Mental health statistical note最新文献

The mental health services of the Veterans Administration (VA) form an important component of the organized mental health care delivery system in the United States. The 140 VA organizations delivering mental health care represented 3 percent of all mental health organizations in the U.S. in 1986, but accounted for approximately 11 percent of the average daily inpatient mental health census and 8 percent of outpatient mental health visits in organized settings. Their 33,000 full-time equivalent (FTE) staff and $1.4 billion in expenditures devoted to mental health care were approximately 7 percent of the respective totals for all mental health organizations. Between 1983 and 1986, the number of VA organizations offering mental health care increased by only 1, but inpatient mental health additions increased by 22 percent. Average length-of-stay for these inpatients declined by almost as much. Outpatient mental health additions increased by 30 percent, and FTE staff in VA mental health services grew by 10 percent. Mental health services were provided by VA organizations in all States except Alaska, Hawaii, Montana, and North Dakota in 1986. (Veterans are free to make use of programs outside their State of residence.) The largest numbers of mental health services, additions, and episodes were found in States with very large populations, such as California, New York, and Texas. However, the highest rates of additions and episodes per 100,000 civilian population were generally in States with small populations, and often in rural States. For example, Maine, South Dakota, Wyoming, and West Virginia were among the States with the highest rates of additions and episodes. Reflecting the composition of the total population in VA facilities, of 315,630 in VA mental health services, over 95 percent were male, a relatively large percentage (17 percent) were 65 or over, and very few were under 18 years old. About two-thirds were white, non-Hispanic; one-fourth were black, non-Hispanic; and 8 percent were Hispanic. About one-sixth were suffering primarily from drug or alcohol abuse; almost all the rest suffered primarily from mental illness. In November 1986, approximately 36,000 staff persons worked in VA mental health services. About 84 percent of these worked full-time; 9 percent, part-time; and 7 percent, as trainees. The staff included approximately 2,800 psychiatrists, 700 other physicians, 1,600 psychologists, 1,800 social workers, and 7,200 nurses. Three-fourths of the expenditures for VA mental health services went for staff, with other operating expenses consuming most of the remainder.

Between 1984 and 1986, the number of full-time equivalent (FTE) staff employed in specialty mental health organizations in the United States increased 12 percent from 440,925 to 494,591. Much of this increase could probably be attributed to the increase in the number of mental health organizations during this period from 4,438 to 4,747. With the exception of freestanding psychiatric outpatient clinics, which showed a 1 percent decrease, all of the other mental health organization types showed varying amounts of increase in FTE staff, with the most notable gains reported by private psychiatric hospitals, RTCs for emotionally disturbed children, and multiservice mental health organizations. Of the 494,591 FTE staff employed in mental health organizations in 1986, 70 percent were classified as patient care staff and 30 percent as administrative and support staff. Private psychiatric hospitals, State mental hospitals, and freestanding psychiatric outpatient clinics had slightly higher percentages of administrative and support staff (40, 35, and 33 percent, respectively), with consequent smaller percentages of patient care staff (60, 65, and 67 percent, respectively). For all other organization types, the percentages of patient care staff were higher, varying from 70 to 87 percent. Professional patient care staff constituted 47 percent of all FTE staff in mental health organizations in 1986, and other mental health workers (less than B.A.) represented only 23 percent of the total. Among each of the organization types, however, the percentages of professional patient care staff were generally higher, and the percentages of other mental health workers lower, with the major exception of State mental hospitals. Seventy-five percent or more of the staff employed in the various types of specialty mental health organizations in 1986 worked on a full-time basis, with the exception of freestanding psychiatric outpatient clinics and the separate psychiatric services of non-Federal general hospitals in which full-time staff represented only 53 and 67 percent of all staff, respectively. For the most part, a majority (50 percent or more) of each of the staff disciplines employed in specialty mental health organizations worked on a full-time basis. The major exceptions were psychiatrists and other physicians, most of whom worked either on a part-time or a trainee basis.

The total number of psychiatric beds in mental health organizations in the United States increased 2 percent between 1984 and 1986, from 262,673 to 267,613. This was in contrast to a 4 percent decrease observed nationally in all non-Federal hospital beds between 1984 and 1986. As a result, non-Federal psychiatric beds comprised 20 percent of non-Federal hospital beds in 1986, compared to 19 percent in 1984. The overall growth in psychiatric beds between 1984 and 1986 was due to increases in psychiatric beds in VA medical centers, private psychiatric hospitals, and residential treatment centers for emotionally disturbed children (RTCs) which more than offset smaller decreases in psychiatric beds noted in State and county mental hospitals, multiservice mental health organizations, and separate psychiatric services of non-Federal general hospitals. Between 1984 and 1986, the national pattern of an increase in psychiatric beds was reflected in 31 States, while the remaining 19 States and the District of Columbia showed decreases in psychiatric beds during this period. Among the States, the availability of psychiatric beds, measured by bed rates per 100,000 civilian population, varied substantially in 1986. Twenty-seven States and the District of Columbia had 100 or more beds per 100,000 population, while 8 States had fewer than 75 beds per 100,000 population. Although the number of State and county mental hospital beds decreased between 1984 and 1986, these facilities accounted for 45 percent of all psychiatric beds in 1986. In the number of psychiatric beds available, State and county mental hospitals predominated in all but seven States. Nationally, the separate psychiatric inpatient services of non-Federal general hospitals ranked second in number of psychiatric beds in 1986, with 17 percent of the total; followed by private psychiatric hospitals, with 11 percent; VA medical centers, with 10 percent; RTCs, with 9 percent; and multiservice mental health organizations, with 8 percent.

