DEPARTMENT OF HEALTH AND HUMAN SERVICES
Substance Abuse and Mental Health Services Administration
This report was prepared for the Substance Abuse and Mental Health Services Administration (SAMHSA), U.S. Department of Health and Human Services (HHS), by Eagle Technologies, Inc., under Contract No. HHSS283201600001C. The Contracting Officer’s Representative (COR) at SAMHSA/CBHSQ was Nichele Waller.
SAMHSA complies with applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. SAMHSA cumple con las leyes federales de derechos civiles aplicables y no discrimina por motivos de raza, color, nacionalidad, edad, discapacidad o sexo.
All material appearing in this report is in the public domain and may be reproduced or copied without permission from SAMHSA. Citation of the source is appreciated. However, this publication may not be reproduced or distributed for a fee without the specific, written authorization of the Office of Communications, SAMHSA, U.S. Department of Health and Human Services.
Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. Mental Health Annual Report: 2013–2018. Use of Mental Health Services: National Client-Level Data. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2020.
This publication may be downloaded at
https://www.samhsa.gov/data/data-we-collect/mental-health-client-level-data.
Center for Behavioral Health Statistics and Quality
Substance Abuse and Mental Health Services Administration
5600 Fishers Lane, Room 15SEH03
Rockville, Maryland 20857
June 2020
Chapter 1. Summary of Annual Data in State Client-Level Data Reporting: 2013–2018
Chapter 3. Characteristics of Young Adults Aged 18 to 24 Years Receiving Mental Health Services
Chapter 4. Characteristics of Adults Aged 25 to 54 Years Receiving Mental Health Services
Chapter 5. Characteristics of Older Adults Aged 55 Years and Older Receiving Mental Health Services
Chapter 7. Client Outcomes Among Individuals Receiving Mental Health Services: 2013–2018
Chapter 8. Geographic and Clinical Trends: 2013–2018
Chapter 9. Client Characteristics by State or Jurisdiction: 2013–2018
Chapter 10. Client Characteristics by State or Jurisdiction: 2018
Appendix A. MH-TEDS/MH-CLD Crosswalk Tables
Appendix C. MH-TEDS and MH-CLD Data Dictionary of Included Variables
Appendix D. SMI/SED Federal Definitions
Appendix E. Mental Health and Substance Use Diagnosis Codes
Appendix F. Terms and Acronyms
Appendix G. List of Contributors
1.1a Individuals, by mental health diagnosis: Number, 2013–2018
1.1b Individuals, by mental health diagnosis: Column percent distribution, 2013–2018
1.2a Individuals, by gender and age: Number, 2013–2018
1.2b Individuals, by gender and age: Column percent distribution, 2013–2018
1.3a Individuals, by race and ethnicity: Number, 2013–2018
1.3b Individuals, by race and ethnicity: Column percent distribution, 2013–2018
1.4a Individuals aged 17 years and younger, by mental health diagnosis: Number, 2013–2018
1.5a Individuals aged 18 to 24 years, by mental health diagnosis: Number, 2013–2018
1.6a Individuals aged 25 to 54 years, by mental health diagnosis: Number, 2013–2018
1.7a Individuals aged 55 years and older, by mental health diagnosis: Number, 2013–2018
1.8a Individuals, by marital status and living arrangement: Number, 2013–2018
1.8b Individuals, by marital status and living arrangement: Column percent distribution, 2013–2018
1.11a Individuals, by timing of admission and mental health service setting: Number, 2013–2018
1.13a Individuals, by Census region and division: Number, 2013–2018
1.13b Individuals, by Census region and division: Column percent distribution, 2013–2018
C1 Number of states reporting data, MH-CLD and MH-TEDS 2013–2018
C2 Item percentage response rate, by state or jurisdiction: MH-CLD and MH-TEDS 2018
1. Census regions and Census divisions of the United States
This report presents results from the Mental Health Client-Level Data (MH-CLD) and Mental Health Treatment Episode Data Set (MH-TEDS) for individuals receiving mental health services from state mental health systems in 2018, as well as selected trends in data collected from such individuals between 2013 and 2018. The report provides information on mental health diagnoses, mental health treatment settings, and demographic and substance use characteristics of individuals in mental health treatment in facilities that reported to individual state administrative data systems.
In the 2018 reporting period, 48 states and other jurisdictions (hereafter, “states”) submitted 6,213,791 records for individuals receiving mental health services. Alaska, American Samoa, the Federated States of Micronesia, Georgia, Guam, Kansas, Maine, Marshall Islands, New Jersey, and the U.S. Virgin Islands did not report data for the 2018 reporting period, as of July 8, 2019 [Table 1.1 and Appendix Table B1].
Of the 6,213,791 eligible client-level records for the 2018 reporting period, 88 percent had valid mental health or substance use diagnoses. Such records form the basis for most tables in this report. However, individual records may not have data for all variables; therefore, the analysis of specific variables may be based on a smaller number of individuals [Tables 1.1a–b].
For the 2013 reporting period, 45 states reported that a total of 5,576,659 individuals received mental health services; for the 2014 reporting period, 47 states reported that a total of 5,818,881 individuals received mental health services; for the 2015 reporting period, 45 states reported that a total of 5,311,897 individuals received mental health services; for the 2016 reporting period, 47 states reported that a total of 5,813,339 individuals received mental health services; for the 2017 reporting period, 48 states reported that a total of 5,934,383 individuals received mental health services; and for the 2018 reporting period, 48 states reported that a total of 6,213,791 individuals received mental health services [Table 1.1].
A total of 1,800,613 children and adolescents aged 17 years and younger were served in the 2018 reporting period [Table 2.1a]; 1,630,278 had a valid mental health diagnosis code [Table 2.3a].
Among males aged 17 years and younger served in the 2018 reporting period, the most frequently reported diagnoses were ADHD (31 percent), trauma- and stressor-related disorders (20 percent), anxiety disorders (9 percent), and depressive disorders (9 percent) [Table 2.3c].
Among females aged 17 years and younger served in the 2018 reporting period, the most frequently reported diagnoses were trauma- and stressor-related disorders (28 percent), depressive disorders (20 percent), anxiety disorders (14 percent), and ADHD (14 percent) [Table 2.3c].
A total of 645,452 young adults aged 18 to 24 years were served in 2018 [Table 3.1a]; 557,478 had a valid mental health diagnosis code [Table 3.3a].
Depressive disorders were the most frequently reported diagnoses among individuals aged 18 to 24 years served in the 2018 reporting period, across all selected categories for gender, race, ethnicity, educational attainment, and marital status [Tables 3.3c and 3.5c].
A total of 2,831,082 adults aged 25 to 54 years were served in 2018 [Table 4.1a]; 2,476,907 had a valid mental health diagnosis code [Table 4.3a].
Among males aged 25 to 54 years served in the 2018 reporting period, the most frequently reported diagnoses were depressive disorders (25 percent), schizophrenia and other psychotic disorders (24 percent), and bipolar disorders (14 percent); among females, the most frequently reported diagnoses were depressive disorders (33 percent), bipolar disorders (18 percent), and anxiety disorders (14 percent) [Table 4.3c].
A total of 932,573 adults aged 55 years and older were served in 2018 [Table 5.1a]; 827,060 had a valid mental health diagnosis code [Table 5.3a].
Among males aged 55 years and older served in the 2018 reporting period, the most frequently reported diagnoses were schizophrenia and other psychotic disorders (30 percent), depressive disorders (30 percent), and bipolar disorders (12 percent); among females served during this period, the most frequently reported diagnoses were depressive disorders (39 percent), schizophrenia and other psychotic disorders (19 percent), and bipolar disorders (15 percent) [Table 5.3c].
A total of 1,026,726 individuals aged 12 years and older with co-occurring mental and substance use disorders were served in 2018 [Table 6.1a].
For males with co-occurring mental and substance use disorders aged 12 years or older served during the 2018 reporting period, the most frequently reported diagnoses were depressive disorders (25 percent), schizophrenia and other psychotic disorders (22 percent), and bipolar disorders (14 percent); among females, the most frequently reported diagnoses were depressive disorders (31 percent), bipolar disorders (19 percent) and anxiety disorders (12 percent) [Table 6.2c].
Among individuals served in both the 2015 and 2018 reporting periods, 92 percent of those who lived in a private residence in 2015 also reported living in a private residence in 2018; 3 percent transitioned to homelessness; 2 percent transitioned to residential care; and 3 percent, combined, transitioned to other living arrangements, institutional settings, or jail [Table 7.5b].
Among individuals aged 18 years and older who were served in both the 2015 and 2018 reporting periods, 66 percent of those who were employed in 2015 also reported being employed in 2018; 13 percent transitioned to being unemployed, and 21 percent had left the labor force [Table 7.6b].
Tables 8.2 and 8.3 present, respectively, the number and adjusted number of individuals per 100,000 population served in the 2018 reporting period, by mental health diagnosis, Census region, Census division, and state or jurisdiction.
Among individuals served in the 2018 reporting period, the primary mental health diagnoses with the largest per 100,000 population ratios (adjusted for age, gender, and ethnicity) were depressive disorders (443 per 100,000 population), trauma- and stressor-related disorders (246 per 100,000 population), and schizophrenia and other psychotic disorders (201 per 100,000 population) [Table 8.3].
Across all Census divisions in the 2018 reporting period, depressive disorders were the primary mental health diagnosis with the highest adjusted ratio per 100,000 population, ranging from 238 per 100,000 population for New England to 695 per 100,000 population for the West North Central division [Table 8.3].
Mental health services data are currently collected for and reported to the Substance Abuse and Mental Health Services Administration’s (SAMHSA) Center for Behavioral Health Statistics and Quality (CBHSQ). State mental health agencies (SMHAs) are the state entities with primary responsibility for reporting the data in accordance with the reporting terms and conditions of the Behavioral Health Services Information System (BHSIS) Agreements funded by SAMHSA. The BHSIS Agreement stipulates that states and jurisdictions submit Uniform Reporting System (URS) data and client-level data by December 1 each year, in compliance with mental health block grant reporting requirements (42 U.S.C. §300x–6).
