Mental Health Care / The U.S. is Amazing

Additional uplifting info from the Federal Government is available at Health & Human Services website. Be sure to take your antidepressant meds before reading.


Agency for Healthcare Resources and Quality.

Access to/Cost of Care

Access to mental health care is an ongoing problem for people in rural/frontier areas of the country as well as many other groups. For example, 4 percent of young adults reported foregoing mental health care in the past year, despite self-reported mental health needs. Commonly cited reasons ranged from inability to pay, belief that the problem would go away, and lack of time. Cost of mental health care is also a burden. For example, individuals nationwide spent an average of 10 percent of their family’s annual income out of pocket for mental health/substance abuse treatment. Also, mental disorders were one of the five most costly conditions in the United States in 2006, with expenditures at $57.5 billion. (The curious fact – there is no accountability for the effectiveness of treatment. Like public school teachers in the U.S., tracking of performance by outcome is “not acceptable.”)

Mental disorders were one of the five most costly conditions for children in 2006.

  • The five most costly children’s conditions in 2006 were mental disorders, asthma, trauma-related disorders (fractures and other injuries), acute bronchitis, and infectious diseases, according to the latest data from AHRQ . Treating mental disorders in children, such as depression, cost the most at $8.9 billion compared with $8 billion for asthma and $6.1 billion for trauma-related disorders. Mean expenditures per child with expenses were highest for mental disorders at $1,931. Medicaid paid for more than one-third of the expenditures for mental disorders (35.2 percent), with private insurance paying the largest percentage of expenditures. Out-of-pocket payments were highest for mental disorders at 21.3 percent. These data are taken from the Medical Expenditure Panel Survey (MEPS), a detailed source of information on U.S. health services use, cost, and sources of payment. For more information, see MEPS Statistical Brief #242, The Five Most Costly Children’s Conditions, 2006: Estimates for the U.S. Civilian Noninstitutionalized Children, Ages 0 to 17, at Software Help) (Americans think that costs paid by insurance are “free” – but payments are a hidden tax on everyone: price of care, pharmaceuticals, insurance premiums, advertising, paperwork, ++ continue to skyrocket, while access to quality care, or any care in many locations is vanishing, if it ever existed.)

