults who visited a doctor's office for mental health treatment in the past year were more likely to be 50 years old or older (33.7 percent) than those who were seen at mental health centers (23.6 percent), in private therapists' offices (26.9 percent), or any other place (29.6 percent) (Table 4.3). Adults who were seen at mental health centers and those seen at some other place were more likely to be 18 to 25 years of age (16.4 and 20.2 percent, respectively) than those seen in private therapists' offices (12.7 percent) or doctor's offices (11.6 percent).
More females than males received outpatient treatment at every location (Table 4.3). Among persons who received outpatient treatment, males were more likely than females to receive their outpatient treatment at a mental health center (23.4 vs. 17.3 percent) (Table 4.2). On the other hand, females were more likely than males to receive their treatment at a doctor's office (22.2 vs. 13.9 percent).
Among adults receiving treatment at an outpatient mental health center, about 79 percent were white and 10 percent were black; 86 percent of those treated in private therapists' offices were white compared with 5 percent who were black (Table 4.3). Of those who visited doctors' offices, 87.4 percent were white and 5.6 percent were black. Thus, about twice the proportion of blacks received treatment at a mental health center as at a private therapist's office or doctor's office. Among persons receiving any outpatient treatment, blacks (29.2 percent) were more likely than whites (18.3 percent) to receive treatment at a mental health center (Table 4.2). Whites (59.3 percent) were more likely than blacks (41.4 percent) or Hispanics (49.8 percent) to receive treatment at a private therapist's office.
Adults who received mental health treatment in the past year at a mental health center were more than 3 times as likely to have less than a high school education (24.1 percent) as were adults who received treatment at a private therapist's office (7.3 percent) (Table 4.3). Almost 41 percent of persons who visited a private therapist in the past year were college graduates (40.9 percent). This was twice as high as the percentage of college graduates among persons who visited a mental health center (20.3 percent). College graduates were more than twice as likely as adults with less than a high school education to receive their outpatient treatment at a private therapist's office (70.6 vs. 32.4 percent, respectively) (Table 4.2).
Most adults seen in private therapists' offices were employed full time (58.2 percent) (Table 4.3). Those seen in mental health centers were least likely to be employed full time (34.5 percent). Among adults receiving outpatient treatment, 29.2 percent of those who were not in the labor force were seen at a mental health center, while only 13.0 percent of those employed full time were seen at these centers (Table 4.2). In contrast, 64.7 percent of full-time employed adults receiving outpatient treatment were seen in private therapists' offices compared with only 45.7 percent of those who were not in the labor force (Table 4.2).
Adults who received treatment at a doctor's office were more likely to be married (60.0 percent) than were adults who received treatment at any other location, but about half of those seen by private therapists were also married (50.9 percent) (Table 4.3). Adults who received treatment at a mental health center were more likely to have never been married (38.1 percent) than adults who received treatment at a private therapist's office (25.6 percent) or a doctor's office (19.1 percent). Among adults receiving outpatient mental health treatment in the past year, the percentage receiving treatment at a mental health center was highest among those who have never been married (27.5 percent), next highest among those who were divorced or separated (22.5 percent), and lowest among those who were married (13.5 percent) (Table 4.2).
Among adults receiving outpatient mental health treatment in the past year, there were no significant differences between any regions or divisions in the percentages who received treatment at a mental health center. The percentage receiving their treatment at a private therapist's office was highest in the Pacific division (66.5 percent). The percentage receiving their outpatient treatment at a doctor's office was lowest in the Pacific division (12.4 percent) and highest in the East South Central division (25.7 percent) (Table 4.2).
Among persons receiving outpatient mental health treatment, adults in large and small metropolitan counties were more likely to receive treatment from a private therapist (61.8 and 57.4 percent, respectively) than adults in nonmetropolitan areas (43.0 percent) (Table 4.2). Adults in nonmetropolitan counties were more likely than adults in large metropolitan counties to receive their outpatient treatment at a mental health center (27.2 vs. 16.4 percent, respectively). Adults in large metropolitan counties were the least likely to receive their outpatient mental health treatment from a doctor's office (16.8 percent).
Adults seen in private therapists' offices were over 3½ times more likely to have family incomes of $75,000 or more than those seen in mental health centers (30.8 vs. 8.5 percent) (Table 4.3). Those seen in mental health centers were most likely to have incomes of less than $20,000 (42.0 percent).
Among adults receiving outpatient mental health treatment in the past year, the percentage visiting a private therapist was higher among persons from families with higher incomes. Among adults with family incomes of $75,000 or more, 71.7 percent visited a private therapist's office, while among those with incomes of less than $20,000 a year, only 41.5 percent visited a private therapist (Table 4.2). Among adults receiving outpatient mental health treatment in the past year, the percentage visiting a mental health center was higher among persons from lower income families. While 36.0 percent of those with incomes of less than $20,000 were seen in a mental health center, only 6.7 percent of those with the highest incomes ($75,000 or more) were seen in such centers.
Adults receiving government assistance accounted for a far greater proportion of persons seen in mental health centers (39.5 percent) than in private therapists' offices (13.3 percent), doctors' offices (13.9 percent), or any other place (28.0 percent) (Table 4.3).
Adults who received mental health treatment at a private therapist's office in the past year were more likely to have private insurance than adults who received treatment at an outpatient mental health center. Among adults who received treatment at a private therapist's office, 83.3 percent had private insurance in the past year, while among adults who received treatment at an mental health center, only 48.6 percent had private insurance (Table 4.3). Among adults who received mental health treatment at a doctor's office in the past year, 79.7 percent had private insurance.