URS data reporting started in 2002 in an effort spearheaded by SAMHSA’s Center for Mental Health Services (CMHS) to collect both system performance measures and client outcomes at an aggregate level. The collection of client-level data came later.
In 2008, SAMHSA, through CMHS, tested the feasibility of transitioning from aggregate reporting of SAMHSA’s mental health national outcome measures (NOMs)1 to individual-level data reporting. This led to the development of the Mental Health Client-Level Data (MH-CLD) reporting method. The development was supported by data infrastructure grants (DIGs), which were a vehicle through which states and jurisdictions received financial and technical assistance from SAMHSA to assist in their capacity-building efforts toward meeting the block grant reporting requirements.
The general framework for the MH-CLD involves a compilation of the demographic, clinical, and outcome data of individuals served by the SMHA within a state-defined 12-month reporting period. States may choose the calendar year or the state fiscal year as their reporting period. Individuals served is defined as all enrolled individuals who received mental health and support services, including screening, assessment, crisis services, and telemedicine, from programs operated or funded by the SMHA during the reporting period.
Two data sets are submitted each reporting period: Basic Client Information (BCI) is due December 1, and the State Hospital Readmission (SHR) data set is due March 1 of the following year. These two data sets inform five mental health NOMs: access to services/capacity, stability in housing/residential status, 30-day and 180-day readmission to state hospital, adult employment or children’s school attendance and education level, and criminal justice involvement. There are five additional NOMs—social connectedness, decreased mental illness symptomatology, perception of care, cost-effectiveness, and use of evidence-based practices—that have not been converted into client-level data reporting and continue to be captured in the URS. Data are reported in accordance with the Health Insurance Portability and Accountability Act (HIPAA) rules for non-protected health information (non-PHI).
In 2010, SAMHSA, through CBHSQ, began a parallel effort of testing the feasibility of building a national behavioral health database that integrates both mental health and substance use data using a uniform platform for data reporting. This effort led to the integration of mental health data into the well-established system of reporting for substance use client-level data, known as the Treatment Episode Data Set (TEDS).2 To enable reporting of mental health client data to TEDS, the system was modified to incorporate data elements that capture the characteristics unique to the mental health services system and the individuals receiving mental health services. These characteristics include, among others, the extended period of time that an individual may be engaged in treatment, the recovery process, and the simultaneous receipt of different types of services from different service providers. This method of reporting mental health data at the individual level is referred to as the Mental Health Treatment Episode Data Set (MH-TEDS).
Unlike MH-CLD, MH-TEDS is structured around treatment events, that is, admissions and discharges from specific service settings. Admission and discharge records can be linked to track treatment episodes and the treatment services received by individuals. Thus, with MH-TEDS, both the individual client and the treatment episode can serve as a unit of analysis, whereas with MH-CLD the client is the sole unit of analysis. The common TEDS platform in which both the substance use and mental health data are reported enhances the ability to report data for people with co-occurring mental and substance use disorders. It also offers optional data fields for individuals with mental illness that are not captured in MH-CLD, such as referral source, details on criminal justice referral, income sources, and health insurance.
MH-TEDS is a compilation of demographic, substance use, mental health, clinical, legal, and socioeconomic characteristics of individuals who are primarily receiving publicly funded mental health and/or substance use services. MH-TEDS data support program performance measurement and management goals. The same set of mental health NOMs enumerated under MH-CLD is also supported by MH-TEDS. Thus, while both MH-TEDS and MH-CLD collect similar client-level data, the collection methodology differs.
National mental health client-level data reporting was launched in 2011, when MH-CLD was the only reporting method available. The number of states reporting MH-CLD or MH-TEDS has increased from 19 in 2011 to 48 in 2018 (see Appendix B for details). It is important to note that the level and extent of reporting varies. Note also that New York and Tennessee submit data only for a subset of the total number of individuals that they served during a reporting period.
Beginning in the 2014 reporting period, states could choose which method—MH-CLD or MH-TEDS—to use for data reporting. In 2018, 33 states and two other jurisdictions (Commonwealth of the Northern Mariana Islands and the Republic of Palau) used MH-CLD; 11 states (Connecticut, Delaware, Louisiana, Michigan, Mississippi, Nebraska, North Carolina, Oklahoma, Pennsylvania, Vermont, and West Virginia), the District of Columbia, and Puerto Rico used MH-TEDS [Appendix Table B1]. Connecticut reports data through both MH-CLD (for children and adolescents) and MH-TEDS (for adults).
In summary, this report presents the client-level data reported for the 2013 through 2018 reporting periods. Data from all six reporting periods are presented in Chapters 1 through 6. Chapter 7 presents outcomes for individuals served across two or more reporting periods. Chapter 8 presents, for each state or jurisdiction, the number of individuals served in the 2013–2018 reporting periods, according to select mental health diagnoses for age, gender, and race based on the U.S. state-level population. Chapter 9 presents state-level data for the 2013 through 2018 reporting periods, and Chapter 10 presents state-level data only for the 2018 reporting period.
See Appendix A for a crosswalk of data fields collected in MH-TEDS and MH-CLD.
This report presents mental health client-level data submitted for the 2013 through 2018 reporting periods using the Mental Health Client-Level Data (MH-CLD) and the Mental Health Treatment Episode Data Set (MH-TEDS). This report provides information on the demographics, characteristics, and outcomes of individuals served by state mental health agencies (SMHAs) for these six reporting periods, with particular focus on the most recent reporting period. The Substance Abuse and Mental Health Services Administration (SAMHSA) has provided support to states to build capacity to collect and report client-level data.
Both the MH-TEDS and MH-CLD include individuals served through SMHAs during the state- defined 12-month reporting period. Most states elect to use the state fiscal year, which, for the 2018 reporting period, usually ran from July 1, 2017, through June 30, 2018; however, some states define their fiscal year differently. See Appendix B for details.
MH-CLD presented in this report contains one record for each individual served. Data items are populated by the states based on the status of the individual, either at the start and end of the state’s reporting period, or the most recently available data. MH-TEDS contains one record for each admission to, and discharge from, a particular service type/setting (referred to as a treatment episode) within the client’s treatment continuum during the reporting period. Data collected from MH-TEDS admission records and update/discharge records are stored as two separate data sets that are linked using a HIPAA-compliant, non-protected health information, unique client identifier located in both files. Linking the records allows for the creation of a single client record comparable to the MH-CLD format.
The process of creating an individual record using the MH-TEDS data allows for the reporting of these individuals in both the MH-TEDS and MH-CLD data sets. Tables in all chapters of this report use individuals as the unit of analysis for the combined data from MH-TEDS and MH-CLD.
MH-TEDS and MH-CLD collect a variety of data items, including demographics (e.g., age, gender, race, and ethnicity), national outcome measures (NOMs, e.g., living arrangements, employment status, criminal justice involvement, and school attendance), and other clinical measures (e.g., co-occurring mental health and substance use disorders). Throughout this report, data for living arrangements and employment are presented according to individuals’ status at the end of the given reporting period. Valid data on criminal justice involvement were reported for less than 40 percent of the individuals served for each reporting period; thus, arrest data were excluded from this report. Global Assessment of Functioning (GAF) and Children’s Global Assessment (CGAS) scores were dropped from the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and thus are excluded from this report due to insufficient data. See Appendix C for a description of the variables; see Appendix D for the federal definitions of serious mental illness (SMI) and serious emotional disturbance (SED).
Mental health diagnoses are reported in the MH-TEDS and MH-CLD as codes from either the International Classification of Diseases, Clinical Modification (ICD-9-CM/ICD-10-CM), or from the DSM-IV/5. Up to three mental health diagnostic codes may be reported for each client. For this report, diagnostic codes were categorized based on a modified version of the Clinical Classification Software (CCS). The mental health section of the CCS has 15 diagnostic categories and 25 subcategories; in all, 12 mental health diagnoses were selected for tabulation, with all other mental health diagnoses grouped as other mental health diagnoses for a given table. See Appendix E for details.
The 12 mental health diagnostic groups used in this report are: trauma- and stressor- related disorders; anxiety disorders; attention deficit/hyperactivity disorder (ADHD); conduct disorder; delirium, dementia, and amnestic and other cognitive disorders (delirium/dementia); bipolar disorders; depressive disorders; oppositional defiant disorder; personality disorders; pervasive developmental disorders; schizophrenia and other psychotic disorders; and alcohol or substance-related disorders.
Records with partially complete data have been retained in this report. For example, an entire client record is not removed from the report because a single data item is missing. When records include missing or invalid data for a specific variable, those records are excluded from tabulations of that variable. The total number of records on which a percentage distribution is based is reported in each table.
In general, this report presents national- and state-level data from the MH-CLD in the 2018 reporting period, as well as trend data from the 2013–2018 reporting periods. There are three major levels of data reporting: (1) the entire population within each age category, (2) the subgroup population of individuals with, or at risk for, serious emotional disturbance (SED) or serious mental illness (SMI), and (3) the entire population within each mental health diagnosis category.
Because different stages of life are associated with distinct forms of mental and behavioral disorders and with distinctive treatment service utilization patterns, this report examines the characteristics of individuals receiving mental health services by the following age groups: children and adolescents (aged 17 years and younger), young adults (aged 18 to 24 years), adults (aged 25 to 54 years), and older adults (aged 55 years and older). Accordingly, Chapters 2 through 5, which focus on specific age groups, include age-specific sets of mental health diagnoses.3
Additionally, this report includes the subpopulation of individuals with co-occurring mental and substance use disorders. For this subpopulation, the report includes individuals aged 12 years and older to match the population used in the substance use TEDS reports. Determination of individuals with co-occurring mental and substance use disorders was based on the variable in the data set called co-occurring mental and substance use disorders.
Identification of individuals with a serious mental illness (SMI) or serious emotional disturbance (SED) is based on each state’s definitions for SMI and SED. This is reported as a single variable: SMI/SED status. Individuals aged 17 years and younger who are indicated in the data set as having SED, or being at risk of SED, are included in the SED subpopulation, while individuals aged 18 years and older who are indicated as having an SMI are included in the SMI subpopulation. Exceptions may exist for a few states where young adults (aged 18 to 21 years) continue to receive mental health services from the state’s child mental health system. They are included in the SED subpopulation as reported by the state.
