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Section VI: National Mental Health Statistics
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Chapter 19. Selected Characteristics of Adults Treated in Specialty Mental Health Care Programs, United States, 1997
Laura J. Milazzo-Sayre; Marilyn J. Henderson, M.P.A.; Ronald W. Manderscheid,
Ph.D.
Center for Mental Health Services, Substance Abuse and Mental Health Services
Administration
Beatrice G. Blacklow, M.P.H.; Christian Evans; Alisa A. Male, M.A.
Synectics for Management Decisions, Inc.
Introduction
This chapter presents selected highlights of findings from the Client/Patient
Sample Survey conducted in 1997 by the Survey and Analysis Branch, Division
of State and Community Systems Development, Center for Mental Health Services
(CMHS), Substance Abuse and Mental Health Services Administration (SAMHSA).
The 1997 Client/ Patient Sample Survey (CPSS) was a nationwide sample survey
designed to collect statistics on the demographic, clinical, and service use
characteristics of persons receiving care in the inpatient, residential, and
less than 24-hour care1 programs of specialty mental health organizations.
The purpose of the survey was to provide national estimates for two client groups:
persons admitted during the year and persons under care on a single day in the
inpatient, residential, and less than 24-hour care programs. Added together,
the admission and under-care populations in these settings provide a picture
of the entire treated population within the Nation's organized specialty mental
health service delivery system. The survey included a sample of persons who
received care in a sample of programs of the specialty mental health organizations
described in chapter 18 of this book. The types of organizations were State
and county mental hospitals, private psychiatric hospitals, the separate psychiatric
services of the Department of Veterans Affairs (VA) medical centers and non-Federal
general hospitals, multiservice mental heath organizations, residential treatment
centers for emotionally disturbed children (RTCs), other residential programs
affiliated with mental health organizations, and freestanding outpatient clinics
and partial care organizations (see Appendix B).
The first section of this chapter highlights adults ages 18 and older whose
ability to function within key life areas (e.g., interpersonal relationships,
social situations, and work performance) is seriously impaired, an indicator
of the severity of their mental illness. Estimates are provided primarily for
three adult age groups: 18 to 44, 45 to 64, and 65 and older. This section provides
analyses by program type (inpatient, residential, less than 24- hour), type
of organization within program setting, and client group (persons under care,
admissions).
The second section of this chapter provides estimates on the median lengths
of stay in days for persons of all ages from the admission and under-care populations
who were terminated2 from inpatient care during 1997. Medians are
presented for these terminations by race/ ethnicity, gender, age, and selected
principal diagnoses3 across the various types of organizations providing
inpatient care.
For additional details about the survey and in- depth analyses of national
estimates derived from the 1997 CPSS on selected characteristics of persons
admitted and under care in the specialty mental health sector, please see Mental
Health, United States, 2000, Chapter 15, "Persons Treated in Specialty Mental
Health Care Programs, United States, 1997." Additional analyses of national
estimates derived from the 1997 CPSS, specific to the subpopulation of children
and youth under age 18, follow in chapter 20 of this volume. A brief description
of the survey design, estimation procedures, variance calculations, and statistical
significance calculations is provided in appendix B. All differences noted in
the text are statistically significant at the p = .05 level or less. Lack of
comment on the differences between any two estimates does not imply that a test
was completed with a finding of no statistical significance.
Serious Functional Impairment
The level of impairment that a person has in his or her daily life serves as
an indicator of the severity of that person's mental illness. Tables 1 through
13 provide a picture of the subpopulation of adults treated in the specialty
mental health sector whose ability to function is seriously impaired. The measure
used in the 1997 CPSS to collect data on level of functioning was an adaptation
of the Global Assessment of Functioning (GAF) scale for reporting overall functioning
on Axis-V of the American Psychiatric Association's Diagnostic and Statistical
Manual of Mental Disorders (4th ed.) (DSM-IV). On a scale of 1 to 100, with
100 indicating superior functioning, CMHS used a rating of 60 as the cutoff
point at which functional impairment is serious enough that it "substantially
interferes with or limits one or more major life areas."4 This usage
accords with the official CMHS definitions for adults with serious mental illness
(SMI) and children or adolescents with a serious emotional disturbance (SED).
