Anxiety Disorders
Panic DisorderPanic disorder affects about 2.4 million adult Americans and is twice as common in women as in men. A panic attack is a feeling of sudden terror that often occurs with a pounding heart, sweating, nausea, chest pain or smothering sensations and feelings of faintness or dizziness. Panic disorder frequently occurs in addition to other serious conditions like depression, drug abuse, or alcoholism. If left untreated, it may lead to a pattern of avoidance of places or situations where panic attacks have occurred. In about a third of cases, the threat of a panic attack becomes so overwhelming that a person may become isolated or housebound—a condition known as agoraphobia. Panic disorder is one of the most treatable of the anxiety disorders through medications or psychotherapy. Early treatment of panic disorder can help prevent agoraphobia.
Obsessive-Compulsive Disorder (OCD)
OCD affects about 3.3 million adult Americans, and occurs equally in men and women. It usually appears in childhood. Persons with OCD suffer from persistent and unwelcome anxious thoughts, and the result is the need to perform rituals to maintain control. For instance, a person obsessed with germs or dirt may wash his hands constantly. Feelings of doubt can make another person check on things repeatedly. Others may touch or count things or see repeated images that disturb them. These thoughts are called obsessions, and the rituals that are performed to try to prevent or get rid of them are called compulsions. Severe OCD can consume so much of a person's time and concentration that it interferes with daily life. OCD responds to treatment with medications or psychotherapy.
Post-Traumatic Stress Disorder (PTSD)
PTSD affects about 5.2 million adult Americans, but women are more likely than men to develop it. PTSD occurs after an individual experiences a terrifying event such as an accident, an attack, military combat, or a natural disaster. With PTSD, individuals relive their trauma through nightmares or disturbing thoughts throughout the day that may make them feel detached, numb, irritable, or more aggressive. Ordinary events can begin to cause flashbacks or terrifying thoughts. Some people recover a few months after the event, but other people will suffer lasting or chronic PTSD. People with PTSD can be helped by medications and psychotherapy.
Generalized Anxiety Disorder (GAD)
GAD affects about 4 million adult Americans and twice as many women as men. GAD is more than day-to-day anxiety. It fills an individual with an overwhelming sense of worry and tension. A person with GAD might always expect disaster to occur or worry a lot about health, money, family, or work. These worries may bring physical symptoms, especially fatigue, headaches, muscle tension, muscle aches, trouble swallowing, trembling, twitching, irritability, sweating, and hot flashes. People with GAD may feel lightheaded, out of breath, or nauseous, or might have to go to the bathroom often. When people have mild GAD, they may be able to function normally in social settings or on the job. If GAD is severe, however, it can be very debilitating. GAD is commonly treated with medications.
Social Anxiety Disorder
Social phobia affects about 5.3 million adult Americans. Women and men are equally likely to develop social phobia, which is characterized by an intense feeling of anxiety and dread about social situations. These individuals suffer a persistent fear of being watched and judged by others and being humiliated or embarrassed by their own actions. Social phobia can be limited to only one type of situation—fear of speaking in formal or informal situations, eating, drinking, or writing in front of others—or a person may experience symptoms any time they are around people. It may even keep people from going to work or school on some days, as physical symptoms such as blushing, profuse sweating, trembling, nausea, and difficulty talking often accompany the intense anxiety. Social phobia can be treated successfully with medications or psychotherapy.
Attention-Deficit/Hyperactivity Disorder (ADHD)
ADHD affects as many as 2 million American children and is a diagnosis applied to children and adults who consistently display certain characteristic behaviors over a period of time. The most common behaviors fall into three categories: inattention, hyperactivity, and impulsivity. People who are inattentive have a hard time keeping their mind on any one thing and may get bored with a task after only a few minutes. People who are hyperactive always seem to be in motion. They can't sit still and may dash around or talk incessantly. People who are overly impulsive seem unable to curb their immediate reactions or think before they act. Not everyone who is overly hyperactive, inattentive, or impulsive has an attention disorder. While the cause of ADHD is unknown, in the last decade, scientists have learned much about the course of the disorder and are now able to identify and treat children, adolescents, and adults who have it. A variety of medications, behavior-changing therapies, and educational options are already available to help people with ADHD focus their attention, build self-esteem, and function in new ways.
Depressive Disorders
About 18.8 million American adults experience a depressive illness that involves the body, mood, and thoughts. Depression affects the way a person eats and sleeps, the way one feels about oneself, and the way one thinks about things. People with a depressive illness cannot just "pull themselves together" and get better. Without treatment, symptoms can last for weeks, months, or years.
Depression can occur in three forms:
Major Depressive Disorder
Major depressive disorder involves a pervading sense of sadness and/or loss of interest or pleasure in most activities that interferes with the ability to work, study, sleep, eat, and enjoy once pleasurable activities. This is a severe condition that can impact a person's thoughts, sense of self worth, sleep, appetite, energy, and concentration. The condition can occur as a single debilitating episode or as recurring episodes.
Dysthymia
Dysthymia involves a chronic disturbance of mood in which an individual often feels little satisfaction with activities of life most of the time. Many people with dysthymia also experience major depressive episodes in their lives leading to a recurrent depressive disorder. The average length of an episode of dysthymia is about four years.
Bipolar Disorder
Bipolar Disorder, or manic-depressive illness, is a type of mood disorder characterized by recurrent episodes of highs (mania) and lows (depression) in mood. These episodes involve extreme changes in mood, energy, and behavior. Manic symptoms include extreme irritable or elevated mood; a very inflated sense of self-importance, risk behaviors, distractibility, increased energy, and a decreased need for sleep.
The most important thing to do for people with depression is to help them get an appropriate diagnosis and treatment. Treatment, usually in the form of medication or psychotherapy, can help people who suffer from depression.
*Do not ignore remarks about suicide.
If someone tells you they are thinking about suicide, you should take their distress seriously, listen, and help them get to a professional for evaluation and treatment. If someone is in immediate danger of harming himself or herself, do not leave the person alone. Take emergency steps to get help, such as calling 911. You can also call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255).
Eating Disorders
Anorexia Nervosa
People with this disorder see themselves as overweight despite their actual body weight. With this disorder, a person works to maintain a weight lower than normal for their age and height. This is accompanied by an intense fear of weight gain or looking fat. At times, a person can even deny the seriousness of their low body weight. Eating becomes an obsession and habits develop, such as avoiding meals, picking out a few foods and eating these in small quantities, or carefully weighing and portioning food. People with anorexia may repeatedly check their body weight, and many engage in other techniques to control their weight, like compulsive exercise or purging by vomiting or using laxatives. Some people fully recover after a single episode; some have a pattern of weight gain and relapse; and others experience a deteriorating course of illness over many years.
Bulimia Nervosa
Bulimia is characterized by episodes of binge eating—eating an excessive amount of food at once with a sense of lack of control over eating during the episode—followed by behavior in order to prevent weight gain, such as self-induced purging by vomiting or misuse of laxatives, diuretics, enemas, or other medications; fasting; or excessive exercise. Because purging or other compensatory behavior follows the binge-eating episodes, people with bulimia usually weigh within the normal range for their age and height. However, like individuals with anorexia, they may fear gaining weight, desire to lose weight, and feel dissatisfied with their bodies. People with bulimia often perform the behaviors in secrecy, feeling disgusted and ashamed when they binge, yet relieved once they purge.
Schizophrenia
More than 2 million Americans a year experience this disorder. It is equally common in men and women. Schizophrenia tends to appear earlier in men than in women, showing up in their late teens or early 20s as compared to their 20s or early 30s in women. Schizophrenia often begins with an episode of psychotic symptoms like hearing voices or believing that others are trying to control or harm you. The delusions— thoughts that are fragmented, bizarre, and have no basis in reality—may occur along with hallucinations and disorganized speech and behavior, leaving the individual frightened, anxious, and confused. There is no known single cause of schizophrenia. Treatment may include medications and psychosocial support like psychotherapy, self-help groups, and rehabilitation.
October 29, 2010
Genetic attribution for schizophrenia, depression, and skin cancer: impact on social distance.
Genetic attribution for schizophrenia, depression, and skin cancer: impact on social distance.
New Zealand Journal of Psychology| November 01, 2007 | Breheny, Mary | COPYRIGHT 1998New Zealand Psychological Society. This material is published under license from the publisher through the Gale Group, Farmington Hills, Michigan. All inquiries regarding rights should be directed to the Gale Group. (Hide copyright information)Copyright
Genetic explanations for mental and physical illness are increasingly common in both scientific research and in media reports generated from such research, however, the social impact of these explanations are less well understood. In this study it was predicted that both genetic attribution for illness and type of illness would be related to a desire for social distance. Participants were provided with a description of Jamie, who suffered from skin cancer, major depression, or schizophrenia. This illness was described as either having a strongly genetic basis, no genetic basis, or no causal explanation was provided. Participants then indicated their willingness to interact with Jamie using the Social Distance Scale. Type of illness described did significantly influence social distance score, with participants more willing to interact with Jamie when he was described as having skin cancer than schizophrenia or major depression. There was a significant interaction between illness type and genetic attribution for illness, with an increase in willingness to interact when schizophrenia was described as genetically caused and a decrease in willingness to interact when major depression was described as genetically caused. Genetic explanations may be suggested to reduce the stigma associated with mental illnesses, however, these explanations work in complex ways and may not uniformly reduce illness related stigma.
**********
The role o f genetics in determining health and wellbeing is increasingly discussed in scientific research (de Jong, 2000) and in media reports of such research (Conrad, 2001). The genetic component of complex traits is often investigated (de Jong, 2000), including the contribution of genetics to criminality (see Lowenstein, 2003; Martens, 2002; Retz, Retz-Junginger, Supprian, Thome & Rosler, 2004), and mental illness (see Thompson, Watson, Steinhauer, Goldstein & Pogue-Geile, 2005). Media representations contribute to lay explanations, and genetic factors are commonly identified as causing mental illness. Around two thirds of an Australian community sample attributed schizophrenia and depression to genetic causes (Jorm, Christensen & Griffiths, 2005). However, the impact of a claim of a genetic basis for complex psychological traits has received relatively little attention (Lemke, 2004), and may be a useful framework for understanding public attitudes towards those with mental illnesses (Zissi, 2006).