Chapter 7 presents data on cohorts of individuals who received mental health services through SMHAs during two or more reporting periods. While the narrative of Chapter 7 focuses specifically on a cohort of individuals served in both the 2015 and 2018 reporting periods, additional tables for Chapter 7 encompass cohorts of individuals served across various other combinations of reporting periods between 2013 and 2018. Individuals were selected for analysis if records with the same unique identification number, from the same state, indicated that they were served in both of the given reporting periods.
For both MH-TEDS and MH-CLD, states report only individuals served through SMHAs during the state-defined 12-month reporting period. These data do not represent the total national demand for mental health treatment or describe the mental health status of the national population. In addition, New York and Tennessee report only a subset of the total individuals served through their SMHAs.
Except for Tables 1.12a–b, presented in Chapter 1, this report uses the first-mention (primary) mental health diagnosis as the variable by which individuals are grouped. About 88 percent of all individuals in the 2018 data have at least one mental health diagnosis, while 22 percent have two mental health diagnoses, and 9 percent have three mental health diagnoses [Tables 1.12a–b].
Individuals Served
Regional Distributions
Any-Mention Mental Health Diagnoses
This chapter provides a brief background on state reporting of mental health client-level data and a summary of the data submitted for the 2013 through 2018 reporting periods.4 Data on NOMs and clinical measures are presented by demographic characteristics and mental health diagnoses5 for all individuals.
Caution must be used when comparing data over time. The number of states submitting client-level data has varied for each reporting period: 45 states reported 2013 data, 47 states reported 2014 data, 45 states reported 2015 data, 47 states reported 2016 data, 48 states reported 2017 data, and 48 states reported 2018 data.
All data tables represent sums of individuals who received publicly funded mental health services— individuals served—through the auspices of state mental health agencies (SMHAs).
Tables 1.1a–b. For the 2013 reporting period, 45 states reported that a total of 5,576,659 individuals received mental health services; for the 2014 reporting period, 47 states reported that a total of 5,818,881 individuals received mental health services; for the 2015 reporting period, 45 states reported that a total of 5,311,897 individuals received mental health services; for the 2016 reporting period, 47 states reported that a total of 5,813,339 individuals received mental health services; for the 2017 reporting period, 48 states reported that a total of 5,934,383 individuals received mental health services; and for the 2018 reporting period, 48 states reported that a total of 6,213,791 individuals received mental health services.6
Tables 1.2a–b. Females accounted for between 51 and 52 percent of all individuals served in every reporting period between 2013 and 2018.
Tables 1.2a–b. In all six reporting periods from 2013 through 2018, between 28 and 30 percent of individuals served were aged 17 years and younger; between 10 and 11 percent were aged 18 to 24 years; 46 percent were aged 25 to 54 years; and between 14 and 15 percent were aged 55 years and older. The most frequently reported diagnoses among specific age groups were relatively consistent across the six reporting periods [Tables 1.4a–1.7b].
Tables 1.3a–b. For each of the reporting periods from 2013 through 2018, Whites represented between 67 and 68 percent of the individuals served; Blacks or African Americans represented between 20 and 21 percent; and American Indians or Alaska Natives, Asians, Native Hawaiians or Other Pacific Islanders, and other groups, combined, represented between 12 and 13 percent.8
Hispanics accounted for between 15 and 17 percent of all individuals served in each of the six reporting periods from 2013 through 2018.
Table 1.23b. Blacks or African Americans accounted for 20 percent of individuals served in the 2018 reporting period but just 13 percent of the 2018 U.S. population.9
Tables 1.8a–b. Among individuals aged 18 years and older in each reporting period from 2013 through 2018, more than half reported never being married (ranging between 55 and 60 percent); those who were married at the time of reporting ranged between 15 and 18 percent.
Tables 1.22a–c. Among individuals aged 25 to 54 years served in the 2018 reporting period, 16 percent were currently married. In contrast, 57 percent of the 2018 U.S. population in that age group were currently married.10
Tables 1.8a–b. Individuals living in a private residence accounted for between 83 and 85 percent of those served in the six reporting periods from 2013 through 2018; between 3 and 4 percent reported being homeless.
Tables 1.9a–b. Individuals with serious mental illness (SMI) accounted for between 72 and 78 percent of individuals aged 18 years and older who were served in any of the six reporting periods from 2013 through 2018. Children and adolescents aged 17 years and younger who had, or were at risk for, serious emotional disturbance (SED) accounted for between 70 and 76 percent of individuals aged 17 years and younger who were served in any of the six reporting periods from 2013 through 2018.
Tables 1.10a–b. Among individuals aged 18 years and older served in any of the six reporting periods from 2013 through 2018, the proportion employed ranged between 17 and 23 percent, the proportion unemployed ranged between 27 and 31 percent, and the proportion not in the labor force ranged between 48 and 52 percent.
Tables 1.10a–b. Individuals who completed Grade 12 or a general equivalency diploma (GED) accounted for between 46 and 49 percent of individuals aged 18 years and older who were served in any of the six reporting periods from 2013–2018; between 19 and 24 percent completed at least a year of education beyond Grade 12.
Tables 1.10a–b. In both the 2017 and 2018 reporting periods, veterans accounted for 3 percent of individuals aged 18 years and older served.
Tables 1.11a–b. Among individuals served in any of the six reporting periods from 2013 through 2018, those newly admitted to treatment11 ranged between 46 to 54 percent, and those continuing treatment12 ranged between 46 and 54 percent.
Tables 1.11a–b. For the 2013 to 2018 reporting periods, the proportion of individuals who received mental health services from community-based programs ranged between 97 and 98 percent. Further analysis of the settings in which individuals received mental health services during the 2018 reporting period is presented in Chapters 2 through 6.
Tables 1.14a–1.19b present the gender, age, race, and ethnicity of individuals with the following primary diagnoses: trauma- and stressor-related disorders [Tables 1.14a–b], anxiety disorders [Tables 1.15a–b], attention deficit/hyperactivity disorder [Tables 1.16a–b], bipolar disorders [Tables 1.17a–b], depressive disorders [Tables 1.18a–b], and schizophrenia and other psychotic disorders [Tables 1.19a–b].
Tables 1.20a–1.21b present the gender, age, race, and ethnicity of individuals grouped by the presence or absence of co-occurring mental health and substance use disorders.
Tables 1.13a–b and Figure 1. About a third (between 31 and 36 percent) of all individuals who received mental health services in the 2013 through 2018 reporting periods were in the South. The Census regions with the next largest proportions of individuals who received mental health services in the 2013 through 2018 reporting periods were the West (between 27 and 31 percent), the Midwest (between 18 and 27 percent), and the Northeast (between 11 and 23 percent).
Figure 1. Census regions and Census divisions of the United States
Tables 1.12a–b present the number and percentage distribution of individuals who received any mention—whether first, second, or third—of the listed mental health diagnoses for the 2013, 2014, 2015, 2016, 2017, and 2018 reporting periods. Differences among reporting periods should be interpreted with great caution; variation may be more a function of the mix and number of reporting states than of actual differences.
Number Served
Gender
Race
Ethnicity
Living Arrangements
SED Status
Client Treatment Status at the Start of the Reporting Period
SED Status, by Service Setting
This chapter presents data on children and adolescents aged 17 years and younger who received mental health services through SMHAs in the 2013–2018 reporting periods, with particular focus on the 2018 reporting period. Data on NOMs and clinical measures are presented by demographic characteristics and mental health diagnoses for all children and adolescents. Characteristics for the subpopulation of children and adolescents with, or at risk for, SED are presented where the percentages notably differ from the characteristics of all children and adolescents.
Tables 2.1a–b present the total number of individuals aged 17 years and younger served in the 2013 through 2018 reporting periods, by demographic characteristics.
The number of individuals served who were aged 17 years and younger increased from 1,650,728 in the 2013 reporting period to 1,800,613 in the 2018 reporting period.
Tables 2.3a–2.4c. In the 2018 reporting period, 1,630,278 individuals aged 17 years and younger had a valid mental health diagnosis code, of which 1,174,041 were reported to have, or be at risk of, SED.
Only individuals with valid mental health diagnoses are included in these and all subsequent tabulations of mental health diagnoses in this chapter.
Tables 2.3a–2.4c. Tables 2.3a–c present the most frequently reported diagnoses, by gender, among individuals aged 17 years and younger, while Tables 2.4a–c present the most frequently reported diagnoses, by gender, for individuals aged 17 years and younger with SED. Males accounted for 57 percent and females accounted for 43 percent of individuals aged 17 years and younger who were served in the 2018 reporting period. The most frequently reported diagnoses differed by gender.
Tables 2.3a–2.4c. The most frequently reported diagnoses among individuals aged 17 years and younger served in the 2018 reporting period varied by race. Trauma- and stressor-related disorders were reported most frequently among American Indians or Alaska Natives (30 percent), Native Hawaiian or Other Pacific Islanders (27 percent), Whites (24 percent), and Asians (23 percent); ADHD was the most frequently reported diagnosis among Blacks or African Americans (32 percent).
Tables 2.3a–2.4c. Among Hispanic individuals aged 17 years and younger served in the 2018 reporting period, the most frequently reported diagnoses were trauma- and stressor-related disorders (23 percent); next were ADHD (20 percent) and depressive disorders (17 percent). Among non-Hispanics, the most frequently reported diagnoses were ADHD (25 percent), trauma- and stressor-related disorders (23 percent), and depressive disorders (13 percent).
Tables 2.5a–2.6c. Among individuals aged 17 years and younger served in the 2018 reporting period, trauma- and stressor-related disorders were the most frequently reported diagnoses among those who were in foster care (47 percent), were homeless (39 percent), were in other living arrangements (25 percent), or were in residential care (21 percent). During the same period, individuals aged 17 years and younger living in a private residence were most frequently reported with an ADHD diagnosis (24 percent).
Tables 2.5a–2.6c. Among individuals aged 17 years and younger with SED served in the 2018 reporting period, the most frequently reported diagnosis was ADHD (23 percent); among those without SED, the most frequently reported diagnoses were trauma- and stressor-related disorders (27 percent).