This section presents a look across program and organizational types of the
number of adults experiencing seriously impaired functioning and their principal
psychiatric diagnoses.
Inpatient Care Programs--Under Care
Overall, out of a total 103,822 adults ages 18 and older under care in the
inpatient programs of specialty mental health organizations in 1997, 84,327,
or 81 percent, experienced serious functional impairment in their daily lives
(table 1). This subgroup of the
adult inpatient under-care population is highlighted by age and diagnosis in
the discussion that follows.
- As would be expected, persons with serious functional impairment comprised
the vast majority of persons under care in the inpatient programs of specialty
mental health organizations (table
2). This held true for all age groups and across all types of organizations
where comparisons could be made.
- Comparisons across organizations reveal that the greatest proportion of
persons ages 18 and older under care with serious functional impairment was
found in State and county mental hospitals (52 percent), followed by non-Federal
general hospitals (24 percent; table
2). This pattern also held true for persons ages 25 to 44. Of interest
is the finding that, in contrast to their adult counterparts, a greater proportion
of children and youth under age 18 with serious functional impairment was
under care in private psychiatric hospitals (49 percent) than in State and
county mental hospitals and non-Federal general hospitals (19 and 18 percent,
respectively; table 2).
- When comparisons were made by principal psychiatric diagnosis of persons
with serious functional impairment under care in inpatient programs, it was
found that, overall, more than one-half (53 percent) had a diagnosis of schizophrenia;
persons diagnosed with affective disorders accounted for the second largest
proportion (22 percent; table 3).
- Comparisons of selected diagnoses within organizations reveal that the greatest
proportions of adults ages 18 and older with serious functional impairment
in State and county mental hospitals and VA medical centers had diagnoses
of schizophrenia (69 and 44 percent, respectively; see table
3). Within private psychiatric hospitals and non-Federal general hospitals,
the greatest proportions in the 18 and older age group were among those diagnosed
with affective disorders and those diagnosed with schizophrenia.
- These findings also held true among adults with serious functional impairment
ages 18 to 44 and 45 to 64 in the inpatient programs of each of these organizations.
Where comparisons could be made among those ages 65 and older with serious
functional impairment, schizophrenia accounted for the greatest proportion
of those under care in State and county mental hospitals (54 percent; see
table 3).
- As expected, where comparisons could be made across the three adult age
groups within organizations, State and county mental hospitals were found
to have a greater proportion of persons ages 65 and older with serious functional
impairment and a diagnosis of organic disorders compared with persons ages
45 to 64 and 18 to 44 in this setting (26, 10, and four percent, respectively;
see table 3). Similarly, in VA
medical centers, the proportion of those ages 65 and older with serious functional
impairment and organic disorders exceeded the proportion of those ages 45
to 64 (36 vs. 3 percent, respectively). In non-Federal general hospitals,
much greater proportions of persons with serious functional impairment ages
18 to 44 and 45 to 64 had diagnoses of schizophrenia than did persons ages
65 and older (36 and 46 percent vs. 13 percent, respectively; see table
3).
- Persons with serious functional impairment and diagnoses of affective disorders
comprised greater proportions of the 18 to 44, 45 to 64, and 65 and older
under-care populations in private psychiatric hospitals and non-Federal general
hospitals than in State and county mental hospitals (see table
3). In contrast, persons ages 18 to 44 and 45 to 64 with serious functional
impairment and diagnoses of schizophrenia comprised greater proportions of
the under-care population in State and county mental hospitals than their
counterparts in private psychiatric hospitals, non-Federal general hospitals,
or VA medical centers; this finding also held true for those ages 65 and older,
with the exception of private psychiatric hospitals, where no comparison could
be made (see table 3).