Genetic Attribution
Genetic explanations may influence understandings of human behaviour and the stigma associated with these behaviours (Phelan, 2005). Reframing mental illness as a brain disease with a genetic component has been suggested to reduce the stigma associated with mental illness; however, conversely, this may exacerbate experience of stigma (Bag, Yilmaz, Kirpinar, 2006; Corrigan & Watson, 2004). In support of this, Dietrich, Matschinger and Angermeyer (2006) found that biological or genetic causes of schizophrenia were associated with greater fear and reduced willingness to interact with people with schizophrenia. Phelan (2005) also found that genetic causes were associated with greater seriousness, persistence, and transmissibility of deviance. Research has found less blame attributed to those with genetically caused schizophrenia (Phelan, 2002), and less stigma associated with causes beyond the patients control, including genetic transmission (Martin, Pescosolido & Tuch, 2000; van't Veer, Kraan, Drosseart, & Modde, 2006). Phelan (2005) found some participants reported both reduced blame and increased associative stigma for genetically caused mental illnesses. Genetic causes for mental illness may have complex effects, ameliorating the blame associated with mental illness, bur increasing stigma.
Social Distance
Stigma is an attribute that discredits an individual, reducing them from a whole person to a discounted person in the eyes of others (Major & O'Brien, 2005). The evaluations of stigmatised others are widely shared, and are used as the basis for excluding or avoiding members of the discredited category (Major & O'Brien, 2005). Social distance is a way to assess attitudes towards those with a stigmatised identity, and is defined as the relative willingness to participate in relationships of varying intimacy with those who have a devalued social identity (Lauber, Nordt, Falcato & Rossler, 2004). Measures of social distance are widely used to assess attitudes to mental illness (Reinke, Corrigan, Leonhard, Lundin & Kubiak, 2004), by measuring participants' reported willingness to engage in relationships with a person described as having a particular illness (Lauber et al., 2004).
New Zealand Journal of Psychology| November 01, 2007 | Breheny, Mary | COPYRIGHT 1998New Zealand Psychological Society. This material is published under license from the publisher through the Gale Group, Farmington Hills, Michigan. All inquiries regarding rights should be directed to the Gale Group. (Hide copyright information)Copyright
Genetic explanations for mental and physical illness are increasingly common in both scientific research and in media reports generated from such research, however, the social impact of these explanations are less well understood. In this study it was predicted that both genetic attribution for illness and type of illness would be related to a desire for social distance. Participants were provided with a description of Jamie, who suffered from skin cancer, major depression, or schizophrenia. This illness was described as either having a strongly genetic basis, no genetic basis, or no causal explanation was provided. Participants then indicated their willingness to interact with Jamie using the Social Distance Scale. Type of illness described did significantly influence social distance score, with participants more willing to interact with Jamie when he was described as having skin cancer than schizophrenia or major depression. There was a significant interaction between illness type and genetic attribution for illness, with an increase in willingness to interact when schizophrenia was described as genetically caused and a decrease in willingness to interact when major depression was described as genetically caused. Genetic explanations may be suggested to reduce the stigma associated with mental illnesses, however, these explanations work in complex ways and may not uniformly reduce illness related stigma.
**********
The role o f genetics in determining health and wellbeing is increasingly discussed in scientific research (de Jong, 2000) and in media reports of such research (Conrad, 2001). The genetic component of complex traits is often investigated (de Jong, 2000), including the contribution of genetics to criminality (see Lowenstein, 2003; Martens, 2002; Retz, Retz-Junginger, Supprian, Thome & Rosler, 2004), and mental illness (see Thompson, Watson, Steinhauer, Goldstein & Pogue-Geile, 2005). Media representations contribute to lay explanations, and genetic factors are commonly identified as causing mental illness. Around two thirds of an Australian community sample attributed schizophrenia and depression to genetic causes (Jorm, Christensen & Griffiths, 2005). However, the impact of a claim of a genetic basis for complex psychological traits has received relatively little attention (Lemke, 2004), and may be a useful framework for understanding public attitudes towards those with mental illnesses (Zissi, 2006).
Genetic Attribution
Genetic explanations may influence understandings of human behaviour and the stigma associated with these behaviours (Phelan, 2005). Reframing mental illness as a brain disease with a genetic component has been suggested to reduce the stigma associated with mental illness; however, conversely, this may exacerbate experience of stigma (Bag, Yilmaz, Kirpinar, 2006; Corrigan & Watson, 2004). In support of this, Dietrich, Matschinger and Angermeyer (2006) found that biological or genetic causes of schizophrenia were associated with greater fear and reduced willingness to interact with people with schizophrenia. Phelan (2005) also found that genetic causes were associated with greater seriousness, persistence, and transmissibility of deviance. Research has found less blame attributed to those with genetically caused schizophrenia (Phelan, 2002), and less stigma associated with causes beyond the patients control, including genetic transmission (Martin, Pescosolido & Tuch, 2000; van't Veer, Kraan, Drosseart, & Modde, 2006). Phelan (2005) found some participants reported both reduced blame and increased associative stigma for genetically caused mental illnesses. Genetic causes for mental illness may have complex effects, ameliorating the blame associated with mental illness, bur increasing stigma.
Social Distance
Stigma is an attribute that discredits an individual, reducing them from a whole person to a discounted person in the eyes of others (Major & O'Brien, 2005). The evaluations of stigmatised others are widely shared, and are used as the basis for excluding or avoiding members of the discredited category (Major & O'Brien, 2005). Social distance is a way to assess attitudes towards those with a stigmatised identity, and is defined as the relative willingness to participate in relationships of varying intimacy with those who have a devalued social identity (Lauber, Nordt, Falcato & Rossler, 2004). Measures of social distance are widely used to assess attitudes to mental illness (Reinke, Corrigan, Leonhard, Lundin & Kubiak, 2004), by measuring participants' reported willingness to engage in relationships with a person described as having a particular illness (Lauber et al., 2004).
October 28, 2010
Mental Illness and How You Can Help
Mnetal Illness- How You Can Help
You can help just by being there and offering your reassurance, companionship, emotional strength and acceptance. You can make a difference just by understanding and supporting your friend throughout the course of his or her recovery and beyond. We're here to help you learn how.
Instead of blowing off a person's worries, express your interest and concern. Don't change the subject when a mental illness diagnosis comes up – ask questions, listen to ideas, and be responsive. Ask what you can do to help. If other people make insensitive remarks, don't ignore them – educate people so they understand the facts about mental illness. If someone you work with or go to school with has a mental illness, don't discriminate. Treat people with mental illness just as you would those with any other serious but treatable condition: with respect, compassion and empathy.
You can help just by being there and offering your reassurance, companionship, emotional strength and acceptance. You can make a difference just by understanding and supporting your friend throughout the course of his or her recovery and beyond. We're here to help you learn how.
Instead of blowing off a person's worries, express your interest and concern. Don't change the subject when a mental illness diagnosis comes up – ask questions, listen to ideas, and be responsive. Ask what you can do to help. If other people make insensitive remarks, don't ignore them – educate people so they understand the facts about mental illness. If someone you work with or go to school with has a mental illness, don't discriminate. Treat people with mental illness just as you would those with any other serious but treatable condition: with respect, compassion and empathy.
October 23, 2010
OCD
Obsessive Compulsive Disorder (OCD)
Many people are particular about this or that—they want things to be just so. People with obsessive-compulsive disorder, however, experience these feelings to an extreme extent. They must deal with persistent and unwelcome anxious thoughts (obsessions), which give rise to ritualistic practices (compulsions) that are intended to control the intruding thoughts. People may feel compelled to count objects or actions, check things repeatedly, or wash their hands over and over again. About 3.3 million Americans are living with OCD; men and women are equally affected. Severe cases can take up so much of a person's time and concentration that the actions of normal life are nearly impossible. There's a variety of treatment and support options that can be effective including psychotherapy, medications, and support groups as well as the acceptance and sensitive understanding of friends. If you have a friend with OCD, try to understand that the ideas and actions can't just be wished away. Remember, too, that understanding, respect, and support can help.
Many people are particular about this or that—they want things to be just so. People with obsessive-compulsive disorder, however, experience these feelings to an extreme extent. They must deal with persistent and unwelcome anxious thoughts (obsessions), which give rise to ritualistic practices (compulsions) that are intended to control the intruding thoughts. People may feel compelled to count objects or actions, check things repeatedly, or wash their hands over and over again. About 3.3 million Americans are living with OCD; men and women are equally affected. Severe cases can take up so much of a person's time and concentration that the actions of normal life are nearly impossible. There's a variety of treatment and support options that can be effective including psychotherapy, medications, and support groups as well as the acceptance and sensitive understanding of friends. If you have a friend with OCD, try to understand that the ideas and actions can't just be wished away. Remember, too, that understanding, respect, and support can help.