Tables 2.7a–2.8c. Among individuals aged 17 years and younger who were continuing treatment during the 2018 reporting period, the most frequently reported diagnosis was ADHD (29 percent); among those who were newly admitted to treatment in the 2018 reporting period, the most frequently reported diagnoses were trauma- and stressor-related disorders (27 percent).
Table 2.9. SED status varied by service setting among individuals aged 17 years and younger served in the 2018 reporting period. It should be noted that individuals may have received services in more than one setting and therefore may be counted in multiple rows of Table 2.9.
Number Served
Gender
Race and Ethnicity
Education
Marital Status
Living Arrangements
SMI Status
Veteran Status
Employment Status
Client Treatment Status at the Start of the Reporting Period
Service Setting
SMI Status, by Service Setting
This chapter presents data on young adults aged 18 to 24 years who received mental health services through SMHAs in the 2013–2018 reporting periods, with particular focus on the 2018 reporting period. Data on NOMs and clinical measures for all young adults are presented by demographic characteristics and mental health diagnoses. Characteristics for the subpopulation of young adults with an SMI are presented where the percentages notably differ from all young adults who received mental health services.
Tables 3.1a–b present the total number of individuals aged 18 to 24 years served in the 2013 through 2018 reporting periods, by demographic characteristics.
The number of individuals served who were aged 18 to 24 years increased from 594,733 in the 2013 reporting period to 645,452 in the 2018 reporting period.
Tables 3.3a–3.4c. In the 2018 reporting period, 557,478 individuals aged 18 to 24 years had a valid mental health diagnosis code, of which 380,549 were reported to have SMI.
Only individuals with valid mental health diagnoses are included in these and all subsequent tabulations of mental health diagnoses in this chapter.
Tables 3.3a–c. Females accounted for 54 percent of individuals aged 18 to 24 years who were served during the 2018 reporting period. The most frequently reported diagnoses among males were depressive disorders (24 percent), schizophrenia and other psychotic disorders (14 percent), anxiety disorders (11 percent), and bipolar disorders (11 percent). Among females aged 18 to 24 years, the most frequently reported diagnoses were depressive disorders (35 percent), anxiety disorders (17 percent), and trauma- and stressor-related disorders (15 percent); schizophrenia and other psychotic disorders were reported in 5 percent of females aged 18 to 24 years.
Tables 3.3a–c. Depressive disorders were the most frequently reported diagnoses among individuals of every racial and ethnic group aged 18 to 24 years served during the 2018 reporting period, ranging from 27 percent among Blacks or African Americans to 31 percent among Native Hawaiians or Other Pacific Islanders and Whites, respectively.
Tables 3.5a–c. Among individuals of every education level aged 18 to 24 years served during the 2018 reporting period, the most frequently reported diagnoses were depressive disorders, ranging from 24 percent of individuals who completed Grade 8 or less to 38 percent among individuals who completed at least a year of education beyond Grade 12.
Tables 3.5a–3.6c. Among individuals across all marital status categories aged 18 to 24 years who were served during the 2018 reporting period, the most frequently reported diagnoses were depressive disorders, ranging from 29 percent among widowed individuals to 38 percent among separated individuals.
Tables 3.7a–3.8c. Among individuals aged 18 to 24 years who were served during the 2018 reporting period, depressive disorders were the most frequently reported diagnoses among those who lived in a private residence (32 percent), those who had other living arrangements (29 percent), those who were homeless (27 percent), those who were in foster care (21 percent), and those in residential care (20 percent). Trauma- and stressor-related disorders were the most frequently reported diagnoses for those who were in jail or correctional facilities (22 percent). Among those in institutional settings, schizophrenia and other psychotic disorders were the most frequently reported diagnoses (32 percent).
Tables 3.7a–3.8c. Among individuals aged 18 to 24 years served during the 2018 reporting period, depressive disorders were the most frequently reported diagnoses for those who had SMI (34 percent). Trauma- and stressor-related disorders were the most frequently reported diagnosis for those who did not have SMI (20 percent).
Tables 3.7a–3.8c. Among individuals aged 18 to 24 years served during the 2018 reporting period, depressive disorders were the most frequently reported diagnoses for those who were veterans (37 percent) and those who were not veterans (30 percent).
Tables 3.9a–3.10c. Among individuals aged 18 to 24 years served in the 2018 reporting period, 27 percent were employed, 28 percent were unemployed, and 45 percent were not in the labor force; of those not in the labor force, 45 percent were students.
Tables 3.11a–3.12c. Among individuals aged 18 to 24 years served during the 2018 reporting period, the most frequently reported diagnoses were depressive disorders, regardless of individuals’ treatment status at the start of the reporting period (32 percent among individuals who were newly admitted to treatment and 26 percent among individuals who were continuing treatment).
Tables 3.11a–3.12c. The most frequently reported diagnoses varied by mental health service setting. Individuals may have received services in more than one service setting during the reporting period and therefore may be counted in multiple rows of Tables 3.11a–c and Tables 3.12a–c.
Among individuals aged 18 to 24 years served in the 2018 reporting period, the most frequently reported diagnoses were schizophrenia and other psychotic disorders for those in state psychiatric hospitals (41 percent) and residential treatment centers (23 percent); depressive disorders were the most frequently reported diagnoses among those served in other psychiatric inpatient facilities (31 percent) and community-based programs (30 percent). Trauma- and stressor-related disorders were the most frequently reported diagnoses among those in institutions under the justice system (24 percent).
Table 3.13. Among individuals aged 18 to 24 years served during the 2018 reporting period, SMI status varied by service setting. It should be noted that individuals may have received services in more than one setting and therefore may be counted in multiple rows of Table 3.13.
Number Served
Gender
Race
Ethnicity
Education
Marital Status
Living Arrangements
SMI Status
Veteran Status
Employment Status
Client Treatment Status at the Start of the Reporting Period
Service Setting
SMI Status, by Service Setting
This chapter presents data on adults aged 25 to 54 years who received mental health services through SMHAs in the 2013–2018 reporting periods, with particular focus on the 2018 reporting period. Data on NOMs and clinical measures for all adults aged 25 to 54 years old are presented by demographic characteristics and mental health diagnoses. Characteristics for the subpopulation of adults with SMI are presented where the percentages notably differ from the characteristics of all adults aged 25 to 54 years old.
Tables 4.1a–b present the total of individuals aged 25 to 54 years reported in the 2013 through 2018 reporting periods, by demographic characteristics.
The number of individuals served who were aged 25 to 54 years increased from 2,558,630 in the 2013 reporting period to 2,831,082 in the 2018 reporting period.
Tables 4.3a–4.4c. In the 2018 reporting period, 2,476,907 individuals aged 25 to 54 years had a valid mental health diagnosis code, of which 1,848,515 were reported to have SMI.
Only individuals with valid mental health diagnoses are included in these and all subsequent tabulations of mental health diagnoses in this chapter.
Tables 4.3a–4.4c. Females accounted for 55 percent of individuals aged 25 to 54 years who were served during the 2018 reporting period. The most frequently reported diagnoses among females were depressive disorders (33 percent), bipolar disorders (18 percent), and trauma- and stressor- related disorders (13 percent). Among males, the most frequently reported diagnoses were depressive disorders (25 percent), schizophrenia and other psychotic disorders (24 percent), and bipolar disorders (14 percent).
Tables 4.3a–4.4c. Among individuals of all races, except Asians, who were aged 25 to 54 years and were served in the 2018 reporting period, depressive disorders were the most frequently reported diagnoses; depressive disorders were reported among 30 percent of Whites, 29 percent of Blacks or African Americans, 27 percent of American Indian or Alaska Natives, and 27 percent of Native Hawaiians or Other Pacific Islanders. Among Asians aged 25 to 54 years served in the 2018 reporting period, schizophrenia and other psychotic disorders were the most frequently reported diagnoses (30 percent).
Tables 4.3a–4.4c. Among individuals aged 25 to 54 years served in the 2018 reporting period, depressive disorders were the most frequently reported diagnoses for both those of Hispanic origin (31 percent) and non-Hispanic origin (30 percent).
Tables 4.5a–4.6c. Among individuals aged 25 to 54 years served in the 2018 reporting period, depressive disorders were the most frequently reported diagnoses, ranging from 28 percent among those who completed at most Grade 8 to 32 percent among those who completed at least a year of education beyond Grade 12.
Tables 4.5a–4.6c. Depressive disorders were the most frequently reported diagnoses among individuals aged 25 to 54 years served during the 2018 reporting period across all marital status categories (31 percent). Among individuals in this age group with schizophrenia and other psychotic disorders, 76 percent were never married.
Tables 4.7a–4.8c. Among individuals aged 25 to 54 years served during the 2018 reporting period who were homeless, lived in a private residence, or had other living arrangements,13 the most frequently reported diagnoses were depressive disorders, ranging from 25 percent of individuals with other living arrangements to 31 percent of individuals living in a private residence.
Among individuals aged 25 to 54 years served in the 2018 reporting period, schizophrenia and other psychotic disorders were the most frequently reported diagnoses among those living in an institutional setting (47 percent), in residential care (40 percent), in foster care (28 percent), or in jails or correctional facilities (20 percent).
Tables 4.7a–4.8c. Among individuals with SMI who were aged 25 to 54 years and were served in the 2018 reporting period, the most frequently reported diagnoses were depressive disorders (32 percent); the next most frequent diagnoses for those with SMI were schizophrenia and other psychotic disorders (20 percent) and bipolar disorders (18 percent). Among those without SMI, the most frequent diagnoses were depressive disorders (21 percent) and trauma- and stressor-related disorders (21 percent).
Among individuals with schizophrenia and other psychotic disorders who were aged 25 to 54 years and were served in the 2018 reporting period, 93 percent were reported to have SMI.
Tables 4.7a–4.8c. Among individuals aged 25 to 54 years served during the 2018 reporting period, depressive disorders were the most frequently reported diagnoses both for those who were veterans (29 percent) and those who were not veterans (29 percent).