The percentage receiving outpatient treatment at a mental health center was highest for adults receiving Medicaid or the Children's Health Insurance Program (CHIP) (43.6 percent) and lowest for those with private health insurance (12.7 percent) (Table 4.2).
Adults who received treatment at a private therapist's office in the past year were more likely to perceive their health as excellent (27.6 percent) than adults who received treatment at any other place (Table 4.3). Only 13.4 percent of those receiving treatment at a mental health center, 6.8 percent of those treated at a doctor's office, and 12.9 percent of those treated at all other places perceived their health as excellent. Adults who received treatment at a mental health center were more likely to perceive their health as fair or poor (30.9 percent) than adults who received treatment at a private therapist's office (16.3 percent) or at a doctor's office (20.7 percent).
Among adults who received outpatient mental health treatment in the past year, receiving treatment at a mental health center and receiving treatment at some other place were associated with poorer perceived health status. Receiving treatment at a private therapist's office was associated with better perceived health status. Among those receiving outpatient mental health treatment who perceived their overall health as excellent, 11.8 percent received treatment at a mental health center; among those who perceived their overall health as fair/poor, 29.4 percent received treatment at a mental health center (Table 4.2). Among those with excellent health status, 71.5 percent received treatment at a private therapist's office, while among those with fair/poor health status, only 45.7 percent received such treatment.
For each location reported, respondents were asked how many visits they made in the past 12 months to that location to obtain outpatient mental health treatment or counseling. Figure 4.2 shows that most people reported 2 to 10 visits in the past year, regardless of location, including mental health centers (52.5 percent), private therapists' offices (59.1 percent), and doctors' offices (62.3 percent). Those receiving treatment at a doctor's office were much more likely to have made a single visit (30.0 percent) than those receiving their outpatient treatment in a private therapist's office (7.3 percent) or mental health center (12.7 percent).
Table 4.5 shows the distribution of the number of outpatient visits in the past year by selected respondent characteristics. The majority of adults receiving outpatient treatment (57.0 percent) made 2 to 10 visits in the past year. This held true for all demographic and socioeconomic groups. Overall, 14.4 percent made only one visit for outpatient treatment. Persons aged 18 to 25, blacks, Hispanics, those with less than a high school education or high school graduates, those living in the South, those with no health insurance coverage, and those with "good" health status were most likely to have made only one visit. Persons aged 50 or older, college graduates, those who were divorced or separated, those living in the West region and in the West North Central division, completely rural counties, those with Medicaid/CHIP, and those with fair/poor health were least likely to have made only one visit.
Overall, 9.8 percent of adults receiving outpatient mental health treatment made 26 or more visits. Black or Hispanic persons, those who lived in the South, those who lived in nonmetropolitan counties, and those with family incomes between $20,000 and $75,000 were less likely to have made 26 or more visits. In contrast, persons who were unemployed, those who have never been married, those who lived in the Northeast or Pacific regions, those with family incomes less than $20,000, those with Medicaid/CHIP coverage, and those with fair/poor health were more likely to have made 26 or more visits.
Note: Mental health treatment or counseling is defined as having received inpatient care, outpatient care, or using prescription medication for mental or emotional problems. Outpatient care includes one or more visits for outpatient care at an outpatient mental health clinic or center, the office of a private therapist, psychologist, psychiatrist, social worker, or counselor, a doctor's office, or some other place. "Other" place includes outpatient medical clinics, partial day hospitals or day treatment programs, or some other place.
Source: SAMHSA, Office of Applied Studies, National Household Survey on Drug Abuse, 2000 and 2001.
Private health insurance was the most often mentioned primary payer3 for outpatient mental health treatment (Tables 4.6 and 4.7). Thirty-seven percent of those receiving outpatient treatment reported private health insurance as the primary payer, followed by self/family (27.8 percent), Medicare (8.7 percent), Medicaid (6.4 percent), and free treatment (5.2 percent). Private health insurance was the most often mentioned primary payer for persons in all demographic and socioeconomic subgroups except for (a) those aged 18 to 25, for whom self/family was as likely as private insurance to be the primary payer; (b) persons with less than high school education, for whom Medicare was the most often reported primary payer; (c) those who have never been married, for whom self/family was the most often reported primary payer; (d) those with family incomes less than $20,000, for whom Medicaid or Medicare were the most often reported primary payers; (e) those receiving government assistance, for whom Medicaid was the most often reported primary payer; and (f) those with no health insurance coverage, for whom self/family was the most often reported primary payer.
Although 74.0 percent of persons receiving outpatient treatment had private insurance (Table 2.3), only 37.0 percent reported private insurance as their primary payer. Even among persons with private insurance, only 47.4 percent reported it as their primary payer (Table 4.7).
Figure 4.3 shows the primary payers for outpatient treatment by location of treatment. Among all treatment locations, the largest proportion of primary payers was private insurance, and the smallest proportion was Medicare or Medicaid. Over 50 percent of those receiving treatment in a doctor's office reported private insurance (53.8 percent) as the primary payer compared with 23.7 percent receiving treatment in an outpatient mental health center and 39.7 percent receiving treatment in a private therapist's office. Outpatient mental health centers had the largest percentage of Medicaid and Medicare payers, while private therapists' offices had the largest percentage of self or family payers.
Note: Mental health treatment or counseling is defined as having received inpatient care, outpatient care, or using prescription medication for mental or emotional problems. Outpatient care includes one or more visits for outpatient care at an outpatient mental health clinic or center, the office of a private therapist, psychologist, psychiatrist, social worker, or counselor, a doctor's office, or some other place. "Other" place includes outpatient medical clinics, partial day hospitals or day treatment programs, or some other place.