October 19, 2010
CEUs for Counselors Nationwide
Continuing education (CEU) courses offered
Aspira Continuing Education’s courses encompass all areas of mental health practice. Whether you are completing CEUs for your certification or maintain your license, our online continuing education courses provide the fastest, low cost, convenient way to fulfill your CEU requirements. We offer courses in the following subjects:
Aging and Long Term Care CEUs
Aging and Long Term Care (Abridged)
Alcoholism and Substance Abuse Dependency CEUs
Anger Management CEUs
Anxiety Disorders CEUs
Bipolar Disorder CEUs
Boundaries CEUs
Boundaries in Marriage CEUs
Child Abuse Assessment and Reporting CEUs
Childhood Traumatic Grief Curriculum CEU Course
Clinical Supervision and Professional Development CEUs
Cognitive Behavioral Therapy CEUs
Conflict Resolution CEUs
Crisis Counseling CEUs
Cultural Competency CEUs
Depressive Disorders CEUs
Family Therapy CEUs
From Panic to Power CEUs
Group Therapy CEUs
HIV and AIDS CEUs
How To Build a Thriving Fee-for-Service Practice CEUs
Human Sexuality CEUs
Law and Ethics CEUs
Managed Care CEUs
Mom's House, Dad's House CEUs
Panic Disorder CEUs
Post Traumatic Stress Disorder CEUs
Psychopharmacology CEUs
Spousal and Partner Abuse CEUs
Spousal and Partner Abuse (Abridged) CEU Course
Step-Wives CEUs
Suicide Prevention CEUs
The HIPAA Privacy Rule CEUs
Youth with Co-Occuring Substance Abuse and Mental Health Disorders CEUs
How Aspira Continuing Education CEU classes work
Aspira Continuing Education makes taking all of your CEUs quick and easy
Aspira Continuing Education’s courses encompass all areas of mental health practice. Whether you are completing CEUs for your certification or maintain your license, our online continuing education courses provide the fastest, low cost, convenient way to fulfill your CEU requirements. We offer courses in the following subjects:
Aging and Long Term Care CEUs
Aging and Long Term Care (Abridged)
Alcoholism and Substance Abuse Dependency CEUs
Anger Management CEUs
Anxiety Disorders CEUs
Bipolar Disorder CEUs
Boundaries CEUs
Boundaries in Marriage CEUs
Child Abuse Assessment and Reporting CEUs
Childhood Traumatic Grief Curriculum CEU Course
Clinical Supervision and Professional Development CEUs
Cognitive Behavioral Therapy CEUs
Conflict Resolution CEUs
Crisis Counseling CEUs
Cultural Competency CEUs
Depressive Disorders CEUs
Family Therapy CEUs
From Panic to Power CEUs
Group Therapy CEUs
HIV and AIDS CEUs
How To Build a Thriving Fee-for-Service Practice CEUs
Human Sexuality CEUs
Law and Ethics CEUs
Managed Care CEUs
Mom's House, Dad's House CEUs
Panic Disorder CEUs
Post Traumatic Stress Disorder CEUs
Psychopharmacology CEUs
Spousal and Partner Abuse CEUs
Spousal and Partner Abuse (Abridged) CEU Course
Step-Wives CEUs
Suicide Prevention CEUs
The HIPAA Privacy Rule CEUs
Youth with Co-Occuring Substance Abuse and Mental Health Disorders CEUs
How Aspira Continuing Education CEU classes work
Aspira Continuing Education makes taking all of your CEUs quick and easy
October 18, 2010
Marijuana Treatment Project
The Center for Substance Abuse Treatment (CSAT), part of the Substance Abuse and Mental Health Services Administration, funded three clinical sites and a Coordinating Center (CC) to design and implement the Marijuana Treatment Project (MTP) in the late 1990s. A major focus of CSAT is rigorous testing of approaches to treat marijuana dependence in both adults and adolescents. MTP studied the efficacy of treatments for adults who are dependent on marijuana. At the time of funding, MTP was one of the largest Knowledge Development and Applications initiatives funded by CSAT. Another was the Cannabis Youth Treatment (CYT) Study, which resulted
in the CYT Series, a five-volume resource that provides unique perspectives on treating adolescents for marijuana use (Godley et al. 2001; Hamilton et al. 2001; Liddle 2002; Sampl and Kadden 2001; Webb et al. 2002). This manual for Brief Marijuana Dependence Counseling (BMDC) is based on the research
protocol used by counselors in MTP. The manual provides guidelines for counselors, social workers, and psychologists in both public and private settings who treat adults dependent on marijuana.
The 10 weekly one-on-one sessions in the BMDC manual offer examples of how a counselor can help a client understand certain topics, keep his or her determination to change, learn new skills, and access needed community supports (exhibit I-1). Stephens and colleagues (2002) describe the MTP rationale, design, and participant characteristics. Findings from MTP are presented in supplemental reading B of section VII.
Me? Hooked on Pot?
Many individuals for whom this intervention was designed often have difficulty accepting that they are dependent on marijuana. The topic is controversial, even for those who walk through a counselor’s door to talk about their marijuana use.
People who become clients in BMDC may have
• Put off actions and decisions to the point of being a burden on family and friends
• Given up personal aspirations
• Had nagging health concerns, such as worries about lung damage
• Made excuses for unfinished tasks or broken promises
• Experienced disapproval from family and friends
• Been involved in the criminal justice system.
Current Findings About Marijuana Use
Marijuana is the most commonly used illicit substance in the United States (Clark et al. 2002; Substance Abuse and Mental Health Services Administration 2003). According to the 2003 National Survey on Drug Use and Health, 14.6 million people ages 12 and older had smoked marijuana in the preceding month (Substance Abuse and Mental Health Services Administration 2004). It is estimated that approximately 4.3 million people used marijuana at levels consistent with abuse or dependence in the past year. Given that it is an illicit substance, any use of marijuana carries with it some significant risks. However, this document focuses on people who use marijuana heavily or are dependent on it. This treatment manual is directed primarily at these
persons but may be useful for other persons with substance abuse or substance use disorders. Studies have demonstrated that tolerance and withdrawal develop with daily use of large doses of marijuana or THC (Haney et al. 1999a; Jones and Benowitz 1976; Kouri and Pope 2000). About 15 percent of people who acknowledge moderate-to-heavy use reported a withdrawal syndrome with symptoms of nervousness, sleep disturbance, and appetite change (Wiesbeck et al. 1996). Many adults who are marijuana dependent report affective (i.e., mood) symptoms and craving
during periods of abstinence when they present for treatment (Budney et al. 1999). The contribution of physical dependence to chronic marijuana use is not yet clear, but the existence of a dependence syndrome is fairly certain. An Epidemiological Catchment Area study conducted in Baltimore found that 6 percent of people who used marijuana met Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) (American Psychiatric Association 1994), criteria for dependence and 7 percent met DSM-IV criteria for substance abuse (Rosenberg and Anthony 2001). Coffey and colleagues (2002) found that persons who use marijuana more than
once a week are at significant risk for dependence. In the 1990s, the number of people who sought treatment for marijuana dependence more than doubled (Budney et al. 2001). Therefore, a large group of adults who smoke marijuana is dependent and may need and benefit from treatment. Surveys of people using marijuana who are not in treatment consistently show that a majority report impairment of memory, concentration, motivation, self-esteem, interpersonal relationships,
health, employment, or finances related to their heavy marijuana use (Haas and Hendin 1987;
Section I. Introduction
Rainone et al. 1987; Roffman and Barnhart 1987; Solowij 1998). Similar marijuana-related consequences are seen among those seeking treatment for their marijuana use (Budney et al. 1998; Stephens et al. 1994b, 2000). People using marijuana who participated in previous treatment studies averaged more than 10 years of near-daily use and more than six serious attempts to quit (Stephens et al. 1994b, 2000). These individuals had persisted in their use despite multiple forms of impairment (i.e., social, psychological, physical), and most perceived themselves as unable to stop.
During the past decade evidence has emerged that a variety of problems are associated with chronic marijuana use. Although the severity of these problems appears to be less than that of problems caused by other drugs and alcohol, the large number of people using who may have these problems raises the possibility of a significant public health problem. Like those who use other mood-altering substances, many individuals who use marijuana chronically perceive the
problems to be severe enough to warrant treatment. The results of earlier studies on treatments for marijuana problems indicated that some adults
who used marijuana responded well to several types of interventions, such as cognitive behavioral, motivational enhancement, and voucher-based treatments (Budney et al. 2000; Stephens et al. 1994b, 2000). Relapse rates following treatment were similar to those for other drugs of abuse and, as found with other types of substance abuse treatment, improvements in drug use were accompanied by other positive gains, including improvements in dependence symptoms, problems
related to marijuana use, and anxiety symptoms. However, the generalizability of the treatment findings appeared to be limited by the predominantly white, male, and socioeconomically stable (i.e., educated and employed) characteristics of the samples. Therefore, the results of these studies may be limited to this fairly homogeneous group of people who are marijuana users.
Overview of the Marijuana Treatment Project1
CSAT funded MTP to design and conduct a study of the efficacy of treatments for marijuana
dependence, to extend this line of research, and to broaden the applicability of the approach to a
more diverse group than that used in earlier trials (Stephens et al. 1994b, 2000). The treatment
sites were the University of Connecticut School of Medicine, Department of Psychiatry,
Farmington, Connecticut; The Village South, Miami, Florida; and the University of Washington,
School of Social Work, Seattle, Washington. The CC was at the University of Connecticut,
Department of Psychiatry.
The study examined the efficacy of treatments of different durations for a diverse group of adults who
were marijuana dependent. Two treatments—one lasting two sessions, the other nine sessions—
were compared with a delayed treatment control (DTC) condition, in which subjects were offered
treatment 4 months after their baseline assessment. The same counselors delivered treatments of
both durations to avoid confounding the mode of treatment, length of treatment, and counselor
experience. A case management component was incorporated in the longer treatment to help clients
identify and overcome barriers to successful behavior change in their everyday environments. The
hypothesis was the nine-session and two-session interventions would produce outcomes superior to
the DTC in terms of higher abstinence rates and associated negative consequences.
in the CYT Series, a five-volume resource that provides unique perspectives on treating adolescents for marijuana use (Godley et al. 2001; Hamilton et al. 2001; Liddle 2002; Sampl and Kadden 2001; Webb et al. 2002). This manual for Brief Marijuana Dependence Counseling (BMDC) is based on the research
protocol used by counselors in MTP. The manual provides guidelines for counselors, social workers, and psychologists in both public and private settings who treat adults dependent on marijuana.