Among those who were veterans, 16 percent had diagnoses of trauma- and stressor-related disorders; 12 percent of non-veterans aged 25 to 54 years who were served in the 2018 reporting period had diagnoses of trauma- and stressor-related disorders.
Tables 4.9a–4.10c. Among individuals aged 25 to 54 years served in the 2018 reporting period, 26 percent were employed, 31 percent were unemployed, and 43 percent were not in the labor force. The most frequent diagnoses across all employment statuses were depressive disorders.
Tables 4.11a–4.12c. Among individuals aged 25 to 54 years served in the 2018 reporting period, depressive disorders were the most frequently reported diagnoses, regardless of individuals’ treatment status at the start of the reporting period; depressive disorders were reported for 31 percent of individuals who were newly admitted to treatment and for 28 percent of individuals continuing treatment. The second most frequently reported diagnoses for individuals continuing treatment were schizophrenia and other psychotic disorders (22 percent); for those newly admitted to treatment, the second most frequently reported diagnoses were anxiety disorders (14 percent).
Tables 4.11a–4.12c. It should be noted that individuals may have received services in more than one service setting during the reporting period and therefore may be counted in multiple rows of Tables 4.11a–c and 4.12a–c.
Community-based programs accounted for 97 percent of individuals aged 25 to 54 years served during the 2018 reporting period. Among individuals aged 25 to 54 years served in community-based programs during the 2018 reporting period, the most frequent diagnoses were depressive disorders (30 percent), bipolar disorders (16 percent), and schizophrenia and other psychotic disorders (16 percent). Depressive disorders were also the most frequently reported diagnoses among those aged 25 to 54 years who were served during the 2018 reporting period in other psychiatric inpatient settings (30 percent). Schizophrenia and other psychotic disorders were the most frequently reported diagnoses among individuals aged 25 to 54 years who were served during the 2018 reporting period in state psychiatric hospitals (53 percent), residential treatment centers (37 percent), and institutions under the justice system (21 percent).
Table 4.13 presents the number and percentage of individuals aged 25 to 54 years served during the 2018 reporting period, by mental health service setting and SMI status. It should be noted that individuals may have received services in more than one setting and therefore may be counted in multiple rows of Table 4.13.
Number Served
Gender
Race
Ethnicity
Education
Marital Status
Living Arrangements
SMI Status
Veteran Status
Employment Status
Client Treatment Status at the Start of the Reporting Period
Service Setting
SMI Status, by Service Setting
This chapter presents data on individuals aged 55 years and older who received mental health services through SMHAs in the 2013–2018 reporting periods, with particular focus on the 2018 reporting period. Data on NOMs and clinical measures for older adults are presented by diagnostic categories and mental health diagnoses. Characteristics for the subpopulation of older adults with SMI are presented where the percentages notably differ from the characteristics of all individuals aged 55 and older.
Tables 5.1a–b present the total number of individuals aged 55 years and older served in the 2013 through 2018 reporting periods, by demographic characteristics.
The number of individuals served who were aged 55 years and older increased from 769,081 in the 2013 reporting period to 932,573 in the 2018 reporting period.
Tables 5.3a–5.4c. In the 2018 reporting period, 827,060 individuals aged 55 years and older had a valid mental health diagnosis code, of which 655,241 were reported to have SMI.
Only individuals with valid mental health diagnoses are included in these and all subsequent tabulations of mental health diagnoses in this chapter.
Tables 5.3a–5.4c. Females accounted for 59 percent of individuals aged 55 years and older who were served in the 2018 reporting period. Among females, the most frequently reported diagnoses were depressive disorders (39 percent), schizophrenia and other psychotic disorders (19 percent), and bipolar disorders (15 percent). Among males, the most frequently reported diagnoses were schizophrenia and other psychotic disorders (30 percent), depressive disorders (30 percent), and bipolar disorders (12 percent).
Tables 5.3a–5.4c. Among individuals of all races, except for Blacks or African Americans, who were aged 55 years and older and were served in the 2018 reporting period, the most frequently reported diagnoses were depressive disorders, ranging from 34 percent of American Indians or Alaska Natives to 42 percent of Asians; among Blacks or African Americans, the two most frequently reported diagnoses were schizophrenia and other psychotic disorders (38 percent) and depressive disorders (32 percent).
Tables 5.3a–5.4c. Among individuals aged 55 years and older served during the 2018 reporting period, the most frequently reported diagnoses were depressive disorders both for those of Hispanic origin (43 percent) and non-Hispanic origin (35 percent). Schizophrenia and other psychotic disorders were the second most frequently reported diagnoses both for Hispanics and non-Hispanics (21 percent and 24 percent, respectively).
Tables 5.5a–5.6c. Among individuals across all levels of educational attainment who were aged 55 years or older and were served in the 2018 reporting period, the most frequently reported diagnoses were depressive disorders.
Tables 5.5a–5.6c. Among individuals aged 55 years and older served in the 2018 reporting period, the most frequently reported diagnoses across all marital statuses, except those who were never married, were depressive disorders, ranging from 38 percent of those who were divorced to 44 percent of those who were widowed. Among never-married individuals aged 55 years and older who were served in the 2018 reporting period, the most frequently reported diagnoses were schizophrenia and other psychotic disorders (37 percent).
Tables 5.7a–5.8c. Among individuals aged 55 years and older served in the 2018 reporting period who were living in a private residence, were homeless, or had other living arrangements, the most frequently reported diagnoses were depressive disorders, ranging from 29 percent among those with other living arrangements to 38 percent among those who were living in a private residence.
Among individuals aged 55 years and older served in the 2018 reporting period, schizophrenia and other psychotic disorders were the most frequently reported diagnoses among those living in residential care (54 percent), foster care (44 percent), an institutional setting (39 percent), or a jail or correctional facility (29 percent).
Tables 5.7a–5.8c. Among individuals aged 55 years and older served in the 2018 reporting period, the most frequently reported diagnoses were depressive disorders, both among those who had SMI (37 percent) and those who did not have SMI (28 percent). For those with SMI, the second most frequently reported diagnoses were schizophrenia and other psychotic disorders (27 percent); among those without SMI, the second most frequently reported diagnoses were anxiety disorders (16 percent).
Tables 5.7a–5.8c. Among individuals aged 55 years and older served during the 2018 reporting period, depressive disorders were the most frequently reported diagnoses both for those who were veterans (31 percent) and those who were not veterans (35 percent).
Schizophrenia and other psychotic disorders were reported among 28 percent of veterans aged 55 years and older who were served in the 2018 reporting period; 24 percent of non-veterans aged 55 years and older had diagnoses of schizophrenia and other psychotic disorders.
Tables 5.9a–5.10c. Among individuals aged 55 years and older served in the 2018 reporting period, 12 percent were employed, 18 percent were unemployed, and 70 percent were not in the labor force (of which 61 percent were disabled and 13 percent were retired). Among individuals across all employment statuses who were aged 55 years and older and were served in the 2018 reporting period, the most frequently reported diagnoses were depressive disorders, ranging from 34 percent among those not in the labor force to 40 percent among those unemployed.
Tables 5.11a–5.12c. Among individuals aged 55 years and older served in the 2018 reporting period, depressive disorders were the most frequently reported diagnoses, regardless of individuals’ treatment status at the start of the reporting period; depressive disorders were reported for 38 percent of those newly admitted to treatment in the 2018 reporting period and for 33 percent of individuals who were continuing treatment. Schizophrenia and other psychotic disorders were the second most frequently reported diagnoses in the same period for individuals aged 55 years and older who were continuing treatment (29 percent) and for those newly admitted to treatment (15 percent).
Tables 5.11a–5.12c. Individuals may have received services in more than one service setting and therefore may be counted in multiple rows of Tables 5.11a–c and 5.12a–c.
Community-based programs accounted for 98 percent of individuals aged 55 years and older served during the 2018 reporting period. Depressive disorders were the most frequent diagnoses among individuals aged 55 years and older who were served during the 2018 reporting period in community- based programs (36 percent) and other psychiatric inpatient settings (34 percent). Schizophrenia and other psychotic disorders were the most frequently reported diagnoses among individuals aged 55 years and older served during the same period in state psychiatric hospitals (59 percent), residential treatment centers (51 percent), and institutions under the justice system (30 percent).
Table 5.13 presents the number and percentage distribution of individuals aged 55 years and older who were served in the 2018 reporting period by mental health service setting and SMI status. It should be noted that individuals may have received services in more than one setting during the reporting period and therefore may be counted in multiple columns of Table 5.13.
During the 2018 reporting period, community-based programs reported the lowest proportion among all service settings of individuals aged 55 years and older who had SMI (79 percent); institutions under the justice system and state psychiatric hospitals had the highest proportions of individuals aged 55 years and older with SMI (92 and 91 percent each).
Number Served
Gender
Age
Race
Ethnicity
Substance Use Diagnosis
Living Arrangements
SMI/SED Status
Veteran Status
Employment Status
Service Setting
Client Treatment Status at the Start of the Reporting Period
This chapter presents data on individuals aged 12 years and older reported to have co-occurring mental health and substance use disorders who received mental health services through SMHAs during the 2013–2018 reporting periods, with particular focus on the 2018 reporting period. Data on NOMs and clinical measures for all individuals are presented by demographic characteristics and mental health diagnoses. It should be noted that the definition for co-occurring mental health and substance use disorders includes those who have a reported, identified substance use disorder but may not have a formal substance use diagnosis in addition to a reported mental health diagnosis. It should also be noted that data reported in this chapter exclude individuals whose only mental health diagnoses were alcohol or substance-related disorders.
Tables 1.2a and 6.1a. States reported a total of 1,026,726 individuals with co-occurring mental health and substance use disorders aged 12 years and older who were served in the 2018 reporting period, accounting for 17 percent of all individuals served during this period.
Mental health diagnoses for individuals with co-occurring mental health and substance use disorders aged 12 years and older who were served in the 2018 reporting period differed somewhat by gender, age group, race, ethnicity, living arrangements, employment, not in labor force details, service setting, and timing of admission. Mental health diagnoses for this cohort were largely similar across SMI/SED status.