Inpatient Care Programs--Admissions
Of the total 1.7 million adults ages 18 and older admitted for inpatient care,
1,355,539, or 78 percent, experienced serious functional impairment in their
daily lives (see table 1). Comparisons
by age for selected diagnoses of this subgroup are the focus of the following
analyses.
- As was true for persons under care in the inpatient programs of mental health
organizations, the majority of admissions to inpatient settings were seriously
functionally impaired. This finding was true within each age group and across
each type of organization where comparisons could be made (see table
4).
- More than half (54 percent) of all adults ages 18 and older with serious
functional impairment admitted for inpatient care in specialty mental health
organizations were found in non-Federal general hospitals; one in five were
admitted to private psychiatric hospitals (see table
4). These findings held true within each adult age group. Of interest
is the finding that the greatest proportion of admissions under age 18 with
serious functional impairment was in private psychiatric hospitals, followed
by non-Federal general hospitals (54 and 30 percent, respectively).
- Comparisons of selected principal psychiatric diagnoses among adult inpatient
admissions ages 18 and older with serious functional impairment reveal that
the greatest concentration had diagnoses of affective disorders (38 percent);
the second greatest concentration had diagnoses of schizophrenia (26 percent;
see table 5). This finding is
the reverse of that among the 18 and older under-care population with serious
functional impairment, where the greatest proportion had diagnoses of schizophrenia
and the second greatest proportion had diagnoses of affective disorders (see
table 3).
- As was found for all adults ages 18 and older, the greatest proportion of
inpatient admissions ages 18 to 44 with serious functional impairment had
diagnoses of affective disorders (40 percent); the second greatest proportion
had diagnoses of schizophrenia (26 percent; see table
5). Comparisons of diagnostic groups within organizations reveal that
this finding also held true for persons ages 18 to 44 admitted to non-Federal
general hospitals; similarly, in private psychiatric hospitals, affective
disorders ranked first (47 percent). Within State and county mental hospitals,
persons ages 18 to 44 with serious functional impairment and diagnoses of
affective disorders or schizophrenia were predominant (23 and 33 percent,
respectively).
- Comparisons across organizations showed that greater proportions of admissions
ages 18 to 44 with serious functional impairment and diagnoses of affective
disorders were found in private psychiatric hospitals and non-Federal general
hospitals (47 and 44 percent, respectively) than in State and county mental
hospitals and VA medical centers (23 and 16 percent, respectively; see table
5).
- Among total inpatient admissions ages 45 to 64 with serious functional impairment,
one- third had diagnoses of affective disorders (36 percent), and one-third
had diagnoses of schizophrenia (33 percent; see table
5). Within State and county mental hospitals, a greater proportion of
persons ages 45 to 64 with serious functional impairment had diagnoses of
schizophrenia (43 percent) compared with other diagnoses, with the exception
of affective disorders, where no statistically significant difference was
found.
- In private psychiatric hospitals, a greater proportion of persons ages 45
to 64 with serious functional impairment had diagnoses of affective disorders
(41 percent) compared with other diagnoses, with the exception of alcohol-related
disorders and schizophrenia, where no statistically significant differences
were found among the three diagnostic groups. In non-Federal general hospitals,
persons with diagnoses of affective disorders and those with diagnoses of
schizophrenia accounted for the greatest proportions of the admission population
ages 45 to 64 (40 and 32 percent, respectively; table
5).
- Comparisons across types of organizations reveal that a greater proportion
of admissions ages 45 to 64 with serious functional impairment in private
psychiatric hospitals and non-Federal general hospitals had diagnoses of affective
disorders than in VA medical centers (41 and 40 percent vs. 19 percent, respectively;
table 5). A greater proportion
of admissions to State and county mental hospitals had diagnoses of schizophrenia
than in VA medical centers (43 vs. 24 percent, respectively).
- Overall, the greatest proportion of inpatient admissions ages 65 and older
with serious functional impairment had diagnoses of affective disorders (37
percent), with the exception of organic disorders, where no statistically
significant difference was found (25 percent; table
5).