The 10 weekly one-on-one sessions in the BMDC manual offer examples of how a counselor can help a client understand certain topics, keep his or her determination to change, learn new skills, and access needed community supports (exhibit I-1). Stephens and colleagues (2002) describe the MTP rationale, design, and participant characteristics. Findings from MTP are presented in supplemental reading B of section VII.
Me? Hooked on Pot?
Many individuals for whom this intervention was designed often have difficulty accepting that they are dependent on marijuana. The topic is controversial, even for those who walk through a counselor’s door to talk about their marijuana use.
People who become clients in BMDC may have
• Put off actions and decisions to the point of being a burden on family and friends
• Given up personal aspirations
• Had nagging health concerns, such as worries about lung damage
• Made excuses for unfinished tasks or broken promises
• Experienced disapproval from family and friends
• Been involved in the criminal justice system.
Current Findings About Marijuana Use
Marijuana is the most commonly used illicit substance in the United States (Clark et al. 2002; Substance Abuse and Mental Health Services Administration 2003). According to the 2003 National Survey on Drug Use and Health, 14.6 million people ages 12 and older had smoked marijuana in the preceding month (Substance Abuse and Mental Health Services Administration 2004). It is estimated that approximately 4.3 million people used marijuana at levels consistent with abuse or dependence in the past year. Given that it is an illicit substance, any use of marijuana carries with it some significant risks. However, this document focuses on people who use marijuana heavily or are dependent on it. This treatment manual is directed primarily at these
persons but may be useful for other persons with substance abuse or substance use disorders. Studies have demonstrated that tolerance and withdrawal develop with daily use of large doses of marijuana or THC (Haney et al. 1999a; Jones and Benowitz 1976; Kouri and Pope 2000). About 15 percent of people who acknowledge moderate-to-heavy use reported a withdrawal syndrome with symptoms of nervousness, sleep disturbance, and appetite change (Wiesbeck et al. 1996). Many adults who are marijuana dependent report affective (i.e., mood) symptoms and craving
during periods of abstinence when they present for treatment (Budney et al. 1999). The contribution of physical dependence to chronic marijuana use is not yet clear, but the existence of a dependence syndrome is fairly certain. An Epidemiological Catchment Area study conducted in Baltimore found that 6 percent of people who used marijuana met Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) (American Psychiatric Association 1994), criteria for dependence and 7 percent met DSM-IV criteria for substance abuse (Rosenberg and Anthony 2001). Coffey and colleagues (2002) found that persons who use marijuana more than
once a week are at significant risk for dependence. In the 1990s, the number of people who sought treatment for marijuana dependence more than doubled (Budney et al. 2001). Therefore, a large group of adults who smoke marijuana is dependent and may need and benefit from treatment. Surveys of people using marijuana who are not in treatment consistently show that a majority report impairment of memory, concentration, motivation, self-esteem, interpersonal relationships,
health, employment, or finances related to their heavy marijuana use (Haas and Hendin 1987;
Section I. Introduction
Rainone et al. 1987; Roffman and Barnhart 1987; Solowij 1998). Similar marijuana-related consequences are seen among those seeking treatment for their marijuana use (Budney et al. 1998; Stephens et al. 1994b, 2000). People using marijuana who participated in previous treatment studies averaged more than 10 years of near-daily use and more than six serious attempts to quit (Stephens et al. 1994b, 2000). These individuals had persisted in their use despite multiple forms of impairment (i.e., social, psychological, physical), and most perceived themselves as unable to stop.
During the past decade evidence has emerged that a variety of problems are associated with chronic marijuana use. Although the severity of these problems appears to be less than that of problems caused by other drugs and alcohol, the large number of people using who may have these problems raises the possibility of a significant public health problem. Like those who use other mood-altering substances, many individuals who use marijuana chronically perceive the
problems to be severe enough to warrant treatment. The results of earlier studies on treatments for marijuana problems indicated that some adults
who used marijuana responded well to several types of interventions, such as cognitive behavioral, motivational enhancement, and voucher-based treatments (Budney et al. 2000; Stephens et al. 1994b, 2000). Relapse rates following treatment were similar to those for other drugs of abuse and, as found with other types of substance abuse treatment, improvements in drug use were accompanied by other positive gains, including improvements in dependence symptoms, problems
related to marijuana use, and anxiety symptoms. However, the generalizability of the treatment findings appeared to be limited by the predominantly white, male, and socioeconomically stable (i.e., educated and employed) characteristics of the samples. Therefore, the results of these studies may be limited to this fairly homogeneous group of people who are marijuana users.
Overview of the Marijuana Treatment Project1
CSAT funded MTP to design and conduct a study of the efficacy of treatments for marijuana
dependence, to extend this line of research, and to broaden the applicability of the approach to a
more diverse group than that used in earlier trials (Stephens et al. 1994b, 2000). The treatment
sites were the University of Connecticut School of Medicine, Department of Psychiatry,
Farmington, Connecticut; The Village South, Miami, Florida; and the University of Washington,
School of Social Work, Seattle, Washington. The CC was at the University of Connecticut,
Department of Psychiatry.
The study examined the efficacy of treatments of different durations for a diverse group of adults who
were marijuana dependent. Two treatments—one lasting two sessions, the other nine sessions—
were compared with a delayed treatment control (DTC) condition, in which subjects were offered
treatment 4 months after their baseline assessment. The same counselors delivered treatments of
both durations to avoid confounding the mode of treatment, length of treatment, and counselor
experience. A case management component was incorporated in the longer treatment to help clients
identify and overcome barriers to successful behavior change in their everyday environments. The
hypothesis was the nine-session and two-session interventions would produce outcomes superior to
the DTC in terms of higher abstinence rates and associated negative consequences.
October 12, 2010
Care of Adults With Mental Health and Substance Abuse Disorders in U.S. Community Hospitals
Care of Adults With Mental Health and Substance Abuse Disorders in U.S. Community Hospitals, 2004
Executive Summary
Mental health and substance abuse (MHSA) disorders place a substantial burden on individuals, families, the health care system, and the economy. Beyond the personal costs of these conditions, mental illness and substance abuse result in lost productivity, increased medical expenditures, and other costs including those resulting from law enforcement activities.
Community hospitals play an important role in the treatment of individuals with MHSA disorders. For some of these patients, the MHSA disorder is the principal diagnosis, or the main reason for the hospital stay. For others, the MHSA disorder complicates a principal non-MHSA diagnosis and is listed on the hospital record as a secondary diagnosis. In 2004, 24 percent of stays in community hospitals were for patients with principal and/or secondary MHSA diagnoses.
In 2004, adults with a mental health and/or substance abuse diagnosis accounted for 1 out of 4 stays at U.S. community hospitals—7.6 million hospital stays.
This Fact Book examines community hospital care for adults 18 years of age and older with MHSA diagnoses. Community hospitals are non-Federal, short-term (or acute care) general and specialty hospitals. They include any type of hospital that is open to the public, such as academic medical centers, medical specialty hospitals, and public hospitals, but they do not include specialty psychiatric or substance abuse treatment facilities.
This Fact Book provides an overview of hospital stays involving MHSA disorders and addresses these key questions:
■What are the common reasons for hospitalization, by type and diagnosis?
■How do stays vary by gender and age?
■How are patients admitted to the hospital?
■What is the mean length of stay?
■How much do hospital stays cost?
■What percentage of hospital resource use is attributable to MHSA disorders?
■Who is billed for hospital stays?
■Where do patients go after they are discharged?
In addition, this Fact Book presents detailed statistics on three special topics related to MHSA hospitalizations:
■Dual diagnosis stays (i.e., the patient has both a substance-related and a mental health disorder).
■Stays related to suicide or attempted suicide.
■Maternal stays complicated by a mental health or substance abuse disorder.
Eleven mutually exclusive categories of MHSA disorders are examined in this Fact Book:
•Mood disorders.
•Substance-related disorders.
•Delirium, dementia, and amnestic and cognitive disorders.
•Anxiety disorders.
•Schizophrenia and other psychotic disorders.
•Personality disorders.
•Adjustment disorders.
•Disruptive behavior disorders.
•Impulse control disorders.
•Disorders usually diagnosed in infancy, childhood, and adolescence.
•Miscellaneous mental disorders.
What Are the Common Reasons for Hospitalization, by Type and Diagnosis?
In 2004, nearly 1 out of 4 hospital stays for adults in U.S. community hospitals involved MHSA disordersi—about 7.6 million hospitalizations. Of these, 1.9 million hospitalizations (6 percent of adult hospital stays) had a principal MHSA diagnosis and 5.7 million (18 percent) were primarily for non-MHSA diagnoses but had a secondary mental health or substance abuse diagnosis.
The top 5 MHSA diagnosesii seen in the hospital were mood disorders, substance-related disorders, delirium/dementia, anxiety disorders, and schizophrenia. One out of every 10 hospital stays included a diagnosis of mood disorders (over 3.3 million stays). One out of every 14 hospital stays included substance-related disorders (2.3 million stays). One out of every 20 stays was related to delirium/dementia (1.7 million stays).
--------------------------------------------------------------------------------
iBased on all-listed diagnoses.
iiBased on all-listed MHSA diagnoses.
--------------------------------------------------------------------------------
How Do Stays Vary by Gender and Age?
Gender
There were more MHSA-related hospital stays for women than for men. Although women comprised 51 percent of the U.S. adult population, they accounted for 58 percent of MHSA-related stays and 62 percent of non-MHSA stays. The most frequent MHSA diagnosis among hospitalized women was mood disorders. Substance abuse was the most frequent MHSA diagnosis in the hospital for men. Substance-related disorders were 3 times more common among hospitalized men than women.