Tables 6.2a–c. For males with co-occurring mental health and substance use disorders aged 12 years or older served during the 2018 reporting period, the most frequently reported diagnoses were depressive disorders (25 percent), schizophrenia and other psychotic disorders (22 percent), and bipolar disorders (14 percent). Among their female counterparts, the most frequently reported diagnoses were depressive disorders (31 percent), bipolar disorders (19 percent) and anxiety disorders (12 percent).
Tables 6.2a–c. Among individuals with co-occurring mental health and substance use disorders served in the 2018 reporting period, for all age categories, the most frequently reported diagnoses were depressive disorders, ranging between 21 percent in the 12 to 14 years age group and 33 percent in the 55 to 59 years age group, as well as 33 percent in the 60 to 64 years age group. Schizophrenia and other psychotic disorders were reported almost as frequently as depressive disorders in the 65 years and older age group (29 percent).
Tables 6.3a–c. Among individuals with co-occurring mental health and substance use disorders served during the 2018 reporting period, the most frequently reported diagnoses were depressive disorders for Whites (29 percent) and American Indian or Alaska Natives (29 percent). Schizophrenia and other psychotic disorders were the most frequently reported diagnoses for Asians (27 percent), Blacks or African Americans (29 percent). The most frequently reported diagnoses among Hawaiians or Other Pacific Islanders were schizophrenia and other psychotic disorders (24 percent).
Tables 6.3a–c. Among individuals with co-occurring mental health and substance use disorders served in the 2018 reporting period, the most frequently reported diagnoses were depressive disorders for both those of Hispanic origin (26 percent) and non-Hispanic origin (29 percent).
Tables 6.4a–c. Among individuals with co-occurring mental health and substance use disorders served during the 2018 reporting period, mental health diagnoses showed no major differences by substance use diagnosis. Depressive disorders were the most frequently reported diagnoses for individuals who had co-occurring alcohol dependence (33 percent), opioid dependence (33 percent), cocaine dependence (30 percent), and marijuana dependence (25 percent). Depressive disorders were also the most frequently reported mental health diagnoses for those who had co-occurring non-dependent use of opioids (34 percent), cocaine (28 percent), alcohol (29 percent), and marijuana (25 percent). Depressive disorders were also the most frequently reported diagnoses for individuals with alcohol intoxication (34 percent), alcoholic psychoses (32 percent), and drug psychoses (24 percent).
Tables 6.6a–c. Among individuals with co-occurring mental health and substance use diagnoses served during the 2018 reporting period, depressive disorders were the most frequently reported diagnoses for those living in private residences (30 percent), those who were homeless (29 percent), and among those in other living arrangements (27 percent). Schizophrenia and other psychotic disorders were the most frequently reported diagnoses among those in residential care (37 percent), institutional settings (34 percent), and foster care (28 percent).
Tables 6.6a–c. Among individuals who had co-occurring mental health and substance use disorders and were served during the 2018 reporting period, depressive disorders were the most frequently reported diagnoses among those with SMI (29 percent), among those with SED (25 percent), and among those without SMI/SED (25 percent).
Tables 6.6a–c. Among individuals who had co-occurring mental health and substance use disorders and who were served during the 2018 reporting period, depressive disorders were the most frequently reported diagnoses both for those who were veterans (32 percent) and those who were not (30 percent).
Among individuals who had co-occurring mental health and substance use disorders who were served during the 2018 reporting period, schizophrenia and other psychotic disorders were reported among 22 percent of veterans and 17 percent of non-veterans.
Tables 6.7a–c. Among individuals who had co-occurring mental health and substance use disorders, who were aged 18 years and older, and who were served during the 2018 reporting period, 21 percent were employed, 30 percent were unemployed, and 48 percent were not in the labor force; the most frequently reported diagnoses were depressive disorders across all employment statuses (34 percent among the unemployed, 32 percent among the employed, and 27 percent among those not in the labor force).
Tables 6.8a–c. Individuals may have received services in more than one service setting during the reporting period and therefore may be counted in multiple rows of Tables 6.8a–c.
Among individuals with co-occurring mental health and substance use disorders served during the 2018 reporting period, the most frequently reported diagnosis varied by service setting: Schizophrenia and other psychotic disorders were the most frequently reported diagnoses for those in state psychiatric hospitals (49 percent), residential treatment centers (31 percent), and institutions under the justice system (19 percent). Depressive disorders were the most frequently reported diagnoses for those in other psychiatric inpatient settings (32 percent) and community-based programs (29 percent).
Tables 6.8a–c. Among individuals who had co-occurring mental health and substance use disorders and who were served during the 2018 reporting period, depressive disorders were the most frequently reported diagnoses, regardless of individuals’ treatment status at the start of the reporting period; depressive disorders were reported for 32 percent of those newly admitted to treatment in the 2018 reporting period and for 25 percent of individuals who were continuing treatment.
Living Arrangements
Employment Status
Transitions in Living Arrangements
Transitions in Employment Status
This chapter presents data on cohorts of individuals who received mental health services through SMHAs during two or more reporting periods. While the following narrative focuses specifically on a cohort of individuals served in both the 2015 and 2018 reporting periods [Tables 7.1a–7.6b], additional tables for Chapter 7 [Tables 7.7–7.16b] encompass cohorts of individuals served across various other combinations of reporting periods between 2013 and 2018. The length of treatment was not taken into consideration. NOMs are presented by demographic characteristics, mental health diagnoses, and clinical measures for all individuals, based on the last reported status in each period.
Individuals were selected for analysis by matching any individual records in 2015 with any in 2018 from the same state and with the same unique identification number; other individuals served in the 2015 and 2018 reporting periods were excluded from analysis in this chapter. The resulting data set contained 1,800,068 unique clients [Table 7.1a].
Tables 7.1a–7.2c. States reported a total of 1,019,988 individuals served in both the 2015 and 2018 reporting periods who had known living arrangements in both reporting years.
Among individuals served in both the 2015 and 2018 reporting periods, those living in a private residence accounted for 83 percent in both 2015 and 2018; those living in residential care accounted for 5 percent in 2015 and 6 percent in 2018; those who were homeless accounted for 3 percent in 2015 and 4 percent in 2018; those who were in institutional settings accounted for 2 percent in both 2015 and 2018; those in jails/correctional facilities accounted for 1 percent in 2015 and 2 percent in 2018; and those in foster care accounted for 2 percent in 2015 and 1 percent in 2018.
Tables 7.3a–7.4c. States reported a total of 636,139 individuals aged 18 years or older in 2015 who were served in both the 2015 and 2018 reporting periods who had known employment status in both years. Among individuals aged 18 years and older in 2018 who were served in both the 2015 and 2018 reporting periods, those who were not in the labor force accounted for 62 percent in both 2015 and 2018; those who were unemployed accounted for 20 percent in 2015 and 19 percent in 2018; and those who were employed accounted for 18 percent in 2015 and 19 percent in 2018.
Tables 7.5a–b and Figure 2. Among individuals served in both the 2015 and 2018 reporting periods, 92 percent of those who lived in a private residence in 2015 also reported living in a private residence in 2018; 3 percent transitioned to homelessness; 2 percent transitioned to residential care; and 3 percent, combined, transitioned to other living arrangements, institutional settings, or jail.
Figure 2. Living arrangements in 2018 of individuals aged 18 years and older who reported living in a private residence in 2015, by 2015 mental health diagnosis
Tables 7.5a–b and Figure 3. Among individuals aged 18 years and older served in both the 2015 and 2018 reporting periods, 43 percent who were homeless in 2015 also reported being homeless in 2018; 44 percent transitioned to a private residence, 6 percent to residential care, 4 percent to other living arrangements, 2 percent to institutional settings, and 2 percent to jail or correctional facilities.
Figure 3. Living arrangements in 2018 of individuals aged 18 years and older who reported being homeless in 2015, by 2015 mental health diagnosis
Tables 7.5a–b and Figure 4. Among individuals aged 18 years and older served in both the 2015 and 2018 reporting periods, 60 percent of those who were in jail or correctional facilities in 2015 also reported being in jail or correctional facilities in 2018; 24 percent transitioned to private residences, 6 percent to homelessness, 5 percent to residential care, and 3 percent to institutional settings.
Figure 4. Living arrangements in 2018 of individuals aged 18 years and older who reported being in jail or a correctional facility in 2015, by 2015 mental health diagnosis
Tables 7.6a–b and Figure 5. Among individuals aged 18 years and older who were served in both the 2015 and 2018 reporting periods, 66 percent of those who were employed in 2015 also reported being employed in 2018; 13 percent transitioned to being unemployed, and 21 percent had left the labor force.
Figure 5. Employment status in 2018 of individuals aged 18 years and older who reported being employed in 2015, by 2015 mental health diagnosis
Tables 7.6a–b and Figure 6. Among individuals served in both the 2015 and 2018 reporting periods, 56 percent of those who were unemployed in 2015 also reported being unemployed in 2018; 30 percent of those unemployed in 2015 reported in 2018 that they were not in the labor force, and 13 percent reported that they were employed.
Figure 6. Employment status in 2018 of individuals aged 18 years and older who reported being unemployed in 2015, by 2015 mental health diagnosis
Tables 7.6a–b and Figure 7. Among individuals served in both the 2015 and 2018 reporting periods overall, 84 percent of those who were not in the labor force in 2015 also reported not being in the labor force in 2018; 9 percent transitioned to unemployment, and 7 percent transitioned to employment in 2018. The pattern of transition from not in the labor force to other employment statuses was similar among individuals served with bipolar and depressive disorders compared with individuals across all selected mental health diagnoses combined.
Figure 7. Employment status in 2018 of individuals aged 18 years and older who were not in the labor force in 2015, by 2015 mental health diagnosis
It is important to note that differences among reporting periods should be interpreted with great caution; variation may be more a function of the mix and number of reporting states than of actual differences. Throughout this chapter, states/jurisdictions may refer to any of the 50 states, the District of Columbia, the Commonwealth of Puerto Rico, and the combined jurisdictions of the Republic of Palau and the Commonwealth of the Northern Mariana Islands.