- Where comparisons could be made across organizations for selected diagnoses,
more than one-half (51 percent) of inpatient admissions ages 65 and older
with serious functional impairment in private psychiatric hospitals were found
to have diagnoses of affective disorders. This proportion exceeded that in
State and county mental hospitals and VA medical centers (13 percent, each;
table 5).
- Comparisons between the adult under-care and admission populations in inpatient
care programs reveal that, overall, a greater proportion of admissions ages
18 to 44 with serious functional impairment had diagnoses of affective disorders
than did their counterparts in the under-care population (40 vs. 22 percent,
respectively; table 5 and table
3). Conversely, a greater proportion of adults ages 18 to 44 with serious
functional impairment and diagnoses of schizophrenia were under care than
were admitted to inpatient care (54 vs. 26 percent, respectively). These findings
also held true within State and county mental hospitals.
- Among adults ages 45 to 64 with serious functional impairment, similar patterns
to those for the 18 to 44 age group were found, overall, for all organization
types combined, and within State and county mental hospitals (table
5 and table 3). In addition,
about twice as many persons ages 45 to 64 with serious functional impairment
and diagnoses of schizophrenia were under care in VA medical centers than
were admitted to this setting (49 vs. 24 percent, respectively).
- Overall, a greater proportion of adults ages 65 and older with serious functional
impairment and diagnoses of schizophrenia was found among the under-care population
than among the admission population (39 vs. 15 percent, respectively; table
5 and table 3). However, significant
differences were not found between the admission and under-care populations
ages 65 and older with serious functional impairment for selected diagnoses
within each of the organization types.
Residential Care Programs--Under Care
Out of a total 50,948 adults ages 18 and older under care in the residential
care programs of specialty mental health organizations in 1997, 35,721, or 70
percent, had serious functional impairment in their daily lives (table
1). This subgroup of the adult under-care population in residential care
programs is highlighted by age and diagnosis in the analysis that follows. This
analysis of residential care programs is limited to discussion of the overall
combined total of the residential care programs of specialty mental health organizations.
Findings by type of organization are not presented because of the design of
the 1997 CPSS (see appendix B).
- Similar to the findings for the under-care population in inpatient programs
(table 2), the vast majority of
persons under care in the residential care programs of specialty mental health
organizations were functioning on a seriously impaired level; this held true
for each age group with the exception of those ages 18 to 24 (table
6).
- More than half (59 percent) of adults ages 18 and older with serious functional
impairment under care in residential care programs had a diagnosis of schizophrenia;
the second greatest concentration of these adults had a diagnosis of affective
disorders (13 percent; table 7).
These findings held true for those ages 18 to 44 and 45 to 64 with serious
functional impairment where comparisons could be made.
- The patterns found for adults with serious functional impairment under care
in residential care programs are similar to those found for similar populations
under care in inpatient programs (table
7 and table 3).
Residential Care Programs--Admissions
Of the total adult population ages 18 and older admitted for inpatient care
(105,458), 79 percent had serious functional impairment in their daily lives
(table 1). Comparisons by age and
selected diagnoses of this subgroup of the population ages 18 to 44 are the
focus of the following discussion. As noted in the previous section, the discussion
of findings relevant to residential care programs is limited to the overall
combined total of the residential care programs within specialty mental health
organizations. Therefore, a discussion of findings by type of organization is
not presented because of the design of the 1997 CPSS (see appendix B).
- As was found for their counterparts in the under-care population of residential
care programs (table 6) and in
the admission population of inpatient programs (table
4), residential care program admissions with serious functional impairment
accounted for the majority of admissions to this setting (table
8).
- Where comparisons could be made between the two settings, it was found that
for all program types combined, a greater proportion of persons ages 18 to
44 with serious functional impairment were admitted to residential care programs
than to inpatient programs (91 vs. 75 percent, respectively; table
8 and table 4).