Age
Older age groups accounted for a disproportionate share of hospital stays for MHSA disorders in 2004. For example, adults 80 and older comprised 5 percent of the U.S. adult population, yet they accounted for nearly 21 percent of MHSA hospital stays. In contrast, adults ages 18 to 44 comprised over half the total U.S. population, but accounted for 30 percent of MHSA hospital stays.
Among adults younger than 80, the most common MHSA diagnosis was mood disorders. Overall, 11 percent of stays for people 18-44 years of age, 13 percent of those 45-64 years of age, and 8 percent of those 65-79 years of age included a diagnosis of mood disorders. For adults 80 and older, delirium/dementia was the most common MHSA diagnosis; this disorder was noted in 21 percent of hospital stays for this age group, but mood disorders ranked second for this age group (8 percent of stays).
The second most common MHSA diagnosis for adults ages 18-64 was substance-related disorders, which was noted in about 10 percent of all hospital stays for this age group.
The distribution of age varied by the top 5 most common MHSA diagnoses. Almost half of all substance-related stays were for adults ages 18-44 while nearly all (93 percent) of the stays related to dementia/delirium were for adults age 65 and older.
One out of every 10 hospital stays included a diagnosis of mood disorders.
One out of every 14 hospital stays involved substance-related disorders.
The most frequent MHSA diagnosis among hospitalized women was mood disorders.
The most frequent MHSA diagnosis for men was substance-related disorders. Substance-related disorders were 3 times more common among hospitalized men than women.
Adults 80 and older comprised 5 percent of the U.S. adult population, yet they accounted for 21 percent of MHSA hospital stays.
How Are Patients Admitted to the Hospital?
Nearly 61 percent of MHSA-related admissions occur through the emergency department (ED) compared to only 45 percent of admissions with no MHSA diagnosis.
Adults with only secondary MHSA diagnoses were the most likely to be admitted through the ED—64 percent—compared with 51 percent for admissions with principal MHSA diagnoses only.
What Is the Mean Length of Stay?
Adults with any MHSA diagnosis (principal or secondary) stayed in the hospital longer than adults with non-MHSA diagnoses (5.8 versus 4.5 days). The difference was even more pronounced for adults with only a principal MHSA diagnosis—they stayed in the hospital an average of 8 days compared with 5 days for patients with non-MHSA diagnoses.
How Much Do Hospital Stays Cost?
Cost, by Type
The mean total cost for a hospital stay with any MHSA diagnosis ($7,800) was $1,100 lower than for stays with no MHSA diagnosis ($8,900). The mean cost per day for MHSA hospitalizations also was lower than for non-MHSA hospital stays—$1,600 per day compared with $2,300 per day—indicating that MHSA stays were less resource intensive.
The difference in cost was even more pronounced for adults with only a principal MHSA diagnosis. The mean total cost for a hospital stay with only a principal MHSA diagnosis was 39 percent lower than non-MHSA stays ($6,400 versus $8,900), and costs per day were 171 percent lower ($900 versus $2,300).
Cost, by Principal Diagnosis
Hospitalizations for the 5 most common principal MHSA diagnoses—mood disorder, schizophrenia, substance-related disorders, dementia/delirium, and anxiety disorders—cost $9.9 billion nationally.
The most common principal MHSA diagnosis—mood disorders—had the highest aggregate inpatient hospital costs of all MHSA diagnoses at $3.4 billion nationally in 2004. On a per stay basis, schizophrenia was the most expensive of the common principal MHSA diagnoses to treat at $8,000 per stay.
Hospitalizations for the 5 most common principal MHSA diagnoses cost $9.9 billion nationally.
About 33 percent of all uninsured stays, 29 percent of Medicaid stays, and 26 percent of Medicare stays were related to MHSA disorders, compared with only 16 percent of privately insured stays.
Over 66 percent of adult hospital stays with MHSA diagnoses were billed to the government in 2004.
Who Is Billed for Hospital Stays?
A large proportion of stays for the uninsured and for patients covered by Medicaid and Medicare were related to MHSA disorders. About 33 percent of all uninsured stays, 29 percent of Medicaid stays, and 26 percent of Medicare stays were related to MHSA disorders. On the other hand, only 16 percent of privately insured stays were related to MHSA disorders.
Expected Primary Payer, by Type
Over 66 percent of adult hospital stays with MHSA diagnoses were billed to the government in 2004. Medicaid was billed for 18 percent of all MHSA-related stays and Medicare was billed for 49 percent of all MHSA stays. In comparison, 57 percent of hospital stays with non-MHSA diagnoses were billed to the government.
Stays for patients with MHSA diagnoses were 36 percent more likely to be billed as uninsured than stays unrelated to MHSA diagnoses. Nearly 8 percent of MHSA stays were uninsured compared with about 5 percent of stays with non-MHSA diagnoses. Patients with both principal and secondary MHSA diagnoses were the most likely to be uninsured—nearly 13 percent compared with 5 percent for patients with non-MHSA diagnoses.
Only about 23 percent of stays with MHSA diagnoses were billed to private health insurance compared with about 37 percent of stays with non-MHSA diagnoses.
Expected Primary Payer, by Principal Diagnosis
Hospital stays related to schizophrenia and those associated with delirium/dementia were the most likely to be billed to the government. Over 78 percent of hospital stays for schizophrenia were billed to the government (35 percent to Medicaid and 44 percent to Medicare). Similarly, 90 percent of hospital stays for delirium/dementia were billed to the government (4 percent to Medicaid and 86 percent to Medicare). Schizophrenia is a qualifying disorder for Medicaid, and delirium/dementia is more frequent among the elderly who are covered by Medicare. In contrast, 53 percent of hospital stays for mood disorders and 52 percent of stays for substance-related disorders were billed to government payers.
Where Do Patients Go After They Are Discharged?
Adults with MHSA disorders were more likely to be transferred to non-acute health care facilities (which include psychiatric facilities, nursing homes, and rehabilitation centers) compared to those with non-MHSA diagnoses. Although only 11 percent of non-MHSA stays ended in transfers to non-acute facilities, 16 percent of stays for a principal MHSA diagnosis ended with such a transfer in 2004. Because of the large proportion of elderly patients with dementia as a secondary diagnosis, 27 percent of hospital stays with only secondary MHSA diagnoses ended with transfer to non-acute health care facilities.
Hospital stays that were principally for MHSA disorders were the least likely to be discharged to home health care. Only 2 percent of hospital stays for principal MHSA diagnoses ended in discharge to home health care, compared with 11 percent of stays with only secondary MHSA diagnoses and 10 percent of non-MHSA stays.
Over 78 percent of hospital stays for schizophrenia and 90 percent of hospital stays for delirium/dementia were billed to the government.
Hospital stays related to MHSA disorders accounted for roughly one-fourth of total resource use: 24 percent of all adult stays, 29 percent of days in the hospital, and 22 percent of total hospital costs.
About 3 percent of all hospital stays (nearly 1 million hospitalizations) involved dual diagnosis—both substance-related and mental health disorder.
Men and adults 18-44 are most likely to have a dual diagnosis—55 percent and 60 percent, respectively.
What Percentage of Hospital Resource Use Is Attributable to MHSA Disorders?
MHSA disorders accounted for roughly one-fourth of total resource use in 2004. MHSA disorders were involved in about 24 percent of all adult hospital stays, 29 percent of days in the hospital, and 22 percent of total hospital costs.
Dual Diagnosis Stays
A person with both a substance-related problem and a mental health disorder is considered to have a dual diagnosis. In 2004, nearly 1 million adult hospital stays involved a dual diagnosis—3 percent of all hospital stays. About 13 percent of all MHSA-related hospital stays involved a dual diagnosis.
Among dual diagnosis stays, 34 percent of patients had alcohol-related problems, 45 percent had drug-related problems, and 22 percent had both alcohol- and drug-related problems. The most frequent mental health disorder associated with substance-related problems was mood disorders (68 percent). All other mental health disorders were much less frequent. Anxiety disorders were seen in about 19 percent of hospital stays with a dual diagnosis and schizophrenia was seen in about 18 percent of these stays.
Most dually diagnosed inpatients were men and were younger. Fifty-five percent of stays with a dual diagnosis were for men, even though 41 percent of other MHSA stays and 38 percent of non-MHSA stays were for men. Similarly, nearly 60 percent of all dually diagnosed inpatients were ages 18-44, even though this age group comprised only 26 percent of other MHSA stays and 33 percent of adult non-MHSA hospital stays.
Hospital stays for dual diagnosis were more likely to be billed as uninsured or billed to Medicaid than to any other payer.
Suicide-Related Stays
In 2004, nearly 179,000 adult hospital stays were related to suicide or suicide attempts. By far, the most frequent mechanism of injury for suicide-related hospitalizations was poisoning. Nearly two-thirds of hospital stays for suicide attempts were a result of poisoning, while 1 in 10 hospital stays for suicide attempts was a result of cutting/piercing. Firearms were implicated in only 1 percent of suicide-related hospital stays.
Nearly all suicide-related hospital stays involved MHSA disorders (93 percent). The single most common MHSA diagnosis related to attempted suicide was mood disorders, which accounted for nearly 70 percent of all suicide-related stays.
Adults hospitalized for suicide attempt were younger than other patients. Most suicide-related hospital stays occurred among adults ages 18-44 (72 percent), followed by adults ages 45-64 (24 percent). Patients ages 65 and older made up less than 4 percent of all suicide-related stays. Uninsured stays and stays billed to Medicaid made up nearly half of all suicide-related hospitalizations. Even though only 5 percent of non-MHSA hospital stays were uninsured, 22 percent of suicide-related stays were uninsured. Nearly 13 percent of non-MHSA hospital stays were billed to Medicaid compared with 23 percent of suicide-related stays.
There were nearly 179,000 adult hospital stays related to suicide or suicide attempts.