Table 8.1 presents the number of individuals served in the 2018 reporting period, by mental health diagnosis, Census region, Census division, and state or jurisdiction.14
Tables 8.2 and 8.3 present, respectively, the number and adjusted number of individuals per 100,000 population served in the 2018 reporting period, by mental health diagnosis, Census region, Census division, and state or jurisdiction.
Among individuals served in the 2018 reporting period, the primary mental health diagnoses with the largest per 100,000 population ratios (adjusted for age, gender, and ethnicity) were depressive disorders (443 per 100,000 population), trauma- and stressor-related disorders (246 per 100,000 population), and schizophrenia and other psychotic disorders (201 per 100,000 population) [Table 8.3].
Across all Census divisions in the 2018 reporting period, depressive disorders were the primary mental health diagnosis with the highest adjusted ratio per 100,000 population, ranging from 238 per 100,000 population for New England to 695 per 100,000 population for the West North Central division [Table 8.3].
In 35 of 45 states and jurisdictions for which age, gender, and race adjustment could be performed, depressive disorders were the primary diagnosis group with the highest adjusted ratio of individuals per 100,000 population. For Hawaii, Idaho, Massachusetts, Nevada, and New York, schizophrenia and other psychotic disorders had the highest adjusted ratio of individuals per 100,000 population. In New Mexico, Oregon, South Dakota, and Vermont, trauma- and stressor-related disorders had the highest adjusted ratio of individuals per 100,000 population. In Montana, the diagnosis with the highest adjusted ratio of individuals per 100,000 population was anxiety disorders [Table 8.3].
Tables 8.4–8.9 present—by Census region, Census division, and state or jurisdiction—the number of individuals served in the 2013 through 2018 reporting periods, grouped by the following primary diagnoses: trauma- and stressor-related disorders [Table 8.4], anxiety disorders [Table 8.5], attention deficit/hyperactivity disorder [Table 8.6], bipolar disorders [Table 8.7], depressive disorders [Table 8.8], and schizophrenia and other psychotic disorders [Table 8.9].
Table 8.10 presents the number of individuals with co-occurring mental health and substance use disorders who were served in the 2013 through 2018 reporting periods, by Census region, Census division, and state or jurisdiction. It should be noted that the definition for co-occurring mental health and substance use disorders includes those who have a reported, identified substance use disorder but may not have a formal substance use diagnosis in addition to a reported mental health diagnosis. It should also be noted that data reported in this chapter exclude individuals whose only mental health diagnoses were substance use disorders.
Tables 9.1a–9.50b present, for each state or jurisdiction, the number and percent distribution of individuals served in the 2013 through 2018 reporting periods, according to mental health diagnosis, gender, age, race, ethnicity, and veteran status.
Tables 10.1a–10.47b present, for each state or jurisdiction, the number and percent distribution of individuals served in the 2018 reporting period, according to mental health diagnosis, gender, age, race, ethnicity, and veteran status.
States that submitted no or insufficient data for the 2018 reporting period—Kansas, Maine, and New Jersey—do not appear in tables for this chapter.
This field is calculated from the client’s date of birth at midpoint of the state’s elected reporting period.
Do not round up age. For example, if the calculated age is 13 and 8 months, report only 13. When the client’s calculated age is less than 12 months, report age as zero.
If the reported date of birth of a client changes during the reporting period, use the most recent available information in calculating age.
This data element is reported for all individuals (16 years old and over) who are receiving services in non-institutional settings. Institutional settings include correctional facilities like prison, jail, detention centers, and mental health care facilities like state hospitals, other psychiatric inpatient facilities, nursing homes or other institutions that keep a person, otherwise able, from entering the labor force.
Full Time – use state definition for full time employment; includes members of the Armed Forces, and individuals in full-time Supported Employment.
Part Time – use state definition for part time; includes individuals in part-time Supported Employment.
Unemployed – defined as actively looking for work or laid off from job (and waiting to be recalled) in the past 30 days.
Not in labor force – defined as not employed and not actively looking for work during the past 30 days, includes Homemaker, Student, Retired, Disabled, Other Reported Classification (e.g., volunteers), Sheltered/Not-Competitive Employment, an inmate of an institution.
Employment Status is defined by SAMHSA as an outcome measure and is collected at admission and discharge/update to assess change.
Coding of individuals with overlapping employment statuses: When individuals are engaged in two or more activities (have overlapping status) during the period when their status is collected by the SMHA, use DOL’s system of priorities to determine the appropriate employment status. The prioritization rule is, labor force activities (such as working or looking for work) take precedence over non-labor force activities (such as student and homemaker); and working or having a job takes precedence over looking for work.
Reporting of a person in an internship program: The Individual with Disabilities Education Act (IDEA) ceases to apply for young individuals (18–21 years old) once they received their high school diploma. The following rules should be observed in making determination whether the adult client in an internship program should be reported as ‘Not in Labor Force’ or ‘Employed.’
This field provides more detailed information about those individuals who are coded as “Not in labor force” in Employment Status.
Homemaker, Student, Retired, Disabled
Resident of Institution – Individuals receiving services from institutional facilities such as hospitals, jails, prisons, long-term residential care, etc.
Other – includes volunteer, seasonal worker, other categories used by the state not specified.
Detailed Not in Labor Force is defined by SAMHSA as an outcome measure, and is collected at admission and at discharge/update to assess change.
This field is reported for individuals aged 16 and older whose Employment Status is coded “Not in labor force.”
This field indicates whether the client has co-occurring substance use and mental health disorders.
Yes – Client has co-occurring substance use and mental health disorders.
No – Client does not have co-occurring substance use and mental health disorders.
The assessment of co-occurring mental and substance use disorders may be based on clinical diagnoses, screening results, claims information, or self-report.
This field identifies whether or not the client is of Hispanic origin.
If the ethnicity of a client changes during the reporting period, report the most recent available information at the end of the reporting period.
This field identifies the client’s most recent reported sex at the end of the reporting period.
States that collect transgender as an option must report the data as follows: Transgender man (female sex at birth but identifies as male) – code as female; transgender woman (male sex at birth but identifies as female) – code as male.
If the gender of a client changes during the reporting period, report the most recent available information.
This field specifies client’s residential status at time of admission (new individuals) or start of the reporting period (continuing individuals).
Homeless – person has no fixed address; includes homeless shelters.
Foster Home/Foster Care – individual resides in foster home. A foster home is a home that is licensed by a county or state department to provide foster care to children, adolescents, and/or individuals. This includes therapeutic foster care facilities. Therapeutic foster care is a service that provides treatment for troubled children within private homes of trained families.
Residential Care – individual resides in a residential care facility. This level of care may include a group home, therapeutic group home, board and care residential treatment, rehabilitation center, or agency-operated residential care facilities.
Crisis Residence – a time-limited residential (24 hours/day) stabilization program that delivers services for acute symptom reduction and restores clients to a pre-crisis level of functioning.
Institutional Setting – individual resides in an institutional care facility with care provided on a 24 hour, 7 days a week basis. This level of care may include skilled nursing/intermediate care facility, nursing homes, institute of mental disease (IMD), inpatient psychiatric hospital, psychiatric health facility, veterans’ affairs hospital, state hospital, or intermediate care facility/MR.
Jail/Correctional Facility – individual resides in a jail and/or correctional facility with care provided on a 24 hour, 7 days a week basis. This includes a jail, correctional facility, detention centers, and prison.
Dependent Living: Private Residence – adult individuals living in a house, apartment, or other similar dwelling who are heavily dependent on others for daily living assistance.
Independent Living: Private Residence – individuals living alone or with others in a private residence and capable of self-care. Includes adult children (age 18 and over) living with parents and adolescents living independently. Also includes individuals who live independently with case management and supported housing support.
Private Residence – for adult with unknown dependency status, or for all children living in a private residence regardless of living arrangement.
Other – Other residential status
Living Arrangements is defined by SAMHSA as an outcome measure and is collected at admission and at discharge/update to assess change.
This field identifies the client’s marital status. The following categories are compatible with categories used in the U.S. Census.
Never married – includes individuals who are single or whose only marriage was annulled.
Currently married – includes married couples, those living together as married, living with partners, or cohabitating.
Separated – includes those legally separated or otherwise absent from spouse because of marital discord.
Divorced – legally divorced.
Widowed
Report marital status at time of discharge or the most recent available status at the end of the reporting period.
This field specifies the client’s current mental health diagnoses during the reporting period.
This measure can be reported by using either the Diagnostic and Statistical Manual of Mental Disorders (DSM) from the American Psychiatric Association or the International Classification of Diseases (ICD) from the World Health Organization.
States should report the most recent mental health diagnoses that are current during the reporting period. Most recent is defined by the date when the diagnosis is reported.
States can report up to three mental health diagnoses by completing the Mental Health Diagnosis 1, 2, and 3 data elements in sequential order.
If the client has more than three most recent mental health diagnoses, use the algorithm below. Use this if the diagnoses are collected through administrative method (i.e., based on the clinician’s evaluation of the person and reported in the client’s case record):
If the state is using claims/encounter data to collect a client’s diagnosis, use the three most frequently reported mental health diagnoses in the client’s service claims/ encounters data throughout the reporting period.
This field specifies the client’s most recent reported race at the end of the reporting period.
Alaska Native – used in MH-TEDS only
American Indian or Alaska Native – A person having origins in any of the original people of North and South America (including Central America and the original people of Alaska) and who maintain cultural identification through tribal affiliation or community attachment.
Asian – A person having origins in any of the following people of the Far East, the Indian Subcontinent, or Southeast Asia, including Cambodia, China, India, Japan, Korea, Malaysia, Philippine Islands, Thailand, and Vietnam.
Asian or Pacific Islander (temporary code) – older racial category used only by some states that have not yet adopted the OMB recommended racial categories.
Black or African American – A person having origins in any of the Black racial groups of Africa.
Hispanic (temporary code) – used in MH-CLD only
Native Hawaiian or Other Pacific Islander – A person having origins in any of the original peoples of Hawaii, Guam, American Samoa, or Other Pacific Islander.
White – A person having origins in any of the original people of Europe, North Africa or the Middle East.
Some Other Race Alone – use this category for instances in which the client is not identified in any category above or whose origin group, because of area custom, is regarded as racial class distinct from the above categories (do not use this category for individuals indicating multiple or mixed races).