In 1986, 2,967 mental health organizations, or 62 percent of all mental health organizations in the United States (including territories), offered psychiatric outpatient care services. A total of 5.6 million patient care episodes were provided by these organized outpatient services. These episodes involved a total of 47 million visits and 2.8 million additions, and represented 69 percent of all psychiatric patient care episodes in organized settings that year. Both the number of organizations with psychiatric outpatient care services and the number of outpatient additions to these organizations increased by approximately 4 percent between 1983-84 and 1986. Multiservice mental health organizations were the most prominent type of mental health organization in the provision of psychiatric outpatient care. They comprised 42 percent of the 2,967 organizations offering this type of care and were responsible for 54 percent of the outpatient additions, 53 percent of the episodes, and 54 percent of the visits. Next in importance were freestanding psychiatric outpatient clinics and separate psychiatric services in non-Federal general hospitals. They accounted for 26 percent and 17 percent, respectively, of organizations providing psychiatric outpatient care. Each provided 12 to 18 percent of outpatient additions, episodes, and visits. Over 90 percent of multiservice mental health organizations and Veterans Administration psychiatric organizations offered outpatient psychiatric care. In contrast, this form of care was offered by only 29 percent of State and county mental hospitals, 36 percent of private psychiatric hospitals, 37 percent of nonFederal general hospitals with psychiatric services, and 23 percent of residential treatment centers for emotionally disturbed children.(ABSTRACT TRUNCATED AT 250 WORDS)

The 4,747 mental health organizations (excluding territories) providing mental health services in the United States during 1986 generated almost 7.9 million patient care episodes including those in Veterans Administration outpatient and partial care programs. However, in order to make comparisons between 1986 data and all years dating back to 1955, outpatient and partial care programs administered by the Veterans Administration (VA) are omitted. Thus the 7.5 million patient care episodes (exclusive of the aforementioned VA programs) represented a more than four-fold increase over the 1.7 million patient care episodes in mental health organizations observed 31 years earlier in 1955. The major shifts in patient care episodes over the 1955-1986 period have been from inpatient to ambulatory care services in mental health organizations, and from State and county mental hospitals to community-based mental health organizations. For example, in 1955, 77 percent were inpatient care episodes, and the remaining 23 percent were outpatient episodes; by 1986, inpatient care episodes constituted only 27 percent of the total, while 68 percent were outpatient episodes, and 5 percent were partial care episodes. Moreover, between 1955 and 1986, the primary locus of inpatient care episodes shifted from State and county mental hospitals to non-Federal general hospitals, and by 1986 over one-half of the outpatient care episodes and about two-thirds of the partial care episodes occurred in the multiservice mental health organizations.

EXPENDITURES: Expenditures by the 8 types of mental health organizations covered in this report totaled $18.5 billion in 1986, for the United States and the Territories. Three States (California, New York, and Pennsylvania) accounted for one-third of this total. Nationally, the largest proportion of total expenditures were the expenses of State and county mental hospitals (34 percent, down from 38 percent in 1983) and those of multiservice mental health organizations (20 percent). In all but 19 States, State and county mental hospitals (hereafter called State mental hospitals) had the largest expenditures of any type of mental health organization; in 10 of the remaining 19 states, expenditures of multiservice mental health organizations were largest. Nationally, separate psychiatric services of non-Federal general hospitals, private psychiatric hospitals, and VA psychiatric organizations ranked next, with 16, 14, and 7 percent of total mental health expenditures, respectively. At the other extreme, residential treatment centers (RTCs) for emotionally disturbed children, freestanding psychiatric outpatient clinics, and freestanding psychiatric partial care organizations accounted for 5 percent, 3 percent, and less than 1 percent of national total expenditures, respectively. The $18.5 billion expenditure in 1986 was a 28 percent increase over the 1983 figure, but when adjusted for inflation, the estimated increase was only 5 percent overall and 3 percent on a per capita basis. Constant dollar expenditures (1983 = 100) of most types of mental health organizations increased between 1983 and 1986, but those of freestanding psychiatric outpatient clinics were virtually unchanged, and those of State mental hospitals and VA psychiatric organizations actually decreased. SOURCES OF FUNDS: In 1986, the funds received by mental health organizations totaled $19.0 billion. Of this total, $7.9 billion (41 percent) was provided directly by State governments, predominantly by the State mental health agencies. Direct Federal funds plus Medicare and Medicaid (including the State and local share of Medicaid) provided $4.8 billion, or one-fourth, of total funding. Fees from clients (including private insurance) provided $4 billion, or 21 percent, of total funding; direct local government funds provided 8 percent and all other sources 5 percent. State governments provided 78 percent of the funds received by State mental hospitals and were also the largest single source of funds, although not so dominant, for multiservice mental health organizations, freestanding psychiatric partial care organizations, and freestanding psychiatric outpatient clinics. VA medical centers were funded by the Federal Government, while two-thirds of funding for private psychiatric hospitals came from client fees...