Source: SAMHSA, Office of Applied Studies, National Household Survey on Drug Abuse, 2000 and 2001.
Respondents reporting that they or their family paid any part of the cost for their outpatient mental health treatment were asked how much they paid for all such treatment in the past 12 months. Because of the small sample size for this item, the cost categories were collapsed for analysis. About 40 percent of adults who paid some portion out-of-pocket for their outpatient mental health treatment paid between $100 and $500 (Table 4.8). Two thirds of these adults paid less than $501, and only 8.6 percent paid more than $2,000. Figure 4.4 shows the percentage of out-of-pocket costs for outpatient mental health treatment locations. The largest percentage paying more than $2,000 was among those who received their treatment at a private therapist's office (10.7 percent). The largest percentage paying less than $100 was among those who received their treatment at a doctor's office (44.5 percent).
Note: Mental health treatment or counseling is defined as having received inpatient care, outpatient care, or using prescription medication for mental or emotional problems. Outpatient care includes one or more visits for outpatient care at an outpatient mental health clinic or center, the office of a private therapist, psychologist, psychiatrist, social worker, or counselor, a doctor's office, or some other place. "Other" place includes outpatient medical clinics, partial day hospitals or day treatment programs, or some other place.
Source: SAMHSA, Office of Applied Studies, National Household Survey on Drug Abuse, 2000 and 2001.
This chapter has shown that the location where outpatient mental health treatment is received varies significantly by the demographic and socioeconomic characteristics of the individuals seeking treatment. Adults who received their outpatient treatment at mental health centers were more likely to be 18 to 25 years of age, male, black, have less than a high school education, not be in the labor force, never have been married, live in less urbanized areas, have family annual incomes of less than $20,000, receive government assistance, receive Medicaid/CHIP, and perceive their health as fair or poor. Adults who received their outpatient mental health treatment in private therapists' offices were more likely to be white, college graduates, employed full time, live in large metropolitan areas, have annual family incomes of $75,000 or more, have private insurance, and perceive their overall health as excellent. This finding is consistent with that from a study that combined data from several large-scale epidemiologic surveys and produced estimates of the demographic breakdown of people making at least one visit to a psychologist, psychiatrist, social worker, or counselor (Vessey & Howard, 1993).
The current study also found that adults who received their outpatient treatment in doctors' offices were more likely to be 50 years of age or older, female, high school graduates only, married, have family incomes over $20,000, not receive government assistance, and perceive their health as less than excellent. In addition, the majority of outpatients made between 2 and 10 visits and paid less than $501 out of pocket. About one third had private health insurance as their primary payer, even though 74.0 percent of outpatients reported that they had private insurance.
| Demographic/Socioeconomic Characteristic | Total | Where Received Outpatient Mental Health Treatment1 | |||
|---|---|---|---|---|---|
| Outpatient Mental Health Center |
Private Therapist's Office |
Doctor's Office | Other2 | ||
| Total | 11,811 | 2,286 | 6,743 | 2,286 | 1,447 |
| Age in Years | |||||
| 18–25 | 1,609 | 375 | 855 | 264 | 293 |
| 26–49 | 6,878 | 1,371 | 4,076 | 1,252 | 726 |
