Patterns of Mental Health Service Utilization and Substance Use Among Adults, 2000 and 2001

3. Types of Mental Health Services Received

The past decade has seen significant changes in the patterns and approaches to mental health treatment in the United States. One study tracking trends in mental health and substance abuse service use between 1987 and 1996 found that outpatient visits increased by 29 percent, while inpatient stays did not change (Zuvekas, 2001). However, many such studies have considered mental health and substance abuse services together, and little is known about how service utilization has changed within the specialty mental health sector alone. The Epidemiologic Catchment Area (ECA) study estimated that 10.7 percent of the civilian adult population used outpatient mental health services during 1 year—5.6 percent in the specialty mental health sector and 6.4 percent in the general medical sector (Regier et al., 1993).

Further, little is known about how mental health service utilization overall or types of services vary among population subgroups. Most studies have examined correlates of use for only one type of service or service use among a particular population subgroup. However, one research group found no significant differences in the use of inpatient mental health services among racial/ethnic groups in an insured population after controlling for a number of covariates (Padgett et al., 1994a), but they found that blacks and Hispanics had less use of outpatient services than whites (Padgett et al., 1994b). This suggests that types of mental health services utilization may be associated with sociodemographic characteristics (Howard et al., 1996; Klinkenberg & Calsyn, 1998; Olfson, Pincus, & Sabshin, 1994).

Using data from the 2000 and 2001 National Household Survey on Drug Abuse (NHSDA), this chapter examines the past year prevalence of three types of mental health treatment: any inpatient, any outpatient, and any prescription medication. Also examined is the prevalence of four mutually exclusive categories of the three types of mental health treatments: outpatient only, outpatient and prescription medication only, prescription medication only, and any inpatient treatment (those receiving any inpatient treatment with or without other types of treatment).

3.1 Overall Prevalence of Mental Health Treatment in the U.S. Population, by Type of Treatment

In 2000 and 2001, 10.5 percent of the adult population in the United States, or 21.1 million adults, received mental health treatment. About 16.6 million adults (8.3 percent of the adult population) received prescription medication, almost 12 million (6.0 percent) received outpatient services, and about 1.5 million (0.7 percent) received inpatient services (Figure 3.1). These numbers add to more than 21.1 million because some persons received more than one type of treatment (see Figure 3.2).

Among those receiving mental health treatment, almost 80 percent received prescription medication and less than 60 percent received any outpatient treatment (Table  3.1). When considering mutually exclusive categories of treatment, the greatest proportion of treated adults (40.8 percent) received prescription medication only, followed by a combination of outpatient treatment and prescription medication only (33.1 percent), outpatient treatment only (19.0 percent), and any inpatient treatment (7.0 percent) (Figure 3.3).

Figure 3.1 Adults Receiving Mental Health Treatment in the Past Year

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Figure 3.2 Past Year Mental Health Treatment, by Type (with Numbers in Thousands)

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Figure 3.3 Mental Health Treatment in the Past Year, by Type (Mutually Exclusive Categories with Numbers in Thousands)

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3.2 Characteristics of the Population Receiving Specific Types of Mental Health Treatment

This section presents the demographic and socioeconomic characteristics of persons receiving each of the four mutually exclusive categories of mental health treatment noted in Figure 3.3. These data can be found in Table  3.2. An interesting pattern that emerges from the comparison of these four treatment groups is the differences in socioeconomic status (SES). In Figures 3.4 through 3.8, data are presented for two subgroups of a socioeconomic characteristic for each category of treatment. The percentages in the figures are the percentages of adults receiving each type of treatment who have the given characteristic (e.g., the percentage receiving outpatient treatment only who are college graduates). In general, the data show that those receiving outpatient only treatment had the highest SES, followed by those treated with both outpatient and prescription medication, then those treated with prescription medication only. Those who had been hospitalized for their mental health problems had the lowest SES.

3.2.1 Outpatient Treatment Only

Adults who received only outpatient treatment in the past year were more likely than recipients of any other category of treatment to have characteristics associated with high SES. These adults were more highly educated than those receiving other types of treatment (43.5 percent were college graduates and only 10.5 percent had less than a high school education). They had the highest rate of full-time employment (63.0 percent), were the least likely to be out of the labor force (16.7 percent), and were in families with the highest incomes (28.9 percent had incomes of $75,000 or more). They were the least likely to receive government assistance (12.3 percent) and the most likely to have private health insurance (81.3 percent).

Figure 3.4 Education Level, by Type of Treatment in the Past Year

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Figure 3.5 Employment Status, by Type of Treatment in the Past Year

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Figure 3.6 Family Income, by Type of Treatment in the Past Year

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Figure 3.7 Government Assistance, by Type of Treatment in the Past Year

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Figure 3.8 Health Insurance, by Type of Treatment in the Past Year

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Compared with recipients of the other types of treatment, these adults were younger (79.1 percent were under 50 years of age), were more likely to be from large metropolitan areas (56.5 percent), and were more likely to perceive their overall health as very good or excellent (66.0 percent).

