OVERVIEW OF THE MENTAL HEALTH SYSTEM

Who is Affected By Mental Illness?

One in every five adults, or about 40 million Americans, experiences some type of mental disorder every year. Of this number, more than one half--or 10 percent of the population-have serious mental illness, such as schizophrenia, major depression, or bipolar disorder.

Mental disorders cross all boundaries of race, gender and ethnicity, although recent data suggest that the prevalence of some disorders is higher for some population groups. For example, women and Hispanics are more likely than the average person to have experienced a major depressive episode within the last month. In addition, younger people--ages 15 to 24-- are more likely to have mental disorders than other age groups. Elderly Americans are the demographic group most likely to commit suicide.

Among children, it is estimated that one in every five children and adolescents may have a mental health problem that can be identified and treated. At least one in 20 children--or as many as 3 million children -- may have a serious emotional disturbance. This term refers to a mental health problem that severely disrupts a person's ability to function socially, academically and emotionally.

What Does the Mental Health System Look Like?

Caring for people with mental disorders involves a myriad of providers, services, and settings. Many people think immediately of psychiatrists (who are physicians specializing in the diagnosis and treatment of mental illnesses and are able to prescribe medication) and clinical psychologists (most of whom have doctorates in psychology and licensed as specialists in the diagnosis and treatment of mental disorders) when they consider the delivery of mental health services. But mental health services are also provided by licensed professional counselors, clinical social workers, psychiatric nurses, marriage and family therapists, physicians and nurse practitioners in family practice and other non-psychiatric specialties and other service providers such as occupational therapists, school counselors and school psychologists.

Services are tailored to best meet the needs of the person seeking assistance. These services range from medical services, including the prescribing of medications, to counseling and psychotherapy, to psychosocial rehabilitation services aimed at assisting people with mental illnesses, to services designed to help people with mental illnesses find employment or housing.

What Roles Do the Private and Public Sectors Play in Providing Mental Health Services?

Although mental disorders are typically as treatable as general medical conditions, the historic stigma and misunderstanding surrounding mental health treatment is still reflected in most private health insurance benefit packages, which unfairly and arbitrarily limit access to needed mental health services. Consequently, publicly-financed treatment continues to play a key role in the overall mental health service delivery system. Public sector spending accounts for approximately 56 percent of all mental health and substance abuse treatment services spending. In comparison, the public sector is the payor for 47 percent of total personal health care spending.

Most types of mental health services are available in both the private and public sectors, and mental health consumers often receive services in both sectors. Private providers may be non-profit or for-profit, and offer and array and services that include inpatient hospitalization, partial hospitalization, outpatient counseling and psychotherapy, and rehabilitation or other services available in communities.

The public mental health system, which serves 6.1 million people annually in all 50 states and 5 territories, also provides a range of impatient and outpatient mental health services. The public system often serves people who lack a private health insurance or whose private health insurance has bumped up against inpatient or outpatient visit limitations. The public system is administered by state mental health agencies and financed through state appropriations, Medicaid and small grant programs of the federal Substance Abuse and Mental Health Services Administration (SAMHSA). Many states rely on counties and county-based providers to deliver services in the community.

The public mental health system has undergone dramatic changes over the last three decades. On any day in 1970, more than half a million people received services as inpatients in state-operated psychiatric hospitals. Since that time, a growing body of evidence has demonstrated that most people with mental illnesses can be treated more effectively and at less cost in community settings than in traditional psychiatric hospitals. In response, states have moved rapidly to downsize and close state hospitals. In 1993, for the first time, state spending on community mental health services exceeded spending on state hospital inpatient services.

Although many people think of the 1970's and 1980's as the decades during which deinstitutionalization gained momentum, more than three times as many hospitals have been closed or downsized during the 1990's than during the two previous decades combined. Today, fewer than 70,000 people receive mental health services as inpatients in state hospitals.

How Is the Delivery of Mental Health Services Financed?