Poisoning accounted for 2 out of 3 suicide-related stays—the most frequent mechanism of injury.
Most suicide-related stays (72 percent) were among adults 18-44.
Although only 5 percent of non-MHSA hospital stays were uninsured, 22 percent of suicide-related stays were uninsured.
Five percent of maternal hospital stays involved at least one MHSA disorder.
Medicaid was billed for 38 percent of non-MHSA-related maternal stays but almost 57 percent of MHSA-related maternal stays.
Maternal Stays
In 2004, nearly 4.6 million hospital stays were for women with maternal conditions and of these, 240,000 (5 percent) were complicated by at least one MHSA disorder. Women with MHSA disorders complicating a maternal stay were disproportionately younger, ages 18-24. Even though this group accounted for only 32 percent of non-MHSA-related maternal stays, they were responsible for 40 percent of all MHSA-related maternal stays.
Medicaid was much more likely to be billed for maternal stays complicated by MHSA disorders compared with all other payers. Medicaid was billed for 38 percent of non-MHSA-related maternal stays but almost 57 percent of maternal stays with MHSA disorders.
Return to Contents
Foreword
The mission of the Agency for Healthcare Research and Quality (AHRQ) is to improve the quality, safety, efficiency, and effectiveness of health care for all Americans. To help fulfill this mission, AHRQ develops a number of powerful databases, including those created by the Healthcare Cost and Utilization Project (HCUP). HCUP is a Federal-State-Industry partnership designed to build a standardized, multi-State health data system; HCUP features databases, software tools, and statistical reports to inform policymakers, health system leaders, and researchers.
For data to be useful, they must be disseminated in a timely, accessible way. To meet this objective, AHRQ launched HCUPnet, an interactive, Internet-based tool for identifying, tracking, analyzing, and comparing statistics on hospital utilization, outcomes, and charges (http://www.hcupnet.ahrq.gov/). Menu-driven HCUPnet guides users in tailoring specific queries about hospital care online; with a click of a button, users receive answers within seconds.
To make HCUP data even more accessible, AHRQ disseminates HCUP Statistical Briefs, an online publication series that presents simple, descriptive statistics on a variety of specific, focused topics (http://www.hcup-us.ahrq.gov/reports/statbriefs.jsp). Statistical Briefs are made available regularly throughout the year and have covered topics such as hospitalizations among the uninsured, the national bill for hospital care by payer, and hospitalizations related to childbirth.
In addition, AHRQ produces the HCUP Fact Books to highlight statistics about hospital care in the United States in an easy-to-use, readily accessible format. Each Fact Book provides information about specific aspects of hospital care—the single largest component of our health care dollar. These national estimates are benchmarks against which States and others can compare their own data.
This Fact Book examines inpatient care of mental health and substance abuse (MHSA) disorders. Because HCUP nationwide databases do not include data from long-term care facilities, specialty psychiatric hospitals, or substance-abuse treatment facilities, this report provides a detailed analysis of the treatment of these disorders in short-term, non-Federal, community hospitals. This Fact Book considers MHSA disorders among adults ages 18 and older and offers comprehensive statistics on special topics related to MHSA hospitalizations.
We invite you to tell us how you are using this Fact Book and other HCUP data and tools and to share suggestions on how HCUP products might be enhanced to further meet your needs. Please e-mail us at hcup@ahrq.gov or send a letter to the address below.
Irene Fraser, Ph.D.
Director
Center for Delivery, Organization, and Markets
Agency for Healthcare Research and Quality
540 Gaither Road
Rockville, MD 20850
Return to Contents
Contributors
HCUP is based on data collected by individual State Partner organizations (including State departments of health, hospital associations, and private agencies). These organizations provide the data to AHRQ where the data are converted to uniform data products. Without the participation of the following Partner organizations, HCUP and the 2004 Nationwide Inpatient Sample (NIS) would not be possible:
•Arkansas Department of Health & Human Services
•Arizona Department of Health Services
•California Office of Statewide Health Planning & Development
•Colorado Health and Hospital Association
•Connecticut Integrated Health Information (Chime, Inc.)
•Florida Agency for Health Care Administration
•Georgia Hospital Association (GHA)
•Hawaii Health Information Corporation
•Illinois Department of Public Health
•Indiana Hospital & Health Association
•Iowa Hospital Association
•Kansas Hospital Association
•Kentucky Cabinet for Health and Family Services
•Maryland Health Services Cost Review Commission
•Massachusetts Division of Health Care Finance and Policy
•Michigan Health & Hospital Association
•Minnesota Hospital Association
•Missouri Hospital Industry Data Institute
•Nebraska Hospital Association
•Nevada Department of Human Resources
•New Hampshire Department of Health and Human Services
•New Jersey Department of Health & Senior Services
•New York State Department of Health
•North Carolina Department of Health and Human Services
•Ohio Hospital Association
•Oregon Association of Hospitals and Health Systems
•Rhode Island Department of Health
•South Carolina State Budget & Control Board
•South Dakota Association of Healthcare Organizations
•Tennessee Hospital Association
•Texas Department of State Health Services
•Utah Department of Health
•Vermont Association of Hospitals and Health Systems
•Virginia Health Information
•Washington State Department of Health
•West Virginia Health Care Authority
•Wisconsin Department of Health & Family Services
Return to Contents
Introduction
For those diagnosed with mental health and/or substance abuse (MHSA) disorders, social relationships are strained, and the ability to perform at school and work is impaired. Many are too debilitated to work. The loss of wages is a burden on families and the loss of labor negatively impacts the economy. Moreover, the financial burden of treatment for these chronic conditions is substantial.1-2
Although an untold number of individuals who suffer from MHSA disorders will go untreated, for those who do receive care, treatment settings are varied. Some will seek care in outpatient or ambulatory settings, where the majority of specialty MHSA care takes place. Others will need more intense treatment in an inpatient setting—community hospitals or long-term, residential facilities. With the continued drop in psychiatric beds in specialty facilities, community hospitals have become the primary source of short-term inpatient care.1, 3
This Fact Book examines community hospital stays for adults with MHSA disorders in 2004. MHSA disorders examined in this Fact Book include:
•Mood disorders.
•Substance-related disorders.
•Delirium, dementia, and amnestic and cognitive disorders.
•Anxiety disorders.
•Schizophrenia and other psychotic disorders.
•Personality disorders.
•Adjustment disorders.
•Disruptive behavior disorders.
•Impulse control disorders.
•Disorders usually diagnosed in infancy, childhood or adolescence.
•Miscellaneous mental disorders.
In addition, several special topics are addressed, such as dual diagnosis, hospitalizations for suicide attempt, and maternal stays complicated by MHSA disorders.
Information on data sources and methods are available at the end of the Fact Book. A glossary contains MHSA terms used in this Fact Book. Appendix A provides information on the mapping of diagnostic codes to MHSA disorders. Appendix B provides more detailed information on hospital stays for specific principal MHSA disorders. Appendix C highlights common principal and secondary diagnoses by gender and age.
Treatment in Community Versus Specialty Hospitals
This Fact Book presents information on MHSA stays in U.S. community hospitals, which are defined by the American Hospital Association as “all non-Federal, short-term (or acute care) general and specialty hospitals.”4 Although community hospitals include any type of hospital that is open to the public, such as academic medical centers, medical specialty hospitals, and public hospitals, they do not include specialty psychiatric or substance abuse treatment facilities.
■In 2004, nearly all community hospitals in the United States (98.0 percent) provided care to patients with MHSA disorders.
■Almost one-fourth of adult stays in community hospitals (23.8 percent) involved a MHSA disorder.
■Almost 10 times as many patients with MHSA disorders—7.6 million—were seen in community hospitals as in psychiatric facilities.
■Although specialty psychiatric facilities provided nearly 27 million days of care annually, community hospitals provided over 44 million days of care to patients with MHSA disorders.
■Stays in community hospitals were considerably shorter than stays in specialty facilities. The mean length of stay for MHSA disorders was 5.8 days in community hospitals compared to 33.0 days in specialty psychiatric facilities.
Executive Summary
Mental health and substance abuse (MHSA) disorders place a substantial burden on individuals, families, the health care system, and the economy. Beyond the personal costs of these conditions, mental illness and substance abuse result in lost productivity, increased medical expenditures, and other costs including those resulting from law enforcement activities.
Community hospitals play an important role in the treatment of individuals with MHSA disorders. For some of these patients, the MHSA disorder is the principal diagnosis, or the main reason for the hospital stay. For others, the MHSA disorder complicates a principal non-MHSA diagnosis and is listed on the hospital record as a secondary diagnosis. In 2004, 24 percent of stays in community hospitals were for patients with principal and/or secondary MHSA diagnoses.
In 2004, adults with a mental health and/or substance abuse diagnosis accounted for 1 out of 4 stays at U.S. community hospitals—7.6 million hospital stays.
This Fact Book examines community hospital care for adults 18 years of age and older with MHSA diagnoses. Community hospitals are non-Federal, short-term (or acute care) general and specialty hospitals. They include any type of hospital that is open to the public, such as academic medical centers, medical specialty hospitals, and public hospitals, but they do not include specialty psychiatric or substance abuse treatment facilities.
This Fact Book provides an overview of hospital stays involving MHSA disorders and addresses these key questions:
■What are the common reasons for hospitalization, by type and diagnosis?
■How do stays vary by gender and age?
■How are patients admitted to the hospital?
■What is the mean length of stay?
■How much do hospital stays cost?
■What percentage of hospital resource use is attributable to MHSA disorders?
■Who is billed for hospital stays?
■Where do patients go after they are discharged?
In addition, this Fact Book presents detailed statistics on three special topics related to MHSA hospitalizations:
■Dual diagnosis stays (i.e., the patient has both a substance-related and a mental health disorder).
■Stays related to suicide or attempted suicide.
■Maternal stays complicated by a mental health or substance abuse disorder.