3.2.2 Outpatient and Prescription Medication Only

Compared with adults receiving only outpatient treatment, adults who received treatment consisting of both outpatient care and prescription medication had less education (30.3 percent were college graduates), had a lower rate of full-time employment (48.7 percent), had lower family incomes (24.4 percent had incomes of $75,000 or more), and were less likely to have private health insurance coverage (73.8 percent). These adults had lower perceived overall health status (49.9 percent perceived their health as very good or excellent). While more females than males received every category of treatment, females had the highest representation in this category of treatment (69.8 percent).

3.2.3 Prescription Medication Only

When compared with those receiving all other categories of treatment, adults treated only with prescription medications were older (40.2 percent were aged 50 or older) and were the most likely to be married (56.9 percent).

3.2.4 Any Inpatient Treatment

Of the four categories of treatment described, recipients of any inpatient treatment had the lowest levels of the socioeconomic variables examined. They had less education (38.9 percent had less than a high school education and 7.2 percent were college graduates), lower rates of full-time employment (23.8 percent were employed full time, while 59.2 percent were out of the labor force), and lower incomes (46.4 percent had family incomes of less than $20,000). Almost half of these adults received government assistance (47.8 percent). They were less likely to have private health insurance (39.5 percent), and more than a third (36 percent) were covered by Medicaid or the Children's Health Insurance Program (CHIP).

Adults receiving any inpatient treatment were more likely to be black (18.4 percent) and more likely to be Hispanic (13.1 percent) compared with adults receiving other categories of treatment. Only 28.1 percent of these adults perceived their health as very good or excellent, and almost half (43.1 percent) perceived their health as fair or poor. This was the only category of treatment dominated by males (57.4 percent).

3.3 Prevalence of Specific Types of Mental Health Treatment among Persons in the Adult Population

This section presents percentages of the total adult population in the United States receiving the four categories of mental health treatment described in Section 3.2 (Table  3.3). These percentages are referred to as rates.

For three of the four categories of treatment, females had higher rates than males. Rates of outpatient-only treatment were 2.3 percent for females versus 1.7 percent for males; rates for outpatient and medication only were 4.7 versus 2.2 percent, respectively; and rates for prescription medication only were 5.4 versus 3.1 percent, respectively. However, the rate of inpatient treatment among females (0.8 percent) did not differ from that among males (0.7 percent).

Divorced or separated individuals were more likely than other marital status groups to receive each type of mental health treatment. Divorced or separated individuals were about twice as likely as married persons to receive outpatient treatment only (3.3 vs. 1.6 percent) or outpatient and prescription medication treatment (5.9 vs. 3.1 percent) and approximately 3 times as likely to receive any inpatient care (1.5 vs. 0.4 percent). With the exception of college graduates, whose rates of receipt of outpatient-only treatment and prescription medication-only treatment were essentially the same, all other sociodemographic groups had a higher rate of receiving medication only than outpatient treatment only. Table s 3.4 and 3.5 provide further data on the numbers and percentages of adults who received specific categories of mental health treatment among adults receiving treatment in the past year, by selected characteristics.

3.4 Summary

Most adults receiving any mental health treatment in 2000 and 2001 received prescription medication (80.0 percent), and more than 40 percent received prescription medication and no other treatment. The type of mental health treatment received varied by demographic and socioeconomic characteristics. Compared with adults receiving all other categories of treatment described, those receiving only outpatient treatment in the past year were more likely to be college graduates, to have family incomes of $75,000 or more, to be employed full time, to receive no government assistance, and to have private health insurance. Persons receiving inpatient treatment were more likely to have less than a high school education, to have a family income of less than $20,000, to be out of the labor force, and to be on government assistance or to receive Medicaid/CHIP. In addition, adults receiving only outpatient treatment in the past year were more likely to perceive their health as excellent, and those reporting any inpatient treatment in the past year were more likely to perceive their health as fair/poor.

Table 3.1 Percentages of Adults Who Received Specific Types of Mental Health Treatment among Those Receiving Treatment in the Past Year, by Selected Characteristics: 2000 and 2001

Table 3.2 Percent Distributions of Selected Characteristics among Adults Who Received Specific Categories of Mental Health Treatment in the Past Year: 2000 and 2001

Table 3.3 Percentages of Adults Receiving Specific Categories of Mental Health Treatment in the Past Year, by Selected Characteristics: 2000 and 2001

Table 3.4 Estimated Numbers (in Thousands) of Adults Who Received Mental Health Treatment in the Past Year, by Specific Categories of Treatment and Selected Characteristics: 2000 and 2001

Table 3.5 Percentages of Adults Who Received Specific Categories of Mental Health Treatment in the Past Year, by Selected Characteristics: 2000 and 2001

This page was last updated on June 16, 2008.

SAMHSA, an agency in the Department of Health and Human Services, is the Federal Government's lead agency for improving the quality and availability of substance abuse prevention, addiction treatment, and mental health services in the United States.