Two or more races – use this code when the state data system allows multiple race selection and more than one race is indicated (see guidelines).
For states that collect “Other Race” or allow individuals to specify a single race different from the OMB racial categories, use “Some Other Race Alone.” Note that this category should not be used if the client is indicating multiple or mixed race.
[MH-TEDS only] States that collect “Alaska Native” as a separate category should use “American Indian/Alaska Native” for other American Indians.
In cases where the method of collecting race information differs between commu- nity programs and state hospitals, or where the race reported differs between data systems, the state should resolve the issue in accordance to the state business rule in resolving data quality issues. States may use the following guidelines in the absence of a state business rule or to supplement an existing one:
This field indicates client status at the end of the reporting period—continuing to receive services or reason for discontinuance of treatment.
Continuing Client
Discharged with Treatment Completed – All parts of the treatment plan or program were completed.
Discharged due to Lost Contact/Administrative Discharge
Discharged to Corrections, Jail – Individuals whose course of treatment is terminated because the client has been subject to jail, prison, or house confinement, or has been released by or to the courts.
Discharged due to Death
Discharged due to Aged Out
Discharged due to Other Specified Reasons
Discharged, Reason Unknown
Discharged, Reason not Collected
This field specifies the school grade level of three sub-populations of individuals, as follows:
Current grade level for school-age children (3–17 years old and 18–21 years of age if the client is in special education) who attended school at any time in the past three months.
Highest grade level completed for school-age children who have not attended school at any time within the past three months.
Highest educational attainment for all individuals, whether currently in school or not.
Information for this data element should be collected and reported for all individuals.
“School” includes, but is not limited to, any one or combination of home-schooling, online education, alternative school, vocational school, or regular school (public, private, charter, traditional, military, magnet, independent, parochial, etc.), at which the child is enrolled in any of the following school grade levels: nursery/preschool (including Head Start), kindergarten, elementary/middle school (Grades 1–8), high school (Grades 9–12, including General Equivalency Degree or GED), vocational school (including business, technical, secretarial, trade, or correspondence courses which are not counted as regular school enrollment and are not for recreation or adult education classes), or college/professional degree.
This measure is to be reported only once during the reporting period, either at time of client discharge or at the end of the reporting period if the client is continuing to receive services.
If the information is collected at the time when the school year just ended, report the recent school grade level completed (not the grade level the child is advancing to in the next school year).
For children who are homeschooled or children in Special Education but have been mainstreamed in regular school grades, please report the equivalent grade level.
“A nursery school is defined as a group or class that is organized to provide educational experiences for children during the year or years preceding kindergarten. It includes instruction as an important and integral phase of its program of child care. Private homes in which essentially custodial care is provided are not considered nursery schools. Children attending nursery school are classified as attending during either part of the day or the full day. Part-day attendance refers to those who attend either in the morning or in the afternoon, but not both. Full-day attendance refers to those who attend in both the morning and the afternoon. Children enrolled in Head Start programs or similar programs sponsored by local agencies to provide preschool education to young children are counted under nursery school” (The American Community Survey [ACS]).
A person who had reached the age of 18 prior to collecting this information should report the last grade completed, unless they meet the exception criteria for young individuals.
Report the highest educational attainment completed for all individuals 18 years and older (except the young individuals aged 18–21 in Special Education and receiving mental health services from the Children Mental Health System) whether they are currently in school or not.
This field indicates the type of mental health treatment setting(s) in which the client received services throughout the reporting period.
State Psychiatric Hospital – all SMHA-funded and SMHA-operated organizations operated as hospitals that provide primary inpatient care to individuals with mental illness from a specific geographical area and/or statewide.
SMHA-Funded/Operated Community-Based Program – include community mental health centers (CMHCs), outpatient clinics, partial care organizations, partial hospitalization programs, PACT programs, consumer run programs (including Club Houses and drop-in centers), and all community support programs (CSP).
Residential Treatment Center – an organization, not licensed as a psychiatric hospital, whose primary purpose is the provision of individually planned programs of mental health treatment services in conjunction with residential care for children and youth, and in some cases, adult care.
Other Psychiatric Inpatient – a private provider or medical provider licensed and/ or contracted through the SMHA. This includes public/private hospitals with separate psychiatric wards.
Institutions Under the Justice System – mental health services provided in a jail, prison, juvenile detention center, etc.
This data element refers to the place where services were provided and not particularly the residence of the client.
This field indicates whether the client has serious mental illness (SMI) or serious emotional disturbance (SED) using the state’s definition.
Report the most recent available SMI/SED status at the end of the reporting period.
This field indicates whether the client is already receiving services at the start of the reporting period (continuing) or is a new admission.
New admission – Admission that happened on the first day of the reporting period or thereafter.
Continuing – Already receiving services at the start of the reporting period. The admission date should have occurred at least a day prior to the start of the reporting period.
This field specifies whether the client has served in the uniform services (Army, Navy, Air Force, Marine Corps, Coast Guard, Public Health Service Commissioned Corps, Coast and Geodetic Survey, etc.).
A veteran is a person 16 years or over who has served (even for a short time), but is not now serving, on active duty in the U.S. Army, Navy, Air Force, Marine Corps, Coast Guard, or Commissioner Corps of the U.S. Public Health Service or the National Oceanic and Atmospheric Administration, or who served as a Merchant Marine seaman during World War II. Individuals who served in the National Guard or Military Reserves are classified as veterans only if they have ever been called or ordered to active duty (excluding the 4–6 months of initial training and yearly summer camps).
Table C1 Number of states reporting data, MH-CLD and MH-TEDS 2013–2018
Table C2 Item percentage response rate, by state or jurisdiction: MH-CLD and MH-TEDS 2018
Note that identification of individuals with a serious mental illness (SMI) or serious emotional disturbance (SED) is based on each state or jurisdiction’s definitions for SMI and SED; some states and jurisdictions may use definitions that vary from the federal definitions that appear in this appendix.
Pursuant to section 1912 (c) of the Public Health Service Act, as amended by Public Law 102-321 “adult[s] with a serious mental illness” are individuals:
“These disorders include any mental disorders (including those of biological etiology) listed in DSM-III-R or their ICD-9-CM equivalent (and subsequent revisions), with the exception of DSM-III-R “V” codes, substance use disorders, and developmental disorders, which are excluded, unless they co-occur with another diagnosable serious mental illness…” (p. 29425).
Pursuant to section 1912 (c) of the Public Health Service Act, as amended by Public Law 102-321 “children with a serious emotional disturbance” are individuals:
“These disorders include any mental disorder (including those of biological etiology) listed in DSM-III-R or their ICD-9-CM equivalent (and subsequent revisions) with the exception of DSM-III-R ‘V’ codes, substance use, and developmental disorders, which are excluded, unless they co-occur with another diagnosable serious emotional disturbance…” (p. 29425).
“Functional impairment is defined as difficulties that substantially interfere with or limit a child or adolescent from achieving or maintaining one or more developmentally-appropriate social, behavioral, cognitive, communicative, or adaptive skills. Functional impairments of episodic, recurrent, and continuous duration are included unless they are temporary and expected responses to stressful events in their environment. Children who would have met functional impairment criteria during the referenced year without the benefit of treatment or other support services are included in this definition….” (p. 29425) [Source: Federal Register 58(96): 29422–29425. May 20, 1993; http://www.samhsa.gov/sites/default/files/federal-register-notice-58-96-definitions.pdf].
Admission indicates the beginning of mental health service provision to a person with mental illness through programs under the auspices of the state mental health agency (SMHA). This includes new admissions (someone who has never received any services from the SMHA) and readmissions (someone who had previously received services from the SMHA, had been discharged, and started receiving services during the reporting period).
ADHD is a neurodevelopmental disorder defined by impairing levels of inattention, disorganization, and/or hyperactivity-impulsivity.
A center within the Substance Use and Mental Health Services Administration (SAMHSA) under the U.S. Department of Health and Human Services (HHS), CBHSQ is the lead government agency for behavioral health statistics, as designed by the Office of Management and Budget (OMB).
CD is a serious behavioral and emotional disorder that can occur in children and teens. A child with this disorder may display a pattern of disruptive and violent behavior and have problems following rules.
DSM-5 is the standard classification of mental disorders used by mental health professionals in the United States. DSM consists of three major components: the diagnostic classification, the diagnostic criteria sets, and the descriptive text [Source: https://www.psychiatry.org/psychiatrists/practice/dsm].
GED is designed for people who, for various reasons, did not graduate from high school but want a certificate equivalent to the traditional high school diploma.
ICD-10-CM/ICD-9-CM is based on the World Health Organization’s International Classification of Diseases (ICD-10/ICD-9). ICD-10-CM and ICD-9-CM are used as the official system of assigning codes to diagnoses and procedures associated with hospital utilization in the United States.
ODD is a childhood disorder that is characterized by negative, defiant, disobedient, and often hostile behavior toward individuals and authority figures primarily.
PDD refers to a group of conditions that involve delays in the development of many basic skills. Most notable among them are the ability to socialize with others, to communicate, and to use imagination.
Sources: Mental Health Client-Level Data (MH-CLD State Instruction Manual (version 2.8) and Combined Substance Use and Mental Health Treatment Episode Data Set (TEDS) State Instruction Manual With Data Submission System (DSS) Guide (version 4.3.1)
This report was prepared for the Center for Behavioral Health Statistics and Quality (CBHSQ), Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services (HHS), by Eagle Technologies, Inc., under Contract No. HHSS283201600001C.
Contributors and reviewers at Eagle, listed alphabetically, include Anand Borse, Erin Doherty, Tsegereda Kifle, Thomas Nephew, David Peabody, Parth Thakore, Doren Walker (Project Director), Yang Yuan, and John Zuwasti Curran. Contributors and reviewers at NRI, listed alphabetically, include Azeb Berhane and Ted Lutterman. Production of the report at SAMHSA was managed by Nichele Waller (COR). Contributors and reviewers at SAMHSA, listed alphabetically, include Herman Alvarado, Heydy Juarez, Sharon Liu, and Nichele Waller.