| 50 or older | 3,323 | 540 | 1,812 | 770 | 428 |
| Gender | |||||
| Male | 4,010 | 940 | 2,178 | 556 | 604 |
| Female | 7,801 | 1,347 | 4,565 | 1,731 | 843 |
| Hispanic Origin and Race | |||||
| Not Hispanic | 11,035 | 2,120 | 6,356 | 2,193 | 1,287 |
| White only | 9,833 | 1,796 | 5,827 | 1,997 | 1,053 |
| Black only | 811 | 237 | 336 | 127 | 179 |
| American Indian or Alaska Native only |
107 | * | * | * | * |
| Native Hawaiian or other Pacific Islander only |
11 | * | * | * | * |
| Asian only | 115 | * | * | * | * |
| More than one race | 158 | * | * | * | * |
| Hispanic | 776 | 166 | 387 | 93 | 160 |
| Education | |||||
| Less than high school | 1,519 | 552 | 493 | 271 | 322 |
| High school graduate | 3,190 | 687 | 1,498 | 808 | 477 |
| Some college | 3,195 | 583 | 1,994 | 611 | 339 |
| College graduate | 3,907 | 465 | 2,758 | 596 | 310 |
| Current Employment | |||||
| Full-time | 6,061 | 789 | 3,922 | 1,139 | 584 |
| Part-time | 1,843 | 351 | 1,044 | 351 | 297 |
| Unemployed | 357 | * | 156 | 62 | 74 |
| Not in the labor force3 | 3,550 | 1,038 | 1,621 | 734 | 492 |
| Marital Status | |||||
| Married | 5,790 | 779 | 3,432 | 1,371 | 599 |
| Widowed | 407 | * | * | * | * |
| Divorced or separated | 2,448 | 552 | 1,427 | 353 | 300 |
| Never married | 3,167 | 870 | 1,729 | 436 | 477 |
| Geographic Division | |||||
| Northeast | 2,614 | 483 | 1,537 | 483 | 252 |
| New England | 934 | 158 | 581 | 167 | 82 |
| Middle Atlantic | 1,680 | 325 | 956 | 317 | 170 |
| Midwest | 2,914 | 626 | 1,545 | 617 | 357 |
| East North Central | 2,071 | 433 | 1,071 | 488 | 229 |
| West North Central | 843 | 193 | 474 | 129 | 128 |
| South | 3,641 | 702 | 1,953 | 790 | 509 |
| South Atlantic | 2,028 | 372 | 1,173 | 412 | 259 |
| East South Central | 595 | 131 | 251 | 153 | 99 |
| West South Central | 1,018 | 199 | 529 | 224 | 151 |
| West | 2,642 | 475 | 1,708 | 396 | 329 |
| Mountain | 851 | 156 | 518 | 174 | 92 |
| Pacific | 1,791 | 319 | 1,191 | 222 | 238 |
| County Type | |||||
| Large metropolitan | 5,965 | 978 | 3,683 | 1,000 | 741 |
| Small metropolitan | 3,783 | 747 | 2,172 | 813 | 408 |
| 250,000 to 1,000,000 | 2,729 | 540 | 1,564 | 579 | 300 |
| <250,000 | 1,055 | 207 | 608 | 234 | 108 |
| Nonmetropolitan | 2,063 | 561 | 888 | 473 | 298 |
| Urbanized | 644 | 151 | 323 | 141 | 64 |
| Less urbanized | 1,165 | 322 | 481 | 276 | 192 |
| Completely rural | 254 | * | * | * | * |
| Family Income | |||||
| Less than $20,000 | 2,667 | 959 | 1,106 | 384 | 495 |
| $20,000 to $49,999 | 4,113 | 829 | 2,151 | 893 | 561 |
| $50,000 to $74,999 | 2,138 | 304 | 1,411 | 431 | 185 |
| $75,000 or more | 2,894 | 194 | 2,076 | 578 | 206 |
| Government Assistance4 | |||||
| Yes | 2,293 | 903 | 894 | 318 | 405 |
| No | 9,518 | 1,384 | 5,849 | 1,968 | 1,042 |
| Health Insurance | |||||
| Private | 8,762 | 1,112 | 5,619 | 1,821 | 834 |
| Medicaid/CHIP5 | 1,614 | 704 | 601 | 234 | 256 |
| Other6 | 2,346 | 641 | 1,076 | 463 | 414 |
| No coverage | 865 | 276 | 338 | 122 | 203 |
| Past Year Any Illicit Drug Use7 | |||||
| Yes | 2,331 | 576 | 1,297 | 404 | 338 |
| No | 9,480 | 1,710 | 5,446 | 1,882 | 1,110 |
| Overall Health | |||||
| Excellent | 2,597 | 307 | 1,858 | 383 | 186 |
| Very good | 3,726 | 570 | 2,325 | 726 | 369 |
| Good | 3,079 | 702 | 1,456 | 705 | 486 |
| Fair/poor | 2,404 | 707 | 1,099 | 473 | 406 |
| Demographic/Socioeconomic Characteristic | Where Received Outpatient Mental Health Treatment1 | |||
|---|---|---|---|---|
| Outpatient Mental Health Center |
Private Therapist's Office |
Doctor's Office | Other2 | |
| Total | 19.4 | 57.1 | 19.4 | 12.3 |
| Age in Years | ||||
| 18–25 | 23.3 | 53.1 | 16.4 | 18.2 |
| 26–49 | 19.9 | 59.3 | 18.2 | 10.6 |
| 50 or older | 16.2 | 54.5 | 23.2 | 12.9 |
| Gender | ||||
| Male | 23.4 | 54.3 | 13.9 | 15.1 |
| Female | 17.3 | 58.5 | 22.2 | 10.8 |
| Hispanic Origin and Race | ||||
