Drug Use and Mental Health in the United States

I had another plan for my second blog post but was alerted to the publication of the 2011 National Survey on Drug Use and Health: Mental Health findings by a client. I found this a timely publication to comment on as, in private practice, I am faced this week with trying to find a way to get a patient into residential care when his insurance company won’t cover the treatment that he really needs.

The National Survey on Drug Use and Health is a survey that the government conducts each year. This survey has been part of the federal government data collection since 1971. At present, the current study gathers data through face to face interviews and computer assisted personal interviewing.

This is a numbers and data heavy 130 page document. One might wonder what the practical implication is to knowing these numbers. As a clinician and advocate for mental health and addiction treatment, it informs me as to what problems people are dealing with. It also provides some insight into the reasons why people don’t seek treatment. As an advocate, this provides avenues for possible education and change to allow more people who need treatment, access to that treatment.

All of this information is taken directly from the study:

How many Americans are dealing with mental illness and how many Americans are getting treatment? The study breaks down mental health issues into several categories. First they look at Any Mental Illness. For a person to fit this category, they had to have a diagnosable mental, behavioral and emotional disorder as determined by the DSM-IV. The second category is Serious Mental Illness. In order to be categorized as a Serious Mental Illness, the person had to have a diagnosable DSM-IV illness that seriously impaired functioning. Additionally, when looking at mental illness, the survey also looked at suicidal behavior.

In 2011, 45.6 million American adults suffered from any mental illness. Of these adults, the highest percentages of adults were aged 18 to 25 years old and women were more likely to have any mental illness than men. Not surprisingly, any mental illness was higher among people who were unemployed. A finding that I found interesting given my work with those in the criminal justice system involved any mental illness among those on probation or parole. For those adults who were on probation, 39% had any mental illness in 2011 compared to 19.2 percent of those people not on probation. Those people who were on parole also had a higher incidence of any mental illness than those people not on parole (29.5% compared to 19.5%).

When one looks at Serious Mental Illness, there were approximately 11.5 million adults suffering from a serious mental health condition in 2011. This prevalence was highest among adults 18 to 25 and was also more prevalent in women than in men. Similarly to any mental illness, serious mental illness was more prevalent in those not employed.

In addition to looking at prevalence of illness, the study looked at who is using mental health services and in what fashion. As it turns out, in 2011, those persons aged 26 to 49 were the biggest consumers of mental health services. Women were also more likely to use mental health service than men. When it comes to insurance, 14.6 percent of adults with private health insurance used services while 13.1 percent with no health insurance also used services. People also most commonly used medication (11.5) with many less people (6.7%) using out patient services such as a therapist.

When the study looked at how outpatient services are being paid for an interesting result emerged. 37.9% of consumers used private insurance and 33.7% used self-payment. Medicare and Medicaid were the source of funding in much fewer cases, 15.2 and 11.9% respectively. This is an interesting finding in light of the public debates on funding mental health for Medicare and Medicaid users. Another interesting finding given recent health care debates revolves around unmet need for mental health services. The survey found that there were 10.8 million adult Americans who reported unmet needs for mental health services. The biggest reason cited for this unmet need was an inability to afford the cost of mental healthcare. An additional 16.2% did not know where to go for care. For those with insurance, 8.3% found that their health insurance did not cover enough care and 6.7% had health insurance that did not cover any treatment at all. This information has implications for public outreach and policy change.

One of the more interesting sections of the report for me, working in the addiction field, looks at the co-occurrence of mental illness and substance use. It is widely known that mental health issues and addiction go together frequently. The incidence of illicit drug use is 13.4% higher in adults with mental health issues than in adults without mental health issues. Those with mental health issues were also more likely to be heavy alcohol users as well. Another interesting finding is that 27.6% of adults were considered to be binge drinkers when their alcohol consumption was studied over a one month period.
The interaction between substance use disorders and mental health issues is profound. The survey found that 18.9 million adults qualified for a substance use disorder in the past year. 42.3% of these adults had a mental health issue. This statistic is highest for those aged 18-25 years old and is higher for men than for women. Therefore, when treating someone with a substance disorder, it is imperative that clinicians also be assessing any co-occurring mental health issues in order to best help our clients.

So, again, I come to what is the point of knowing this information? First, it is my hope that those in positions of power or authority in organizations that both fund and treat mental health and substance issues will take this information seriously. Approximately 19 million of the nearly 314 million residents of the United States struggle with addiction issues. These numbers also just represent the statistics for drug and alcohol addictions and do not take into account addiction issues such as gambling, food or sex addiction.