- Unlike their counterparts in the under-care population, admissions to residential
care programs for persons ages 18 and older with serious functional impairment
and diagnoses of schizophrenia were not as predominant compared with those
having other diagnoses where comparisons could be made (table
9). Statistically significant differences were not found between the proportions
of those with diagnoses of schizophrenia and those with diagnoses of affective
disorders among admissions with serious functional impairment ages 18 to 44
and 45 to 64.
- The proportion of admissions ages 18 to 44 with serious functional impairment
diagnosed with schizophrenia was greater than the proportions of those diagnosed
with drug-related disorders and those diagnosed with "other psychoses" (27
percent vs. nine and six percent, respectively; table
9); the proportion of admissions ages 18 to 44 with serious functional
impairment and diagnoses of affective disorders was also greater than the
proportion of those with "other psychoses" (23 vs. six percent, respectively).
- Where comparisons could be made between residential care and inpatient programs,
it was found that inpatient programs had a greater proportion of admissions
ages 18 to 44 with serious functional impairment and diagnoses of affective
disorders than did residential care programs (40 vs. 23 percent, respectively;
table 5 and table
9).
Less Than 24-Hour Care Programs--Under Care
Overall, of the estimated total of 1.63 million adults ages 18 and older under
care in the less than 24-hour care programs of specialty mental health organizations
in 1997, 1.16 million, or 71 percent, had serious functional impairment in their
daily lives (table 1). This subgroup
of the adult population in less than 24-hour care programs is highlighted by
age and diagnosis in the following analyses.
- Within the less than 24-hour care programs of State and county mental hospitals,
statistically significant differences were not found between the proportion
of persons under care with serious functional impairment and those not seriously
impaired. This finding held true for each age group within this setting with
the exception of persons ages 18 to 24; for persons in this age group, only
about one-fourth were seriously functionally impaired, whereas three-fourths
were not (26 vs. 74 percent, respectively; table
10). Where comparisons could be made for the less than 24-hour care programs
of private psychiatric hospitals, most persons under care in the under 18
and 45 to 64 age groups were seriously functionally impaired.
- Regardless of age, the majority of persons under care in the less than 24-hour
care programs of non-Federal general hospitals had serious functional impairment
(table 10). Similarly, where
comparisons could be made for the less than 24-hour care programs of VA medical
centers, most persons under care in the 25 to 44 and 45 to 64 age groups were
seriously functionally impaired.
- Comparisons across the less than 24-hour care programs of the various types
of mental health organizations reveal that the greatest percentage of adults
ages 18 and older under care with serious functional impairment were found
in multiservice mental health organizations (42 percent); the second greatest
percentage was found in freestanding outpatient clinics and partial care organizations
(28 percent; table 10). This
finding held true for each adult age group with the exception of those ages
65 and older.
- Overall, a greater proportion of the adult under-care population in inpatient
programs had serious functional impairment compared with their counterparts
in the less than 24-hour care programs of specialty mental health organizations
(table 2 and table
10).
- Where comparisons could be made by diagnoses of persons ages 18 to 44 with
serious functional impairment across program settings, greater proportions
of those with schizophrenia were found to be under care in State and county
mental hospitals and multiservice mental health organizations than in private
psychiatric hospitals (48 and 38 percent vs. 17 percent, respectively; table
11).
- Similarly, greater proportions of adults ages 45 to 64 with serious functional
impairment and diagnoses of schizophrenia were under care in State and county
mental hospitals and multiservice mental health organizations than in VA medical
centers (57 and 39 percent vs. 23 percent, respectively; table
11). Non-Federal general hospitals had a greater proportion of persons
ages 45 to 64 under care with serious functional impairment and diagnoses
of affective disorders than did VA medical centers (54 vs. 32 percent, respectively).
- Although too few comparisons could be made by diagnosis across settings
for adults ages 65 and older with serious functional impairment, it was found
that State and county mental hospitals had a greater proportion of those under
care with a diagnosis of schizophrenia than did VA medical centers (58 vs.
13 percent, respectively; table 11).