| Not Hispanic | 19.2 | 57.6 | 19.9 | 11.7 |
| White only | 18.3 | 59.3 | 20.3 | 10.7 |
| Black only | 29.2 | 41.4 | 15.7 | 22.0 |
| American Indian or Alaska Native only |
* | * | * | * |
| Native Hawaiian or other Pacific Islander only |
* | * | * | * |
| Asian only | * | * | * | * |
| More than one race | * | * | * | * |
| Hispanic | 21.5 | 49.8 | 12.0 | 20.7 |
| Education | ||||
| Less than high school | 36.3 | 32.4 | 17.8 | 21.2 |
| High school graduate | 21.5 | 47.0 | 25.3 | 14.9 |
| Some college | 18.2 | 62.4 | 19.1 | 10.6 |
| College graduate | 11.9 | 70.6 | 15.3 | 7.9 |
| Current Employment | ||||
| Full-time | 13.0 | 64.7 | 18.8 | 9.6 |
| Part-time | 19.1 | 56.6 | 19.0 | 16.1 |
| Unemployed | * | 43.7 | 17.2 | 20.6 |
| Not in the labor force3 | 29.2 | 45.7 | 20.7 | 13.9 |
| Marital Status | ||||
| Married | 13.5 | 59.3 | 23.7 | 10.4 |
| Widowed | * | * | * | * |
| Divorced or separated | 22.5 | 58.3 | 14.4 | 12.3 |
| Never married | 27.5 | 54.6 | 13.8 | 15.1 |
| Geographic Division | ||||
| Northeast | 18.5 | 58.8 | 18.5 | 9.6 |
| New England | 16.9 | 62.2 | 17.9 | 8.8 |
| Middle Atlantic | 19.4 | 56.9 | 18.8 | 10.1 |
| Midwest | 21.5 | 53.0 | 21.2 | 12.3 |
| East North Central | 20.9 | 51.7 | 23.6 | 11.0 |
| West North Central | 22.9 | 56.2 | 15.3 | 15.2 |
| South | 19.3 | 53.6 | 21.7 | 14.0 |
| South Atlantic | 18.3 | 57.8 | 20.3 | 12.8 |
| East South Central | 22.0 | 42.2 | 25.7 | 16.6 |
| West South Central | 19.6 | 52.0 | 22.1 | 14.8 |
| West | 18.0 | 64.7 | 15.0 | 12.5 |
| Mountain | 18.3 | 60.8 | 20.5 | 10.8 |
| Pacific | 17.8 | 66.5 | 12.4 | 13.3 |
| County Type | ||||
| Large metropolitan | 16.4 | 61.8 | 16.8 | 12.4 |
| Small metropolitan | 19.7 | 57.4 | 21.5 | 10.8 |
| 250,000 to 1,000,000 | 19.8 | 57.3 | 21.2 | 11.0 |
| <250,000 | 19.6 | 57.7 | 22.2 | 10.2 |
| Nonmetropolitan | 27.2 | 43.0 | 22.9 | 14.4 |
| Urbanized | 23.5 | 50.2 | 21.9 | 9.9 |
| Less urbanized | 27.6 | 41.3 | 23.7 | 16.5 |
| Completely rural | * | * | * | * |
| Family Income | ||||
| Less than $20,000 | 36.0 | 41.5 | 14.4 | 18.6 |
| $20,000 to $49,999 | 20.2 | 52.3 | 21.7 | 13.6 |
| $50,000 to $74,999 | 14.2 | 66.0 | 20.1 | 8.7 |
| $75,000 or more | 6.7 | 71.7 | 20.0 | 7.1 |
| Government Assistance4 | ||||
| Yes | 39.4 | 39.0 | 13.9 | 17.7 |
| No | 14.5 | 61.5 | 20.7 | 11.0 |
| Health Insurance | ||||
| Private | 12.7 | 64.1 | 20.8 | 9.5 |
| Medicaid/CHIP5 | 43.6 | 37.2 | 14.5 | 15.9 |
| Other6 | 27.3 | 45.9 | 19.7 | 17.6 |
| No coverage | 31.9 | 39.0 | 14.2 | 23.5 |
| Past Year Any Illicit Drug Use7 | ||||
| Yes | 24.7 | 55.6 | 17.3 | 14.5 |
| No | 18.0 | 57.4 | 19.9 | 11.7 |
| Overall Health | ||||
| Excellent | 11.8 | 71.5 | 14.8 | 7.2 |
| Very good | 15.3 | 62.4 | 19.5 | 9.9 |
| Good | 22.8 | 47.3 | 22.9 | 15.8 |
| Fair/poor | 29.4 | 45.7 | 19.7 | 16.9 |
| Demographic/Socioeconomic Characteristic | Where Received Outpatient Mental Health Treatment1 | |||
|---|---|---|---|---|
| Outpatient Mental Health Center |
Private Therapist's Office |
Doctor's Office | Other2 | |
| Total | 100.0 | 100.0 | 100.0 | 100.0 |
| Age in Years | ||||
| 18–25 | 16.4 | 12.7 | 11.6 | 20.2 |
| 26–49 | 60.0 | 60.4 | 54.8 | 50.2 |
| 50 or older | 23.6 | 26.9 | 33.7 | 29.6 |
| Gender | ||||
| Male | 41.1 | 32.3 | 24.3 | 41.7 |
| Female | 58.9 | 67.7 | 75.7 | 58.3 |
| Hispanic Origin and Race | ||||
| Not Hispanic | 92.7 | 94.3 | 95.9 | 88.9 |
| White only | 78.5 | 86.4 | 87.4 | 72.8 |
| Black only | 10.4 | 5.0 | 5.6 | 12.3 |
| American Indian or Alaska Native only |
* | * | * | * |
| Native Hawaiian or other Pacific Islander only |
* | * | * | * |
| Asian only | * | * | * | * |
| More than one race | * | * | * | * |
| Hispanic | 7.3 | 5.7 | 4.1 | 11.1 |
| Education | ||||
| Less than high school | 24.1 | 7.3 | 11.8 | 22.2 |
| High school graduate | 30.0 | 22.2 | 35.4 | 33.0 |