Eleven mutually exclusive categories of MHSA disorders are examined in this Fact Book:
•Mood disorders.
•Substance-related disorders.
•Delirium, dementia, and amnestic and cognitive disorders.
•Anxiety disorders.
•Schizophrenia and other psychotic disorders.
•Personality disorders.
•Adjustment disorders.
•Disruptive behavior disorders.
•Impulse control disorders.
•Disorders usually diagnosed in infancy, childhood, and adolescence.
•Miscellaneous mental disorders.
What Are the Common Reasons for Hospitalization, by Type and Diagnosis?
In 2004, nearly 1 out of 4 hospital stays for adults in U.S. community hospitals involved MHSA disordersi—about 7.6 million hospitalizations. Of these, 1.9 million hospitalizations (6 percent of adult hospital stays) had a principal MHSA diagnosis and 5.7 million (18 percent) were primarily for non-MHSA diagnoses but had a secondary mental health or substance abuse diagnosis.
The top 5 MHSA diagnosesii seen in the hospital were mood disorders, substance-related disorders, delirium/dementia, anxiety disorders, and schizophrenia. One out of every 10 hospital stays included a diagnosis of mood disorders (over 3.3 million stays). One out of every 14 hospital stays included substance-related disorders (2.3 million stays). One out of every 20 stays was related to delirium/dementia (1.7 million stays).
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iBased on all-listed diagnoses.
iiBased on all-listed MHSA diagnoses.
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How Do Stays Vary by Gender and Age?
Gender
There were more MHSA-related hospital stays for women than for men. Although women comprised 51 percent of the U.S. adult population, they accounted for 58 percent of MHSA-related stays and 62 percent of non-MHSA stays. The most frequent MHSA diagnosis among hospitalized women was mood disorders. Substance abuse was the most frequent MHSA diagnosis in the hospital for men. Substance-related disorders were 3 times more common among hospitalized men than women.
Age
Older age groups accounted for a disproportionate share of hospital stays for MHSA disorders in 2004. For example, adults 80 and older comprised 5 percent of the U.S. adult population, yet they accounted for nearly 21 percent of MHSA hospital stays. In contrast, adults ages 18 to 44 comprised over half the total U.S. population, but accounted for 30 percent of MHSA hospital stays.
Among adults younger than 80, the most common MHSA diagnosis was mood disorders. Overall, 11 percent of stays for people 18-44 years of age, 13 percent of those 45-64 years of age, and 8 percent of those 65-79 years of age included a diagnosis of mood disorders. For adults 80 and older, delirium/dementia was the most common MHSA diagnosis; this disorder was noted in 21 percent of hospital stays for this age group, but mood disorders ranked second for this age group (8 percent of stays).
The second most common MHSA diagnosis for adults ages 18-64 was substance-related disorders, which was noted in about 10 percent of all hospital stays for this age group.
The distribution of age varied by the top 5 most common MHSA diagnoses. Almost half of all substance-related stays were for adults ages 18-44 while nearly all (93 percent) of the stays related to dementia/delirium were for adults age 65 and older.
One out of every 10 hospital stays included a diagnosis of mood disorders.
One out of every 14 hospital stays involved substance-related disorders.
The most frequent MHSA diagnosis among hospitalized women was mood disorders.
The most frequent MHSA diagnosis for men was substance-related disorders. Substance-related disorders were 3 times more common among hospitalized men than women.
Adults 80 and older comprised 5 percent of the U.S. adult population, yet they accounted for 21 percent of MHSA hospital stays.
How Are Patients Admitted to the Hospital?
Nearly 61 percent of MHSA-related admissions occur through the emergency department (ED) compared to only 45 percent of admissions with no MHSA diagnosis.
Adults with only secondary MHSA diagnoses were the most likely to be admitted through the ED—64 percent—compared with 51 percent for admissions with principal MHSA diagnoses only.
What Is the Mean Length of Stay?
Adults with any MHSA diagnosis (principal or secondary) stayed in the hospital longer than adults with non-MHSA diagnoses (5.8 versus 4.5 days). The difference was even more pronounced for adults with only a principal MHSA diagnosis—they stayed in the hospital an average of 8 days compared with 5 days for patients with non-MHSA diagnoses.
How Much Do Hospital Stays Cost?
Cost, by Type
The mean total cost for a hospital stay with any MHSA diagnosis ($7,800) was $1,100 lower than for stays with no MHSA diagnosis ($8,900). The mean cost per day for MHSA hospitalizations also was lower than for non-MHSA hospital stays—$1,600 per day compared with $2,300 per day—indicating that MHSA stays were less resource intensive.
The difference in cost was even more pronounced for adults with only a principal MHSA diagnosis. The mean total cost for a hospital stay with only a principal MHSA diagnosis was 39 percent lower than non-MHSA stays ($6,400 versus $8,900), and costs per day were 171 percent lower ($900 versus $2,300).
Cost, by Principal Diagnosis
Hospitalizations for the 5 most common principal MHSA diagnoses—mood disorder, schizophrenia, substance-related disorders, dementia/delirium, and anxiety disorders—cost $9.9 billion nationally.
The most common principal MHSA diagnosis—mood disorders—had the highest aggregate inpatient hospital costs of all MHSA diagnoses at $3.4 billion nationally in 2004. On a per stay basis, schizophrenia was the most expensive of the common principal MHSA diagnoses to treat at $8,000 per stay.
Hospitalizations for the 5 most common principal MHSA diagnoses cost $9.9 billion nationally.
About 33 percent of all uninsured stays, 29 percent of Medicaid stays, and 26 percent of Medicare stays were related to MHSA disorders, compared with only 16 percent of privately insured stays.
Over 66 percent of adult hospital stays with MHSA diagnoses were billed to the government in 2004.
Who Is Billed for Hospital Stays?
A large proportion of stays for the uninsured and for patients covered by Medicaid and Medicare were related to MHSA disorders. About 33 percent of all uninsured stays, 29 percent of Medicaid stays, and 26 percent of Medicare stays were related to MHSA disorders. On the other hand, only 16 percent of privately insured stays were related to MHSA disorders.
Expected Primary Payer, by Type
Over 66 percent of adult hospital stays with MHSA diagnoses were billed to the government in 2004. Medicaid was billed for 18 percent of all MHSA-related stays and Medicare was billed for 49 percent of all MHSA stays. In comparison, 57 percent of hospital stays with non-MHSA diagnoses were billed to the government.
Stays for patients with MHSA diagnoses were 36 percent more likely to be billed as uninsured than stays unrelated to MHSA diagnoses. Nearly 8 percent of MHSA stays were uninsured compared with about 5 percent of stays with non-MHSA diagnoses. Patients with both principal and secondary MHSA diagnoses were the most likely to be uninsured—nearly 13 percent compared with 5 percent for patients with non-MHSA diagnoses.
Only about 23 percent of stays with MHSA diagnoses were billed to private health insurance compared with about 37 percent of stays with non-MHSA diagnoses.
Expected Primary Payer, by Principal Diagnosis
Hospital stays related to schizophrenia and those associated with delirium/dementia were the most likely to be billed to the government. Over 78 percent of hospital stays for schizophrenia were billed to the government (35 percent to Medicaid and 44 percent to Medicare). Similarly, 90 percent of hospital stays for delirium/dementia were billed to the government (4 percent to Medicaid and 86 percent to Medicare). Schizophrenia is a qualifying disorder for Medicaid, and delirium/dementia is more frequent among the elderly who are covered by Medicare. In contrast, 53 percent of hospital stays for mood disorders and 52 percent of stays for substance-related disorders were billed to government payers.
Where Do Patients Go After They Are Discharged?
Adults with MHSA disorders were more likely to be transferred to non-acute health care facilities (which include psychiatric facilities, nursing homes, and rehabilitation centers) compared to those with non-MHSA diagnoses. Although only 11 percent of non-MHSA stays ended in transfers to non-acute facilities, 16 percent of stays for a principal MHSA diagnosis ended with such a transfer in 2004. Because of the large proportion of elderly patients with dementia as a secondary diagnosis, 27 percent of hospital stays with only secondary MHSA diagnoses ended with transfer to non-acute health care facilities.
Hospital stays that were principally for MHSA disorders were the least likely to be discharged to home health care. Only 2 percent of hospital stays for principal MHSA diagnoses ended in discharge to home health care, compared with 11 percent of stays with only secondary MHSA diagnoses and 10 percent of non-MHSA stays.
Over 78 percent of hospital stays for schizophrenia and 90 percent of hospital stays for delirium/dementia were billed to the government.
Hospital stays related to MHSA disorders accounted for roughly one-fourth of total resource use: 24 percent of all adult stays, 29 percent of days in the hospital, and 22 percent of total hospital costs.
About 3 percent of all hospital stays (nearly 1 million hospitalizations) involved dual diagnosis—both substance-related and mental health disorder.
Men and adults 18-44 are most likely to have a dual diagnosis—55 percent and 60 percent, respectively.
What Percentage of Hospital Resource Use Is Attributable to MHSA Disorders?
MHSA disorders accounted for roughly one-fourth of total resource use in 2004. MHSA disorders were involved in about 24 percent of all adult hospital stays, 29 percent of days in the hospital, and 22 percent of total hospital costs.
Dual Diagnosis Stays
A person with both a substance-related problem and a mental health disorder is considered to have a dual diagnosis. In 2004, nearly 1 million adult hospital stays involved a dual diagnosis—3 percent of all hospital stays. About 13 percent of all MHSA-related hospital stays involved a dual diagnosis.
Among dual diagnosis stays, 34 percent of patients had alcohol-related problems, 45 percent had drug-related problems, and 22 percent had both alcohol- and drug-related problems. The most frequent mental health disorder associated with substance-related problems was mood disorders (68 percent). All other mental health disorders were much less frequent. Anxiety disorders were seen in about 19 percent of hospital stays with a dual diagnosis and schizophrenia was seen in about 18 percent of these stays.
