National Healthcare Disparities Report - LDI Health Economist

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Effectiveness of Care Mental Health and Substance Abuse Importance Chapter 2 Mental Health and Substance Abuse Mortality Number of deaths due to suicide (2009).............................................................34,598 (Kochanek, et al., 2011) Rank among causes of death in the United States—suicide (2009)......................10th (Kochanek, et al., 2011) Alcohol-impaired driving fatalities (2009) ......................................................................10,839 (NHTSA, 2009) Prevalence People age 12 and over with alcohol and/or illicit drug dependence or abuse in the past year (2009)..............................................................................22.5 million (8.9%) (SAMHSA, 2010) Youths ages 12-17 with a major depressive episode during the past year (2009)..........................................................................................................2.0 million (8.1%) (SAMHSA, 2010) Adults age 18 and over with a major depressive episode during the past year (2009) ........................................................................................14.8 million (6.5%) (SAMHSA, 2010) Adults with at least one major depressive episode in their lifetime (2006)......................................................................................................30.4 million (13.9%) (SAMHSA, 2007) Cost National expenditures for treatment of mental health and substance abuse disorders (2014 est.)..............................................................................................$239 billion (SAMHSA, 2008) Cost-effectiveness of screening and brief counseling for problem drinking..............................................................................................$0-$14,000/QALY (Maciosek, et al., 2006) Measures The NHQR and NHDR track measures of the quality of treatment for major depression and substance abuse. Mental health treatment includes counseling, inpatient care, outpatient care, and prescription medications. This section highlights four measures of mental health and substance abuse treatment: n Receipt of treatment for depression. n Suicide deaths. n Receipt of treatment for illicit drug use or alcohol problem. n Completion of substance abuse treatment. 92 National Healthcare Disparities Report, 2011
Effectiveness of Care Findings Treatment: Receipt of Treatment for Depression In 2006, approximately 1.4 million hospitalizations were specifically for mental health conditions and one in five hospital stays included some mention of a mental health condition as either a principal or secondary diagnosis (Saba, et al., 2008). Mood disorders were the most common principal diagnosis for all nonelderly people. Treatment for depression can be very effective in reducing symptoms and associated illnesses and returning individuals to a productive lifestyle. The Sequenced Treatment Alternatives to Relieve Depression study, funded by the National Institute of Mental Health, was the largest clinical trial ever conducted to help determine the most effective treatment strategies for major depressive disorder. It involved both primary care and specialty care settings. Participants included people with complex health conditions, such as multiple concurrent medical and psychiatric conditions. This study found that between 28% and 33% of participants achieved a symptom-free state after the first round of medication, and nearly 70% achieved remission after 12 months (Insel & Wang, 2009). Strategies for treating depression in primary care settings, such as the collaborative care model, have also been shown to generate positive net social benefits in cost-benefit analyses compared with usual care (Glied, et al., 2010). Barriers to high-quality mental health care include cost of care, lack of sufficient insurance for mental health services, social stigma, fragmented organization of services, and mistrust of providers. In rural and remote areas, limited availability of skilled care providers is also a major problem. For racial and ethnic populations, these problems are compounded by the lack of culturally and linguistically competent providers. Chapter 2 Mental Health and Substance Abuse National Healthcare Disparities Report, 2011 93
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U.S. Department of Health and Human
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