| Some college | 25.5 | 29.6 | 26.7 | 23.4 |
| College graduate | 20.3 | 40.9 | 26.1 | 21.4 |
| Current Employment | ||||
| Full-time | 34.5 | 58.2 | 49.8 | 40.3 |
| Part-time | 15.4 | 15.5 | 15.4 | 20.5 |
| Unemployed | * | 2.3 | 2.7 | 5.1 |
| Not in the labor force3 | 45.4 | 24.0 | 32.1 | 34.0 |
| Marital Status | ||||
| Married | 34.1 | 50.9 | 60.0 | 41.4 |
| Widowed | * | * | * | * |
| Divorced or separated | 24.1 | 21.2 | 15.4 | 20.7 |
| Never married | 38.1 | 25.6 | 19.1 | 32.9 |
| Geographic Division | ||||
| Northeast | 21.1 | 22.8 | 21.1 | 17.4 |
| New England | 6.9 | 8.6 | 7.3 | 5.7 |
| Middle Atlantic | 14.2 | 14.2 | 13.8 | 11.7 |
| Midwest | 27.4 | 22.9 | 27.0 | 24.7 |
| East North Central | 18.9 | 15.9 | 21.3 | 15.8 |
| West North Central | 8.4 | 7.0 | 5.6 | 8.9 |
| South | 30.7 | 29.0 | 34.5 | 35.2 |
| South Atlantic | 16.3 | 17.4 | 18.0 | 17.9 |
| East South Central | 5.7 | 3.7 | 6.7 | 6.8 |
| West South Central | 8.7 | 7.8 | 9.8 | 10.4 |
| West | 20.8 | 25.3 | 17.3 | 22.8 |
| Mountain | 6.8 | 7.7 | 7.6 | 6.3 |
| Pacific | 14.0 | 17.7 | 9.7 | 16.4 |
| County Type | ||||
| Large metropolitan | 42.8 | 54.6 | 43.8 | 51.2 |
| Small metropolitan | 32.7 | 32.2 | 35.5 | 28.2 |
| 250,000 to 1,000,000 | 23.6 | 23.2 | 25.3 | 20.7 |
| <250,000 | 9.0 | 9.0 | 10.2 | 7.4 |
| Nonmetropolitan | 24.5 | 13.2 | 20.7 | 20.6 |
| Urbanized | 6.6 | 4.8 | 6.2 | 4.4 |
| Less urbanized | 14.1 | 7.1 | 12.1 | 13.3 |
| Completely rural | * | * | * | * |
| Family Income | ||||
| Less than $20,000 | 42.0 | 16.4 | 16.8 | 34.2 |
| $20,000 to $49,999 | 36.3 | 31.9 | 39.1 | 38.8 |
| $50,000 to $74,999 | 13.3 | 20.9 | 18.8 | 12.8 |
| $75,000 or more | 8.5 | 30.8 | 25.3 | 14.2 |
| Government Assistance4 | ||||
| Yes | 39.5 | 13.3 | 13.9 | 28.0 |
| No | 60.5 | 86.7 | 86.1 | 72.0 |
| Health Insurance | ||||
| Private | 48.6 | 83.3 | 79.7 | 57.7 |
| Medicaid/CHIP5 | 30.8 | 8.9 | 10.2 | 17.7 |
| Other6 | 28.0 | 16.0 | 20.2 | 28.6 |
| No coverage | 12.1 | 5.0 | 5.4 | 14.1 |
| Past Year Any Illicit Drug Use7 | ||||
| Yes | 25.2 | 19.2 | 17.7 | 23.3 |
| No | 74.8 | 80.8 | 82.3 | 76.7 |
| Overall Health | ||||
| Excellent | 13.4 | 27.6 | 16.8 | 12.9 |
| Very good | 25.0 | 34.5 | 31.7 | 25.5 |
| Good | 30.7 | 21.6 | 30.8 | 33.6 |
| Fair/poor | 30.9 | 16.3 | 20.7 | 28.1 |
| Demographic/Socioeconomic Characteristic | Total | Number of Outpatient Visits for Mental Health Treatment | |||
|---|---|---|---|---|---|
| 1 | 2–10 | 11–25 |  26 |
||
| Total | 11,553 | 1,666 | 6,588 | 2,167 | 1,131 |
| Age in Years | |||||
| 18–25 | 1,574 | 296 | 911 | 234 | 133 |
| 26–49 | 6,739 | 1,005 | 3,659 | 1,374 | 700 |
| 50 or older | 3,240 | 364 | 2,018 | 559 | 298 |
| Gender | |||||
| Male | 3,897 | 563 | 2,251 | 739 | 344 |
| Female | 7,656 | 1,103 | 4,337 | 1,429 | 787 |
| Hispanic Origin and Race | |||||
| Not Hispanic | 10,787 | 1,534 | 6,162 | 2,000 | 1,091 |
| White only | 9,628 | 1,324 | 5,530 | 1,768 | 1,005 |
| Black only | 773 | 162 | 394 | 159 | 57 |
| American Indian or Alaska Native only |
107 | * | * | * | * |
| Native Hawaiian or other Pacific Islander only |
11 | * | * | * | * |
| Asian only | 112 | * | * | * | * |
| More than one race | 157 | 13 | * | * | * |
| Hispanic | 766 | 132 | 427 | 167 | 40 |
| Education | |||||
| Less than high school | 1,461 | 266 | 801 | 278 | 116 |
| High school graduate | 3,069 | 527 | 1,807 | 483 | 252 |
| Some college | 3,139 | 447 | 1,807 | 558 | 328 |
| College graduate | 3,883 | 426 | 2,174 | 848 | 435 |
| Current Employment | |||||
| Full-time | 5,983 | 906 | 3,483 | 1,099 | 494 |
| Part-time | 1,801 | 230 | 1,015 | 358 | 198 |
| Unemployed | 349 | 45 | 200 | 61 | 44 |
| Not in the labor force1 | 3,419 | 485 | 1,890 | 649 | 396 |
| Marital Status | |||||
| Married | 5,716 | 859 | 3,511 | 888 | 458 |
| Widowed | 390 | * | * | * | * |
