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Patterns
of Mental Health Service Utilization and Substance Use Among Adults, 2000
and 2001
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Highlights
The National Household Survey on Drug Abuse (NHSDA) is the largest survey of its kind in the United States. The survey has been conducted since 1971 and is the primary source of information on substance use and abuse in the civilian, noninstitutionalized population. The sample size was greatly increased starting in 1999, resulting in interviews each year with about 70,000 people aged 12 or older, including 45,000 adults aged 18 or older. Beginning in 2000, the survey included measures of treatment for mental health problems other than substance use. Current data on patterns of mental health service use and the characteristics of persons receiving treatment are critical for policy-makers and service providers in the mental health service delivery system.
This report presents data for respondents aged 18 or older from the combined 2000 and 2001 NHSDA and is therefore the largest nationally representative study of the prevalence of mental health treatment and substance use among adults to date. Annual average estimates presented include the prevalence of mental health treatment among adults, the types of treatment received, and the characteristics of persons receiving treatment, including their substance use, abuse, and treatment for problems with substance use. Selected findings are given below.
Prevalence and Types of Mental Health Treatment
- In 2000 and 2001, an annual average of 21.1 million adults, or 10.5 percent of the U.S. population aged 18 or older, received treatment for a mental or emotional problem within the past 12 months. Over 16.5 million (8.3 percent of the adult population) received prescription medication to treat a mental or emotional problem, almost 12 million (6.0 percent) were treated on an outpatient basis, and about 1.5 million (0.7 percent) were hospitalized for mental health treatment. Persons may have received more than one type of treatment. (Tables 2.1 and 2.2)
- Among approximately 12 million adults who received outpatient treatment in the year prior to the interview, the majority (57.1 percent) were seen in private therapists' offices (includes private therapists, psychologists, psychiatrists, social workers, and counselors); 19.4 percent were seen in doctors' offices, 19.4 percent in outpatient mental health centers, and 12.3 percent in some other place (e.g., outpatient medical clinic, partial day hospital or day treatment program). Persons may have received treatment in more than one location. (Tables 4.1 and 4.2)
- Adults seen in private therapists' offices had the highest levels of income, education, and self-perceived health status. Those seen in doctors' offices were older than those seen in other places, had lower incomes, and less education than those seen in private therapists' offices. Those treated in outpatient mental health centers were younger, had the lowest incomes and educational attainment, were more likely to use illicit drugs, and had the lowest self-perceived health status. (Tables 4.1, 4.2, and 4.3)
- Almost 44 percent of the 1.5 million adults who were hospitalized for mental health treatment in the past year spent 5 or more nights in such facilities. (Table 5.1)
- The more than 16.5 million adults receiving prescription medication to treat their mental or emotional problems represent most (78.9 percent) of the 21.1 million adults receiving any mental health treatment in the past year. (Tables 2.1 and 3.1)
- Among adults receiving mental health treatment in the past year, most obtained only prescription medication (40.8 percent), 19.0 percent obtained only outpatient treatment, 33.1 percent obtained outpatient and prescription medication only, and 7.0 percent were hospitalized. (Table 3.5)
- Among adults receiving mental health treatment in the past year, the percentage of blacks receiving inpatient treatment was about 3½ times the percentage of whites, and the percentage of Hispanics receiving inpatient treatment was almost 3 times the percentage of whites. The percentage receiving outpatient treatment was about the same for blacks, whites, and Hispanics. (Table 3.1)
Substance Use and Mental Health Treatment
- Adults with alcohol dependence or abuse in the past year were almost 3 times more likely (18.6 percent) to have had mental health treatment than past month heavy drinkers who did not have dependence or abuse (6.8 percent), and their rate of treatment was almost 2½ times that of those who had never used alcohol in their lifetime (7.6 percent). (Table 6.1)
- Adults with marijuana dependence or abuse were almost 3 times more likely (22.9 percent) than those who had never used marijuana (7.9 percent) to have received mental health treatment in the past year. They also had higher rates of treatment than persons who used marijuana in their lifetime but not in the past year (14.6 percent), past year users who were not heavy users and did not have dependence or abuse (15.6 percent), and heavy users who did not have marijuana dependence or abuse (14.0 percent). (Table 6.1)
- Adults with dependence on or abuse of illicit drugs other than marijuana were more than 4 times more likely (34.7 percent) than those who had never used these other illicit drugs (8.2 percent) to have received mental health treatment in the past year. They were 1 1/2 times as likely to have received mental health treatment as heavy users of illicit drugs other than marijuana who did not have dependence or abuse (19.0 percent). They were more than twice as likely to have received mental health treatment as those who used illicit drugs other than marijuana in their lifetime but did not use in the past year or who used in the past year but not heavily and did not have dependence or abuse (16.7 and 15.8 percent, respectively). (Table 6.1)
- Adults who had received substance abuse treatment had 2 to 5 times higher rates of past year mental health treatment than adults who never had substance abuse treatment. Rates of mental health treatment ranged from 21.2 percent for those who had treatment in their lifetimes (but not in the past year) to 49.3 percent for those who had both drug and alcohol treatment in the past year, compared with 9.7 percent of adults who never had substance abuse treatment. (Table 6.2)
- About 1.3 million adults received only treatment for a substance abuse problem, 1 million received treatment for both mental health and substance abuse problems, and 20 million were treated only for a mental health problem in the past year. (Table 6.3)
Perceived Unmet Need for Treatment
- Among adults not receiving mental health treatment in the past year, 2.4 percent (4.3 million) had perceived an unmet need for such treatment at some time during the year. (Table 7.1)
- Among adults receiving mental health treatment in the past year, 18.9 percent (4.0 million) had perceived an unmet need for treatment at some time during the year. Unmet need among those receiving treatment may be interpreted as delayed or insufficient care. (Table 7.1)
Insurance and Payment for Mental Health Services
- Nearly three quarters (72.6 percent) of adults receiving mental health treatment had private health insurance, while 8.3 percent had no insurance coverage in the past year. (Table 2.3)
- Among adults receiving outpatient treatment, 74.0 percent had private health insurance. However, among these persons with private insurance, fewer than half (47.4 percent) reported private insurance as the primary payer for their outpatient treatment. (Tables 2.3 and 4.7)
- Of the 4.3 million adults who did not receive treatment but perceived an unmet need for treatment, 22.3 percent had no health insurance. (Table 7.2)