Most dually diagnosed inpatients were men and were younger. Fifty-five percent of stays with a dual diagnosis were for men, even though 41 percent of other MHSA stays and 38 percent of non-MHSA stays were for men. Similarly, nearly 60 percent of all dually diagnosed inpatients were ages 18-44, even though this age group comprised only 26 percent of other MHSA stays and 33 percent of adult non-MHSA hospital stays.
Hospital stays for dual diagnosis were more likely to be billed as uninsured or billed to Medicaid than to any other payer.
Suicide-Related Stays
In 2004, nearly 179,000 adult hospital stays were related to suicide or suicide attempts. By far, the most frequent mechanism of injury for suicide-related hospitalizations was poisoning. Nearly two-thirds of hospital stays for suicide attempts were a result of poisoning, while 1 in 10 hospital stays for suicide attempts was a result of cutting/piercing. Firearms were implicated in only 1 percent of suicide-related hospital stays.
Nearly all suicide-related hospital stays involved MHSA disorders (93 percent). The single most common MHSA diagnosis related to attempted suicide was mood disorders, which accounted for nearly 70 percent of all suicide-related stays.
Adults hospitalized for suicide attempt were younger than other patients. Most suicide-related hospital stays occurred among adults ages 18-44 (72 percent), followed by adults ages 45-64 (24 percent). Patients ages 65 and older made up less than 4 percent of all suicide-related stays. Uninsured stays and stays billed to Medicaid made up nearly half of all suicide-related hospitalizations. Even though only 5 percent of non-MHSA hospital stays were uninsured, 22 percent of suicide-related stays were uninsured. Nearly 13 percent of non-MHSA hospital stays were billed to Medicaid compared with 23 percent of suicide-related stays.
There were nearly 179,000 adult hospital stays related to suicide or suicide attempts.
Poisoning accounted for 2 out of 3 suicide-related stays—the most frequent mechanism of injury.
Most suicide-related stays (72 percent) were among adults 18-44.
Although only 5 percent of non-MHSA hospital stays were uninsured, 22 percent of suicide-related stays were uninsured.
Five percent of maternal hospital stays involved at least one MHSA disorder.
Medicaid was billed for 38 percent of non-MHSA-related maternal stays but almost 57 percent of MHSA-related maternal stays.
Maternal Stays
In 2004, nearly 4.6 million hospital stays were for women with maternal conditions and of these, 240,000 (5 percent) were complicated by at least one MHSA disorder. Women with MHSA disorders complicating a maternal stay were disproportionately younger, ages 18-24. Even though this group accounted for only 32 percent of non-MHSA-related maternal stays, they were responsible for 40 percent of all MHSA-related maternal stays.
Medicaid was much more likely to be billed for maternal stays complicated by MHSA disorders compared with all other payers. Medicaid was billed for 38 percent of non-MHSA-related maternal stays but almost 57 percent of maternal stays with MHSA disorders.
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Foreword
The mission of the Agency for Healthcare Research and Quality (AHRQ) is to improve the quality, safety, efficiency, and effectiveness of health care for all Americans. To help fulfill this mission, AHRQ develops a number of powerful databases, including those created by the Healthcare Cost and Utilization Project (HCUP). HCUP is a Federal-State-Industry partnership designed to build a standardized, multi-State health data system; HCUP features databases, software tools, and statistical reports to inform policymakers, health system leaders, and researchers.
For data to be useful, they must be disseminated in a timely, accessible way. To meet this objective, AHRQ launched HCUPnet, an interactive, Internet-based tool for identifying, tracking, analyzing, and comparing statistics on hospital utilization, outcomes, and charges (http://www.hcupnet.ahrq.gov/). Menu-driven HCUPnet guides users in tailoring specific queries about hospital care online; with a click of a button, users receive answers within seconds.
To make HCUP data even more accessible, AHRQ disseminates HCUP Statistical Briefs, an online publication series that presents simple, descriptive statistics on a variety of specific, focused topics (http://www.hcup-us.ahrq.gov/reports/statbriefs.jsp). Statistical Briefs are made available regularly throughout the year and have covered topics such as hospitalizations among the uninsured, the national bill for hospital care by payer, and hospitalizations related to childbirth.
In addition, AHRQ produces the HCUP Fact Books to highlight statistics about hospital care in the United States in an easy-to-use, readily accessible format. Each Fact Book provides information about specific aspects of hospital care—the single largest component of our health care dollar. These national estimates are benchmarks against which States and others can compare their own data.
This Fact Book examines inpatient care of mental health and substance abuse (MHSA) disorders. Because HCUP nationwide databases do not include data from long-term care facilities, specialty psychiatric hospitals, or substance-abuse treatment facilities, this report provides a detailed analysis of the treatment of these disorders in short-term, non-Federal, community hospitals. This Fact Book considers MHSA disorders among adults ages 18 and older and offers comprehensive statistics on special topics related to MHSA hospitalizations.
We invite you to tell us how you are using this Fact Book and other HCUP data and tools and to share suggestions on how HCUP products might be enhanced to further meet your needs. Please e-mail us at hcup@ahrq.gov or send a letter to the address below.
Irene Fraser, Ph.D.
Director
Center for Delivery, Organization, and Markets
Agency for Healthcare Research and Quality
540 Gaither Road
Rockville, MD 20850
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Contributors
HCUP is based on data collected by individual State Partner organizations (including State departments of health, hospital associations, and private agencies). These organizations provide the data to AHRQ where the data are converted to uniform data products. Without the participation of the following Partner organizations, HCUP and the 2004 Nationwide Inpatient Sample (NIS) would not be possible:
•Arkansas Department of Health & Human Services
•Arizona Department of Health Services
•California Office of Statewide Health Planning & Development
•Colorado Health and Hospital Association
•Connecticut Integrated Health Information (Chime, Inc.)
•Florida Agency for Health Care Administration
•Georgia Hospital Association (GHA)
•Hawaii Health Information Corporation
•Illinois Department of Public Health
•Indiana Hospital & Health Association
•Iowa Hospital Association
•Kansas Hospital Association
•Kentucky Cabinet for Health and Family Services
•Maryland Health Services Cost Review Commission
•Massachusetts Division of Health Care Finance and Policy
•Michigan Health & Hospital Association
•Minnesota Hospital Association
•Missouri Hospital Industry Data Institute
•Nebraska Hospital Association
•Nevada Department of Human Resources
•New Hampshire Department of Health and Human Services
•New Jersey Department of Health & Senior Services
•New York State Department of Health
•North Carolina Department of Health and Human Services
•Ohio Hospital Association
•Oregon Association of Hospitals and Health Systems
•Rhode Island Department of Health
•South Carolina State Budget & Control Board
•South Dakota Association of Healthcare Organizations
•Tennessee Hospital Association
•Texas Department of State Health Services
•Utah Department of Health
•Vermont Association of Hospitals and Health Systems
•Virginia Health Information
•Washington State Department of Health
•West Virginia Health Care Authority
•Wisconsin Department of Health & Family Services
Return to Contents
Introduction
For those diagnosed with mental health and/or substance abuse (MHSA) disorders, social relationships are strained, and the ability to perform at school and work is impaired. Many are too debilitated to work. The loss of wages is a burden on families and the loss of labor negatively impacts the economy. Moreover, the financial burden of treatment for these chronic conditions is substantial.1-2
Although an untold number of individuals who suffer from MHSA disorders will go untreated, for those who do receive care, treatment settings are varied. Some will seek care in outpatient or ambulatory settings, where the majority of specialty MHSA care takes place. Others will need more intense treatment in an inpatient setting—community hospitals or long-term, residential facilities. With the continued drop in psychiatric beds in specialty facilities, community hospitals have become the primary source of short-term inpatient care.1, 3
This Fact Book examines community hospital stays for adults with MHSA disorders in 2004. MHSA disorders examined in this Fact Book include:
•Mood disorders.
•Substance-related disorders.
•Delirium, dementia, and amnestic and cognitive disorders.
•Anxiety disorders.
•Schizophrenia and other psychotic disorders.
•Personality disorders.
•Adjustment disorders.
•Disruptive behavior disorders.
•Impulse control disorders.
•Disorders usually diagnosed in infancy, childhood or adolescence.
•Miscellaneous mental disorders.
In addition, several special topics are addressed, such as dual diagnosis, hospitalizations for suicide attempt, and maternal stays complicated by MHSA disorders.
Information on data sources and methods are available at the end of the Fact Book. A glossary contains MHSA terms used in this Fact Book. Appendix A provides information on the mapping of diagnostic codes to MHSA disorders. Appendix B provides more detailed information on hospital stays for specific principal MHSA disorders. Appendix C highlights common principal and secondary diagnoses by gender and age.
Treatment in Community Versus Specialty Hospitals
This Fact Book presents information on MHSA stays in U.S. community hospitals, which are defined by the American Hospital Association as “all non-Federal, short-term (or acute care) general and specialty hospitals.”4 Although community hospitals include any type of hospital that is open to the public, such as academic medical centers, medical specialty hospitals, and public hospitals, they do not include specialty psychiatric or substance abuse treatment facilities.
■In 2004, nearly all community hospitals in the United States (98.0 percent) provided care to patients with MHSA disorders.
■Almost one-fourth of adult stays in community hospitals (23.8 percent) involved a MHSA disorder.
■Almost 10 times as many patients with MHSA disorders—7.6 million—were seen in community hospitals as in psychiatric facilities.
■Although specialty psychiatric facilities provided nearly 27 million days of care annually, community hospitals provided over 44 million days of care to patients with MHSA disorders.
■Stays in community hospitals were considerably shorter than stays in specialty facilities. The mean length of stay for MHSA disorders was 5.8 days in community hospitals compared to 33.0 days in specialty psychiatric facilities.
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