| Divorced or separated | 2,381 | 277 | 1,301 | 545 | 259 |
| Never married | 3,066 | 483 | 1,528 | 663 | 391 |
| Geographic Division | |||||
| Northeast | 2,552 | 344 | 1,311 | 568 | 329 |
| New England | 923 | 142 | 465 | 196 | 120 |
| Middle Atlantic | 1,629 | 202 | 846 | 372 | 210 |
| Midwest | 2,858 | 375 | 1,793 | 459 | 231 |
| East North Central | 2,027 | 288 | 1,220 | 383 | 137 |
| West North Central | 832 | 88 | 574 | 76 | 94 |
| South | 3,552 | 663 | 2,031 | 588 | 268 |
| South Atlantic | 1,999 | 336 | 1,166 | 361 | 135 |
| East South Central | 565 | 112 | 331 | 84 | 38 |
| West South Central | 988 | 215 | 534 | 144 | 95 |
| West | 2,591 | 283 | 1,453 | 552 | 303 |
| Mountain | 827 | 111 | 478 | 163 | 75 |
| Pacific | 1,764 | 173 | 975 | 388 | 228 |
| County Type | |||||
| Large metropolitan | 5,840 | 791 | 3,122 | 1,235 | 691 |
| Small metropolitan | 3,670 | 574 | 2,147 | 623 | 326 |
| 250,000 to 1,000,000 | 2,650 | 441 | 1,477 | 514 | 219 |
| <250,000 | 1,020 | 133 | 671 | 109 | 107 |
| Nonmetropolitan | 2,043 | 300 | 1,318 | 310 | 115 |
| Urbanized | 639 | 104 | 350 | 145 | 39 |
| Less urbanized | 1,150 | 171 | 795 | 127 | 57 |
| Completely rural | 254 | 25 | 174 | * | * |
| Family Income | |||||
| Less than $20,000 | 2,553 | 374 | 1,292 | 522 | 365 |
| $20,000 to $49,999 | 4,008 | 666 | 2,286 | 757 | 299 |
| $50,000 to $74,999 | 2,112 | 283 | 1,343 | 319 | 167 |
| $75,000 or more | 2,879 | 342 | 1,668 | 569 | 300 |
| Government Assistance2 | |||||
| Yes | 2,199 | 318 | 1,108 | 512 | 260 |
| No | 9,354 | 1,348 | 5,480 | 1,655 | 871 |
| Health Insurance | |||||
| Private | 8,625 | 1,241 | 5,087 | 1,563 | 734 |
| Medicaid/CHIP3 | 1,542 | 173 | 762 | 403 | 204 |
| Other4 | 2,261 | 288 | 1,315 | 378 | 280 |
| No coverage | 843 | 193 | 426 | 129 | 95 |
| Past Year Any Illicit Drug Use5 | |||||
| Yes | 2,279 | 301 | 1,172 | 530 | 277 |
| No | 9,273 | 1,365 | 5,416 | 1,637 | 854 |
| Overall Health | |||||
| Excellent | 2,572 | 329 | 1,515 | 479 | 250 |
| Very good | 3,685 | 579 | 2,123 | 657 | 327 |
| Good | 2,986 | 517 | 1,659 | 568 | 242 |
| Fair/poor | 2,309 | 241 | 1,293 | 463 | 312 |
| Demographic/Socioeconomic Characteristic | Total | Number of Outpatient Visits for Mental Health Treatment | |||
|---|---|---|---|---|---|
| 1 | 2–10 | 11–25 | 26 |
||
| Total | 100.0 | 14.4 | 57.0 | 18.8 | 9.8 |
| Age in Years | |||||
| 18–25 | 100.0 | 18.8 | 57.9 | 14.8 | 8.5 |
| 26–49 | 100.0 | 14.9 | 54.3 | 20.4 | 10.4 |
| 50 or older | 100.0 | 11.2 | 62.3 | 17.3 | 9.2 |
| Gender | |||||
| Male | 100.0 | 14.5 | 57.8 | 19.0 | 8.8 |
| Female | 100.0 | 14.4 | 56.7 | 18.7 | 10.3 |
| Hispanic Origin and Race | |||||
| Not Hispanic | 100.0 | 14.2 | 57.1 | 18.5 | 10.1 |
| White only | 100.0 | 13.8 | 57.4 | 18.4 | 10.4 |
| Black only | 100.0 | 21.0 | 51.1 | 20.6 | 7.4 |
| American Indian or Alaska Native only |
100.0 | * | * | * | * |
| Native Hawaiian or other Pacific Islander only |
100.0 | * | * | * | * |
| Asian only | 100.0 | * | * | * | * |
| More than one race | 100.0 | 8.5 | * | * | * |
| Hispanic | 100.0 | 17.3 | 55.7 | 21.8 | 5.3 |
| Education | |||||
| Less than high school | 100.0 | 18.2 | 54.8 | 19.0 | 8.0 |
| High school graduate | 100.0 | 17.2 | 58.9 | 15.7 | 8.2 |
| Some college | 100.0 | 14.2 | 57.5 | 17.8 | 10.4 |
| College graduate | 100.0 | 11.0 | 56.0 | 21.8 | 11.2 |
| Current Employment | |||||
| Full-time | 100.0 | 15.1 | 58.2 | 18.4 | 8.3 |
| Part-time | 100.0 | 12.8 | 56.4 | 19.9 | 11.0 |
| Unemployed | 100.0 | 12.9 | 57.2 | 17.4 | 12.5 |
| Not in the labor force1 | 100.0 | 14.2 | 55.3 | 19.0 | 11.6 |
| Marital Status | |||||
| Married | 100.0 | 15.0 | 61.4 | 15.5 | 8.0 |
| Widowed | 100.0 | * | * | * | * |
| Divorced or separated | 100.0 | 11.6 | 54.6 | 22.9 | 10.9 |
| Never married | 100.0 | 15.8 | 49.9 | 21.6 | 12.7 |
| Geographic Division | |||||