- A greater proportion of persons ages 18 to 44 with serious functional impairment
and diagnoses of affective disorders were under care in the less than 24-hour
care programs than in the inpatient programs of State and county mental hospitals
(29 vs. 10 percent, respectively; table
11 and table 3). Greater proportions
of adults ages 45 to 64 with serious functional impairment and diagnoses of
schizophrenia were under care in the inpatient programs of non-Federal general
hospitals and VA medical centers (46 and 49 percent, respectively) than in
the less than 24-hour care programs of these organizations (22 and 23 percent,
respectively; table 11 and table
3).
- Where comparisons could be made with residential care programs, for all
program types combined, a greater proportion of persons ages 18 to 44 with
serious functional impairment and diagnoses of affective disorders were found
to be under care in less than 24-hour care programs than in residential care
programs (34 vs. 13 percent, respectively; table
11 and table 7).
Less Than 24-Hour Care Programs--Admissions
Of the total adult population ages 18 and older admitted for less than 24-hour
care, 1,664,937, or 70 percent, had serious functional impairment in their daily
lives (table 1). Comparisons by
age and selected diagnoses of the subgroup of the population ages 18 to 44 are
the focus of the following discussion.
- As was found for their counterparts in the under-care population of less
than 24-hour care programs and in the admission populations of inpatient and
residential care programs, persons with serious functional impairment accounted
for the majority of admissions to less than 24-hour care programs (table
12).
- Persons with serious functional impairment were predominant in each age
group of admissions to the less than 24-hour care programs of non-Federal
general hospitals and multiservice mental health organizations (table
12).
- Where comparisons could be made across organizations among admissions with
serious functional impairment, the greatest concentrations of those ages 18
to 24, 25 to 44, and 45 to 64 were found in the less than 24-hour care programs
of multiservice mental health organizations (45, 45, and 39 percent, respectively);
the next greatest concentrations were in freestanding outpatient clinics and
partial care organizations and non-Federal general hospitals (table
12).
- Among admissions ages 18 to 44 with serious functional impairment, those
with diagnoses of affective disorders accounted for the largest concentrations
of admissions within the less than 24-hour care programs of private psychiatric
hospitals (50 percent), non-Federal general hospitals (43 percent), multiservice
mental health organizations (34 percent), and freestanding outpatient clinics
and partial care organizations (33 percent; table
13). Similarly, among persons ages 45 to 64 with serious functional impairment,
nearly half of those admitted to the less than 24-hour care programs of private
psychiatric hospitals and non-Federal general hospitals had diagnoses of affective
disorders.
- Comparisons between the under-care and admission populations in less than
24-hour care programs reveal that a greater proportion of persons ages 18
to 44 with serious functional impairment and diagnoses of schizophrenia were
under care than were admitted to multiservice mental health organizations
(38 vs. 18 percent, respectively; table
11 and table 13) and freestanding
outpatient clinics and partial care organizations (32 vs. 11 percent, respectively).
- Similarly, a greater proportion of persons ages 45 to 64 with serious functional
impairment and diagnoses of schizophrenia were under care than admitted to
State and county mental hospitals (57 vs. 15 percent, respectively; table
11 and table 13). By contrast,
a greater proportion of persons ages 65 and older with serious functional
impairment and diagnoses of schizophrenia were admitted to non-Federal general
hospitals than were under care in this setting (64 vs. 22 percent, respectively).
- Greater proportions of persons ages 18 to 44 with serious functional impairment
and diagnoses of adjustment disorders were admitted than were under care in
the less than 24-hour care programs of multiservice mental health organizations,
residential treatment centers, and freestanding outpatient clinics and partial
care organizations (table 13
and table 11).
- Adults ages 18 to 44 with serious functional impairment and diagnoses of
schizophrenia were three times as likely to be admitted to the inpatient as
to the less than 24-hour care programs of private psychiatric hospitals (21
vs. 7 percent, respectively; table
5 and table 13). Similarly,
adults ages 45 to 64 with serious functional impairment and diagnoses of schizophrenia
were almost three times as likely to be admitted to the inpatient as to the
less than 24-hour care programs of State and county mental hospitals (43 vs.
