HHS Study Shows Impact of Mental Illness and Substance Abuse

The first study to show the full impact of mental health and substance abuse (MHSA) disorders on the nation's community hospitals has been released by the U.S. Department of Health and Human Services, from the Agency for Healthcare Research and Quality (AHRQ).

Among the many findings of this 2004 study is that nearly one in four hospital admissions for patients age 18 or over consist of patients with a mental health or substance abuse related disorder.

This includes 7.6 million of approximately 32 million hospital patients who have at least one condition diagnosed as any of the following: mood disorders, such as depression or bipolar disorder, substance-related disorders, dementia-related disorders, anxiety disorders, or schizophrenia.

About 1.9 million of the 7.6 million hospital stays were primarily due to a mental health or substance abuse problem. The remaining 5.7 million hospital stays included patients admitted for another condition who also presented with a mental health or substance abuse disorder, or both.

Hospitalizations for the top five mental health and substance abuse (MHSA) diagnoses cost $9.9 billion nationally. This comprehensive report examines economic specifics and patient data such as:

--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?

Age and Gender Differences

Unique findings from the study include previously under-recognized or unknown statistics.

For instance, five percent of maternal stays, or 240,000 women, hospitalized for childbirth or pregnancy were found to have mental health or substance abuse problems. 40 percent of these patients were between 18 and 24 years of age. This age group typically represents 32 present of non-MHSA admissions.

Younger adults also make up the majority of those hospitalized for suicide attempt. 72 percent of suicide-related hospital stays are individuals aged 18-44 (72 percent), followed by adults ages 45-64 (24 percent). Patients aged 65 and older made up less than four percent of all suicide-related stays.

Yet older adults account for a disproportionate share of hospital stays involving MHSA disorders. Adults age 80 and older represent five percent of the U.S. adult population, yet account for about 21 percent of MHSA hospital stays.

Gender differences were noted in the study whereas the most frequent MHSA admission diagnosis for women was mood disorders, while the primary diagnosis for men was substance abuse disorders.

Who Pays for the Hospital Stays

Individuals suffering from a mental health or substance abuse (MHSA) disorders, experience social difficulties and frequently are too debilitated to work. The loss of income burdens both family members and the economy, and the cost of treatment for chronic mental health disorders is considerable.

The study goes in-depth as to who pays for mental health and substance abuse by type of insurer and the extensive impact on Medicare and Medicaid. Some statistics include:

--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.

--33 percent of all uninsured stays, 29 percent of Medicaid stays and 26 percent of Medicare stays involve MHSA disorders.

--16 percent of privately insured stays were related to MHSA disorders.

--Over 78 percent of hospital stays for schizophrenia and 90 percent of hospital stays for delirium/dementia were billed to the government.

Beyond Economics

Substance Abuse and Mental Health Services Administration Administrator Terry Cline, Ph.D., said, "The significant number of hospital stays related to mental health and substance use disorders signals the need for an increased national effort to identify and intervene early before the conditions require a hospital stay.
The majority of patients who suffer from MHSA disorders who seek care do so in an outpatient setting. With a continued decline in psychiatric beds in specialty facilities, community hospitals have become the primary source of short-term inpatient care.

AHRQ Director, Carolyn M. Clancy, M.D says, "This report gives health care policymakers an in-depth look at the impact of mental health and substance abuse care on the health care system."

For more details on this study, see Care of Adults with Mental Health and Substance Abuse Disorders in U.S. Community Hospitals, 2004 (http://www.ahrq.gov/data/hcup/factbk10/)