| Northeast | 100.0 | 13.5 | 51.4 | 22.3 | 12.9 |
| New England | 100.0 | 15.4 | 50.3 | 21.3 | 13.0 |
| Middle Atlantic | 100.0 | 12.4 | 51.9 | 22.8 | 12.9 |
| Midwest | 100.0 | 13.1 | 62.7 | 16.1 | 8.1 |
| East North Central | 100.0 | 14.2 | 60.2 | 18.9 | 6.7 |
| West North Central | 100.0 | 10.5 | 69.0 | 9.1 | 11.3 |
| South | 100.0 | 18.7 | 57.2 | 16.6 | 7.6 |
| South Atlantic | 100.0 | 16.8 | 58.3 | 18.1 | 6.8 |
| East South Central | 100.0 | 19.9 | 58.6 | 14.8 | 6.7 |
| West South Central | 100.0 | 21.7 | 54.1 | 14.6 | 9.6 |
| West | 100.0 | 10.9 | 56.1 | 21.3 | 11.7 |
| Mountain | 100.0 | 13.4 | 57.8 | 19.8 | 9.1 |
| Pacific | 100.0 | 9.8 | 55.3 | 22.0 | 12.9 |
| County Type | |||||
| Large metropolitan | 100.0 | 13.6 | 53.5 | 21.1 | 11.8 |
| Small metropolitan | 100.0 | 15.6 | 58.5 | 17.0 | 8.9 |
| 250,000 to 1,000,000 | 100.0 | 16.6 | 55.7 | 19.4 | 8.3 |
| <250,000 | 100.0 | 13.1 | 65.7 | 10.7 | 10.5 |
| Nonmetropolitan | 100.0 | 14.7 | 64.5 | 15.2 | 5.6 |
| Urbanized | 100.0 | 16.3 | 54.8 | 22.7 | 6.2 |
| Less urbanized | 100.0 | 14.8 | 69.1 | 11.1 | 5.0 |
| Completely rural | 100.0 | 9.9 | 68.4 | * | * |
| Family Income | |||||
| Less than $20,000 | 100.0 | 14.7 | 50.6 | 20.4 | 14.3 |
| $20,000 to $49,999 | 100.0 | 16.6 | 57.0 | 18.9 | 7.5 |
| $50,000 to $74,999 | 100.0 | 13.4 | 63.6 | 15.1 | 7.9 |
| $75,000 or more | 100.0 | 11.9 | 57.9 | 19.8 | 10.4 |
| Government Assistance2 | |||||
| Yes | 100.0 | 14.5 | 50.4 | 23.3 | 11.8 |
| No | 100.0 | 14.4 | 58.6 | 17.7 | 9.3 |
| Health Insurance | |||||
| Private | 100.0 | 14.4 | 59.0 | 18.1 | 8.5 |
| Medicaid/CHIP3 | 100.0 | 11.2 | 49.4 | 26.1 | 13.2 |
| Other4 | 100.0 | 12.7 | 58.2 | 16.7 | 12.4 |
| No coverage | 100.0 | 22.9 | 50.5 | 15.3 | 11.3 |
| Past Year Any Illicit Drug Use5 | |||||
| Yes | 100.0 | 13.2 | 51.4 | 23.2 | 12.2 |
| No | 100.0 | 14.7 | 58.4 | 17.7 | 9.2 |
| Overall Health | |||||
| Excellent | 100.0 | 12.8 | 58.9 | 18.6 | 9.7 |
| Very good | 100.0 | 15.7 | 57.6 | 17.8 | 8.9 |
| Good | 100.0 | 17.3 | 55.6 | 19.0 | 8.1 |
| Fair/poor | 100.0 | 10.4 | 56.0 | 20.1 | 13.5 |
| Demographic/Socioeconomic Characteristic | Total | Primary Payer for Outpatient Mental Health Treatment1 | |||||
|---|---|---|---|---|---|---|---|
| Self/Family | Medicaid | Medicare | Private Health Insurance | Some Other Type2 | Free Treatment | ||
| Total | 11,740 | 3,262 | 747 | 1,019 | 4,346 | 1,752 | 614 |
| Age in Years | |||||||
| 18–25 | 1,594 | 560 | 98 | 55 | 501 | 176 | 205 |
| 26–49 | 6,852 | 1,988 | 461 | 307 | 2,717 | 1,036 | 342 |
| 50 or older | 3,294 | 714 | 188 | 657 | 1,127 | 540 | 67 |
| Gender | |||||||
| Male | 3,985 | 1,181 | 217 | 417 | 1,271 | 699 | 200 |
| Female | 7,754 | 2,081 | 531 | 601 | 3,074 | 1,053 | 414 |
| Hispanic Origin and Race | |||||||
| Not Hispanic | 10,969 | 3,114 | 635 | 928 | 4,116 | 1,593 | 584 |
| White only | 9,779 | 2,910 | 427 | 748 | 3,811 | 1,394 | 488 |
| Black only | 801 | 112 | 168 | 138 | 186 | 132 | 65 |
| American Indian or Alaska Native only |
107 | * | * | * | * | * | * |
| Native Hawaiian or other Pacific Islander only |
11 | * | * | * | * | * | * |
| Asian only | 115 | * | * | * | * | * | * |
| More than one race | 156 | * | * | * | * | * | 3 |
| Hispanic | 771 | 148 | 112 | * | 230 | 159 | 30 |
| Education | |||||||
| Less than high school | 1,507 | 326 | 282 | 385 | 223 | 190 | 103 |
| High school graduate | 3,159 | 649 | 310 | 331 | 1,148 | 571 | 150 |
| Some college | 3,172 | 919 | 124 | 234 | 1,269 | 429 | 198 |
| College graduate | 3,902 | 1,368 | 32 | 70 | 1,706 | 563 | 163 |
| Current Employment | |||||||
| Full-time | 6,040 | 1,963 | 86 | 60 | 2,624 | 1,020 | 288 |
| Part-time | 1,831 | 621 | 104 | 92 | 678 | 216 | 121 |
| Unemployed | 345 | * | 34 | 9 | 131 | 50 | 36 |
| Not in the labor force3 | 3,524 | 592 | 523 | 859 | 914 | 467 | 169 |
| Marital Status | & | ||||||