15 percent, respectively).
Median Length of Stay
Table 14 presents the median length
of stay for persons who were terminated or transferred out of the inpatient
care programs of specialty mental health organizations (excluding deaths) during
1997. Estimates for terminations were derived from both the under-care and admission
populations and allow for comparisons of complete episodes of care. Presented
below are highlights of findings for selected characteristics of terminations-gender,
race/ethnicity, age, and principal psychiatric diagnoses.
- Persons terminated from the inpatient programs had an overall median length
of stay of 5.4 days (table 14).
Persons terminated from State and county mental hospitals and non-Federal
general hospitals had a median stay of 5.7 days; those in private psychiatric
hospitals, a median stay of 5.1 days; and those in VA medical centers, a median
stay of 7.7 days.
- Overall, males and females stayed the same median number of days in specialty
mental health inpatient programs (5.4 days; table
14). Comparisons of the median lengths of inpatient stay for males and
females within each type of organization revealed no significant differences
by gender for each racial/ ethnic grouping.
- Where comparisons could be made by race/ethnicity across organizations,
overall, Hispanics/Latinos were found to have longer median inpatient stays
in VA medical centers than in non-Federal general hospitals (10.3 vs. 3.7
days, respectively; table 14);
this finding held true among males in these settings (9.6 vs. 3.1 days, respectively).
In addition, American Indian/ Alaska Native males had longer inpatient stays
in private psychiatric hospitals than in non-Federal general hospitals (9.0
vs. 0.6 days, respectively).
- Within each type of organization, no significant differences were found
in median days of inpatient stay among the various racial/ethnic groups (table
14). While this finding held true among females, a few significant differences
were observed when comparing males across race/ethnic groups. Specifically,
in private psychiatric hospitals, American Indian/Alaska Native males had
longer stays than White males (9.0 vs. 4.9 days, respectively). In non-Federal
general hospitals, African- American males and White males had longer stays
than American Indian/Alaska Native males (6.5 and 5.5 days vs. 1.0 day, respectively).
- For all inpatient program types combined, persons ages 65 and older had
a slightly longer median stay than did persons ages 25 to 44 (7.0 vs. 4.8
days; table 14). Where comparisons
could be made within each organization, no significant differences were found
among the different age groups in the median number of days persons stayed
for inpatient care.
- When comparisons were made within each of the age groups, the median number
of days persons stayed for inpatient care did not differ significantly across
the various types of organizations, with one exception: Persons ages 25 to
44 in VA medical centers had a longer median stay than did their counterparts
in private psychiatric hospitals (7.0 vs. 4.2 days, respectively; table
14).
- As expected, persons with principal psychiatric diagnoses of adjustment
disorders had the shortest median inpatient days of stay (2.1 days), compared
with persons having other selected psychiatric diagnoses detailed in table
14. This finding held true within non- Federal general hospitals and somewhat
true within State and county mental hospitals and private psychiatric hospitals;
in the latter settings, persons with diagnoses of adjustment disorders had
shorter stays than did persons with most of the other psychiatric diagnoses.
- Additional comparisons of the median days of stay for selected psychiatric
diagnoses within organizations reveal that within State and county mental
hospitals, persons with diagnoses of affective disorders, other psychoses,
and schizophrenia had longer median inpatient stays (9.8, 9.1, and 6.8 days,
respectively) than did persons with diagnoses of alcohol-related, personality,
and adjustment disorders (2.8, 2.8, and 1.6 days, respectively; table
14).
- In non-Federal general hospitals, persons with diagnoses of organic disorders
and those with diagnoses of schizophrenia had longer median stays (9.2 and
7.7 days, respectively) than did persons with diagnoses of alcohol- related
disorders and those with diagnoses of affective disorders (3.7 and 5.6 days,
respectively; table 14). In VA
medical centers, persons diagnosed with schizophrenia had a considerably longer
median stay than did persons diagnosed with adjustment disorders (11.3 vs.
