Research on Child and Adolescent Mental Health

MENTAL HEALTH EXPENDITURES IN THE
EDUCATION SECTOR
While there is wide agreement that the education
sector is an important provider of mental health
services for children, there are no comprehensive
national data on the amount of money spent
providing such services. Given the paucity of
national data, we have looked to other sources.
We have obtained data from the Los Angeles
County Office of Education regarding expenditures
on services provided by mental health
professionals working in the schools, but we
caution that Los Angeles County is unlikely to be
representative. To provide additional information
on the extent of expenditures for mental health
services in the education sector we use estimates
taken from the literature on the excess cost of
educating children designated as having a serious
emotional disturbance (SED).
THE TOP-DOWN APPROACH
Coffey et al. (2000) estimated that $73.4 billion
was spent on mental health services in 1997 (see
also Mark et al., 2000). The top-down approach to
estimating total expenditures on mental health for
children uses micro-level information to allocate
the total expenditures between children and
adults. We estimate children’s (versus adults')
share of expenditures for each major category of
mental health services: outpatient, inpatient, and
prescription drugs. For outpatient visits, we use
the children’s share of total mental health
outpatient visits estimated from NSAF and CTS;
inpatient expenditures are allocated according to
HCUP estimates; psychotropic expenditures are
based on Ingenix. The expenditures on residential
treatment centers for children from Coffey et al.
are fully attributed to children.
LIMITATIONS
Estimating how much is spent on child/adolescent
mental health care is a very complex project and
requires aggregating across data sources that are
not necessarily comparable. Several important
pieces of data rely on regional or State
information that is not necessarily nationally
representative, and other crucial data sources are
older than desirable, in particular IMHO and the
Medicaid data summary published by SAMHSA
(Buck et al., 2000). Unfortunately, running new
analyses even on only a few selected Medicaid
databases was not possible in the scope of this
project. Other limitations are well known and not
unique to this study. For example, underreporting
of MH diagnoses in health care claims may be due
to differential coverage for mental health or to
concern about stigma. Claims data may
underestimate out-of-pocket spending when there
are no claims because of limits in insurance
coverage.
One of the biggest problems is the fragmentation
of mental health delivery. Individual survey data
are more likely than administrative claims data to
capture the full range of services. Our attribution
by a child’s health insurance status, however, will
misclassify such services if they are paid for by
nonhealth sectors (for example, publicly paid
services received by children with private
insurance are allocated to private insurance).
To see the complexity of trying to build up
expenditures using individual payment sources—
and the holes in these estimates—consider the
following table, which shows the type of non-
Federal funding sources in sites that participated
in the Comprehensive Community Mental Health
Services for Children and Their Families Program.
That program was established by Congress in
1992 as a demonstration program that
reorganizes child mental health services into true
“systems” of care. Of course, these programs
include more than just the direct mental health
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