In 1986, a total of 314 private psychiatric hospitals provided inpatient services in 47 States and the District of Columbia (D.C.); 114, outpatient care services in 35 States and D.C.; and 102, partial care services in 26 States and D.C. Between 1983 and 1986, the total number of inpatient, outpatient, and partial care episodes in these hospitals increased from 333,731 to 483,284. During the 1983-86 period, the number of private psychiatric hospitals increased from 220 to 314. Almost all of this increase occurred among hospitals operating on a for-profit basis. By 1986, these hospitals represented three-quarters of all private psychiatric hospitals. With the exception of small not-for-profit hospitals, all bed-size groups in private psychiatric hospitals increased between 1983 and 1986. The number of beds in private psychiatric hospitals increased 41 percent, from 21,474 in 1983 to 30,201 in 1986. Similarly, the number of inpatient additions increased from 164,732 to 234,663 in this period, and inpatients at end of year increased from 16,079 to 24,591. The number of outpatient additions increased by more than half, from 77,589 in 1983 to 123,355 in 1986, and the outpatients at the end of the year rose from 79,598 to 135,606 (70 percent). In the same period, the number of partial care additions increased from 5,642 to 8,820, and partial care patients at the end of the year rose from 3,218 to 3,856 (20 percent). In the 1986 year-end inpatient caseload, males slightly outnumbered females, and the patient population was predominantly white, non-Hispanic. About two-fifths of the patients were under age 18, slightly over half were age 18-64 years, and 8 percent were age 65 or older. Mental illness was the major disability, with alcohol and drug abuse a distant second. By comparison, a smaller proportion of patients were under age 18 in 1983 (31 percent), and a larger proportion were age 18-64 (61 percent). In outpatient and partial care services, a more even distribution of the sexes was generally observed. Proportionately fewer outpatients were under age 18, more were between 18 and 64, and fewer were diagnosed with alcohol and drug abuse, compared with inpatient services. Also, proportionately more outpatients were Hispanic. Concomitant increases occurred in the number of full-time equivalent (FTE) staff, as well as in the amount of money expended by private psychiatric hospitals. FTE staff increased from 42,202 in June 1984 to 58,912 in November 1986.(ABSTRACT TRUNCATED AT 400 WORDS)

Results from the 1985 NIMH Inventory show that 1,339 (43 percent) of the 3,118 mental health organizations surveyed provided mental health services to mentally disordered adult offenders. Almost three-fifths of these forensic services were in multiservice mental health organizations, 23 percent were in freestanding psychiatric outpatient clinics, 14 percent in State mental hospitals, 4 percent in private psychiatric hospitals, and less than 2 percent in residential treatment centers for emotionally disturbed children and freestanding psychiatric partial care organizations. About two-thirds of the 289 State mental hospitals provided forensic services; 55 percent of the 1,383 multiservice mental health organizations and 40 percent of the 756 freestanding psychiatric outpatient clinics offered these services. Psychiatric assessment was the forensic service provided by the largest number of mental health organizations. This was followed, in order, by consultation to law enforcement staff and attorneys, psychiatric outpatient care, monitoring of medication, emergency mental health care, inpatient/residential care, partial care, and emergency detention. About 200,000 mentally disordered offenders received psychiatric assessment services from mental health organizations; slightly over 100,000 were provided psychiatric outpatient care, and smaller numbers of clients received other types of forensic services. A total of 14,538 full-time equivalent (FTE) patient care staff were involved in the delivery of forensic services. In addition, State mental hospitals reported 4,525 FTE administrative and support staff serving forensic patients. Special funding for forensic services, totaling $639 million, was received by just over half of the mental health organizations with these services. About four-fifths of this funding came from State mental health agencies, with the remainder provided by sources such as State correctional agencies, State courts or other State sources, city/county jails, city/county courts, and other local public sources.