“Always the dollars…always the fucking dollars” –

Nicky Santoro, Casino

  • Mental disorders led the list of the five most costly conditions overall in 2006.Mental disorders, heart conditions, cancer, trauma-related disorders, and asthma ranked highest in terms of direct medical spending in 1996 and 2006, according to the latest data from AHRQ. The number of people accounting for expenses for mental disorders nearly doubled from 19.3 million to 36.2 million during that period. Of the five conditions, out-of-pocket payments were highest for the treatment of mental disorders in both 1996 and 2006 (23.1 and 25 percent, respectively). These data are taken from the Medical Expenditure Panel Survey (MEPS), a detailed source of information on U.S. health services use, cost, and sources of payment. For more information, see MEPS Statistical Brief #248, The Five Most Costly Conditions, 1996 and 2006: Estimates for the U.S. Civilian Noninstitutionalized Population, at (Plugin Software Help)
  • People with psychotic disorders and bipolar disorder are 45 percent and 26 percent less likely, respectively, to have a primary care doctor than those without mental disorders. Researchers compared access and barriers to medical care among 156,475 adults reporting psychotic and mood disorders or no mental disorders, who completed the National Health Interview Survey (NHIS) and NHIS-Disability Component for 1994 and 1995. People with psychotic disorders, bipolar disorder, or major depressive disorder had 2.5 to 7 times greater odds of barriers to care, ranging from delaying medical care because of costs to being unable to get needed medical care or a needed prescription medication. However, those with major depression were as likely to report having a regular source of care as those who did not report psychiatric disorders. Bradford, Kim, Braxton, and others, “Access to medical care among persons with psychotic and major affective disorders,” Psychiatric Services 59(8), pp. 847-852, 2008 (AHRQ grant HS13353).
  • Young adults’ mental health problems are compounded by the number of barriers they face when accessing medical care.Four percent of young adults reported foregoing mental health care in the past year, despite self-reported mental health needs. Commonly cited reasons ranged from inability to pay, belief that the problem would go away, and lack of time. Among individuals suffering from depressive symptoms, young adults reported significantly lower rates of counseling use than adolescents. Female gender, high maternal education, school attendance, and receipt of routine physical exams were significantly predictive of counseling use among young adults. Young black adults were significantly less likely to receive counseling than their white counterparts. These findings were based on analysis of data from a sample of 10,817 participants in the National Longitudinal Study of Adolescent Health in 1995 and follow-up data 7 years later. Yu, Adams, Burns, et al., “Use of mental health counseling as adolescents become young adults,” Journal of Adolescent Health 43:268-276, 2008 (AHRQ grant HS00086).
  • A quality improvement (QI) program that improves access to psychotherapy (QI-therapy) and antidepressant medication (QI-meds) is cost-effective for managing depression in primary care patients.The researchers examined the cost effectiveness of managing care of 746 primary care patients with 12-month depressive disorder and 502 patients with current depressive symptoms but no disorder (sub-threshold depression). The patients were randomly assigned to enhanced usual care or to QI-Meds or QI-Therapy for 6 to 12 months.The cost of the QI program was $2,028 per quality-adjusted life year (QALY) for those with sub-threshold depression and $53,716 per QALY for those with depressive disorder. This is similar to the cost effectiveness of many widely used medical therapies. The researchers calculated that the costs of the intervention per se — as distinct from intervention effects on use of services and medication — were $86 per patient in the QI-Meds group and $79 per patient in the QI-Therapy group. Wells, Schoenbaum, Duan, et al., “Cost effectiveness of quality improvement programs for patients with subthreshold depression or depressive disorder,” Psychiatric Services 58(10):1269-1278, 2007 (AHRQ grant HS08349). (Aye, yay, yai! “Care and Treatment” are bizarre word concepts that have nothing to do with actual “care and treatment” but become abstract financial fictions: and costs keep skyrocketing.)
  • Southerners bear a higher financial burden for mental health/substance abuse treatment.About 11 percent of people using outpatient mental health and substance abuse (MH/SA) treatment in the South used more than 5 percent of their family’s annual income to cover their out-of-pocket treatment costs from 2001 to 2005. Southerners paid the highest percentage of treatment costs out of their own pockets because they were most likely to use prescription medications for their treatment and they paid the greatest share (39 percent) of the costs of these medications. For other regions of the country, between 8 and 10 percent of MH/SA treatment recipients spent more than 5 percent of their family’s annual income, and 10 percent did nationwide. Patient out-of-pocket costs included fees for psychiatrists, psychologists, social workers, and other specialty providers; MH treatment provided by primary care physicians; and medications. Prescription medications accounted for almost two-thirds of out-of-pocket spending for outpatient MH treatment. (Pill-Mill doctors, clinics, have created an epidemic of  prescription med addiction across the U.S. – Money, money, money made by “legal” drug cartels.) Zuvekas and Meyerhoefer, “State variations in the out-of-pocket spending burden for outpatient mental health treatment,” Health Affairs 28(3):713-722, 2009 (AHRQ Publication No. 09-R056).*
  • Managed behavioral health care organizations have reduced the costs of specialty mental health and substance abuse treatment by shifting to outpatient services.There remains concern that managed behavioral health care organizations (MBHOs) may (a done deal) shift mental health treatment to primary care and prescription drugs in order to reach contractual cost-savings goals. However, this study of a single MBHO found no evidence to suggest that it shifted treatment costs in this way. Researchers analyzed claims data from 1991-1995 from an insurer that introduced an MBHO in 1992 to control treatment costs. The use of any psychotropic medication rose 64 percent over the 4-year period among enrollees of the large employer group that had parity for physical and mental health care and by 87 percent in the smaller groups without parity. Often these medications were prescribed in primary care settings. Introduction of the MBHO was not significantly associated with the use of any psychotropic medication alone, and for newer antidepressants, it was associated with a 2.4 percentage point decrease in medication use alone in the large group. Zuvekas, Rupp, and Norquist, “Cost shifting under managed behavioral health care,” Psychiatric Services 58(1):100-108, 2007 (AHRQ Publication No. 07-R036).*
  • Hospital cost and stay duration for the elderly with non-dementia psychiatric illnesses varies by care settings.General hospitals, psychiatric units, long-stay hospitals, and skilled nursing facilities (SNFs) are the inpatient settings where non-dementia psychiatric illnesses (NDPI), such as depression, bipolar disorders, and substance abuse, are treated. Medicare’s cost-cutting reimbursement strategies and caps on stay lengths in addition to treatment advances have affected how the elderly receive care for NDPI. Analysis of Centers for Medicare & Medicaid Services data from 1992 to 2002 found that mean inpatient length of stay for NDPI illnesses fell from nearly 14.9 days in 1992 to just 12.1 days in 2002. Similarly, mean Medicare expenditures per stay declined from $8,461 to $6,207. Each of the four types of facilities treating these patients was impacted differently during the 10-year period. For example, the portion of NDPI stays that were in general hospitals fell from 34.5 percent to 27.4 percent, and the portion in long-stay hospitals fell from 19.5 percent to 11.3 percent. However, mean Medicare-covered SNF days per NDPI stay remained stable, while mean Medicare-covered costs rose from $4,153 to $6,375. Hoover, Akincigil, Prince, et al., “Medicare inpatient treatment for elderly non-dementia psychiatric illnesses 1992-2002; length of stay and expenditures by facility type,” Administration and Policy in Mental Health 35(4): 231-240, 2008 (AHRQ grant HS16097).
  • States vary greatly in nursing home admissions for people with mental illnesses.State variation in services for people with mental illnesses and how they are admitted to nursing homes may result in longer-than-average stays for those individuals. Researchers analyzed 2005 data from the Centers for Medicare and Medicaid Services. They found that States varied widely in nursing home admission rates for people suffering from mental illness. For example, nursing homes in Wyoming, Nevada, Arkansas, and South Dakota had the lowest rates for admitting individuals with schizophrenia and bipolar disorder, while Connecticut, Ohio, and Massachusetts had the highest rates. What’s more, in 2004 nearly 46 percent of people with mental illnesses admitted to nursing homes in the United States remained in the facility 90 days after admission compared with 24 percent of people who did not have a mental illness. The way Medicaid pays nursing homes may be one reason for State variations in admissions for people with mental illnesses. For instance, Medicaid pays nursing homes higher rates for people with mental illnesses who have minimal physical problems. Thus, these higher rates may give nursing homes an incentive to admit these patients. Variation could also be a result of some States being able to offer home and community-based services or State psychiatric hospitals in lieu of nursing home care. Grabowski, Aschbrenner, Feng, and Mor, “Mental illness in nursing homes: Variations across States,” Health Affairs 28(3), pp. 689-700, 2009 (AHRQ grant T32 HS00011).
Page last reviewed October 2014

Internet Citation: Mental Health: Research Findings. October 2014. Agency for Healthcare Research and Quality, Rockville, MD.


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