4.5 days, respectively).
- When median days of stay for persons terminated from inpatient care were
compared across organizational settings, a few differences were found. Persons
with affective disorders stayed significantly longer in State and county mental
hospitals than in private psychiatric hospitals and non-Federal general hospitals
(9.8 vs. 5.1 and 5.6 days, respectively; table
14). Persons with diagnoses of schizophrenia stayed longer in VA medical
centers than in private psychiatric hospitals (11.3 vs. 6.2 days). Persons
with diagnoses of personality disorders had a longer median stay in private
psychiatric hospitals than in State and county mental hospitals (7.3 vs. 2.8
days, respectively).
Summary
The majority of persons in the under-care and admission populations of the
inpatient, residential, and less than 24-hour care programs of specialty mental
health organizations in 1997 were seriously impaired in their ability to function
in daily activities involving, for example, interaction with others in a familial
or social context, self-care, or work performance. Although a number of selected
psychiatric diagnoses were analyzed, the data revealed that most persons with
serious functional impairment in the under-care and admission populations of
the three program settings were concentrated in two of the more debilitating
diagnostic groups: affective disorders and schizophrenia. These findings suggest
that persons treated in the specialty mental health sector may be more seriously
impaired because of their mental illness than persons with similar diagnoses
who either do not receive treatment or are treated in private practices.
Overall, the median length of stay for persons receiving services in the inpatient
care programs of specialty mental health organizations was less than one week
(5.4 days). No statistically significant differences were found between males
and females, among the various race/ethnic groups, or by gender within race/ethnic
groups. Only a few differences were found by age within organizations. Persons
with more debilitating psychiatric diagnoses tended to have longer stays within
specialty mental health inpatient care programs than persons with less debilitating
diagnoses.
FOOTNOTES
1 The term less than 24-hour care programs refers to
mental health services that are not provided overnight; included are outpatient
and partial care services provided in organized mental health care settings.
Previous client/patient sample surveys collected data separately for the outpatient
and partial care programs of specialty mental health organizations.
2 Terminations are persons from the admission and under-care
caseloads of mental health care programs who were terminated from, or transferred
out of, the program. It does not include deaths.
3 The diagnostic groupings used in this chapter are defined
as follows:
|
| Selected Diagnoses |
Combined DSM-IV and ICD-9-CM
Codes* |
|
| Alcohol-related disorders |
291; 303; 305.0 |
| Drug-related disorders |
292; 304; 305.1-305.9 |
| Organic disorders |
290; 293; 294; 310; 780.09 |
| Affective disorders |
296; 298.0; 300.4; 301.11; 301.13 |
| Schizophrenia |
295; 299 |
| Other psychoses |
297; 298 (except 298.0) |
| Personality disorders |
301 (except 301.11 and 301.13); 312.3 |
| Adjustment disorders |
309 (except 309.21, 309.81and 309.82) |
|
| * DSM-IV |
American Psychiatric
Association. (1994). Diagnostic and Statistical Manual of Mental
Disorders (3rd ed.). Washington, DC. |
| ICD-9-CM |
National Center
for Health Statistics, Department of Health and Human Services. (1980).
International Classification of Diseases (9th rev.), Clinical
Modification (Vol. I.). (DHHS Pub. No. (PHS)80-1260.) Washington, DC:
Superintendent of Documents, U.S. Government Printing Office. |
4 See Department of Health and Human Services, Substance Abuse
and Mental Health Services Administration. (1999). Final notice establishing
a final estimation methodology for adults with serious mental illness (SMI).
Federal Register, 64(121), 33,890-33,897; and Department of Health and
Human Services, Substance Abuse and Mental Health Services Administration. (1998).
Final notice establishing a final estimation methodology for children with serious
emotional disturbance (SED). Federal Register, 63(137), 38,661-38,665.
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