Trends in Behavioral Health

National Press Foundation

July 25, 2017

Brian M. Hepburn, M.D.

Executive Director
National Association of State Mental Health
Program Directors (NASMHPD)
 Will Discuss
NASMHPD Strategic Plan
Trends in psychiatric hospitalization
Trends in Behavioral Health Systems
Trends in Financing Behavioral Health
Services
Goals for future Behavioral Health
System
Represents the $41 Billion Public Mental Health
System serving 7.5 million people annually in all 50
states, 4 territories, and the District of Columbia.

Affiliated with the approximately 195 State

Psychiatric Hospitals: Serving 147,000 people per
year and 41,800 people at any one point in time.
 NASMHPD Strategic Plan

6/23/2016 4
 NASMHPD Strategic Plan - Values
Least Restrictive and Most Empowerment
Integrated Setting Community Education
Human Rights and Health Zero Suicide
Equity Working Collaboratively
Health and Wellness Effective and Efficient
Management and
Recovery and Person-
Accountability
Centered Services and
Culturally and Linguistically
Planning
Responsive
Unique Role of Safety Net High Quality Workforce
Services in the Public Capacity
Mental Health System
 MISSION

NASMHPD will work with states, federal

partners, and stakeholders to promote
wellness, recovery, and resiliency for
individuals with mental health conditions or
co-occurring mental health and substance
related disorders across all ages and cultural
groups, including: youth, older persons,
veterans and their families, and people under
the jurisdiction of the court across the full
continuum of services including inpatient.
 NASMHPD Research Institute works with the
states and territories. Thank you to NRI for
allowing NASMHPD to use the following slides.
NRI collects and analyzes data related to
federal reporting requirements for the Mental
Health Block Grant Program, as well as
collection and reporting activities related to
state psychiatric hospitals.
NRI maintains a data base on financing, quality
management and information systems.
NRI conducts specialty state study analyses.
 For Additional Information

Ted Lutterman
703-738-8164
Ted.lutterman@nri-inc.org

Slide 8
Psychiatric Hospitals
 Residents in State Psychiatric Hospitals,
Jails, and Prisons, 1950 to 2014
800,000

700,000 State Psychiatric Jail

Hospital Residents
600,000
Prison
500,000

400,000

300,000

200,000

100,000

0
 Trend in All Psychiatric Beds: By Type
of Hospital, 1970 to 2015
550,000

500,000
State Hospitals
450,000 Private Psychiatric
Hospitasl
VA Psychaitric Services
400,000
General Hospitals
350,000 Total Psych Beds

300,000

250,000

200,000

150,000

100,000

50,000

0
1970 1976 1980 1985 1990 1995 1998 2000 2002 2010 2015

Slide 11
 Estimating the Total Psychiatric Inpatient
Capacity
SAMHSA periodically surveys private psychiatric hospitals and general hospitals
with separate psychiatric units. Currently 2010 is the most recent data available,
but 2014 information should be available soon.

NRI combined 2012 URS data on State Psychiatric Hospitals with data on private
psychiatric hospitals and non-Federal general hospitals with separate psychiatric
units (from SAMHSAs 2010 National Mental Health Services Survey (N-MHSS))

Number of Number of Beds/

Type of Psychiatric Facility Facilities Residents
State Psychiatric Hospitals (2012) 195 41,821
Non-Federal General Hospitals with Separate
Psychiatric Units (2010) 1,157 35,351

Private Psychiatric Hospitals (2010) 374 24,919

Total Psychiatric Inpatient Capacity 1,726 102,091

 Number of Public and Private
Psychiatric Beds per 100,000
State Population: 2010 estimate

Psychiatric Bed Rates

per 100,000 population

13.2 to 23.29 (13)

26.3 to 33.49 (13)
33.5 to 42.99 (13)
43 to 81.5 (12)

State Psychiatric Hospital data are residents in state hospitals on the first day of 2012. Private psychiatric
bed counts represent separate psychiatric units in general hospitals and private psychiatric hospitals from
SAMHSA's 2010 Survey Slide 13
 Intended Use of State Psychiatric
Hospitals: 2015

41
Forensic 39
35
42
Elderly 42
39
43
Adults 44
41
15
Adolescents 21
18
Acute Care (less than 30 days)
10
Children 14 Intermediate Care (30-90 days)
13 Long-Term Care (more than 90 days)
0 5 10 15 20 25 30 35 40 45 50
Number of States
 Much of the attention recently has been
on state hospital beds but increasingly
psychiatric admissions are in the private
sector.
State hospitals are primarily taking court
involved admissions.
Historically, the biggest reason an
individual went to the state hospital was
because they were uninsured.
 This parallels general health care, where
there is Increased expectation that
individuals get care independent of
ability to pay. This is made easier since
the uninsured population has decreased
and therefore less uncompensated care.
Therefore, most persons receive their
inpatient care in the private sector.
Trends in Behavioral
Health Systems
Organization of M/SUD Service
Responsibilities:2015

Combined MH/SA (35)

Separate Department (4)
Separate, In Same Umbrella Dept.(11)
No Response (1)
State Mental Health Authority
persons Served Per 1,000
State Population.

4.6 to 16 (12)
16 to 22.6 (15)
22.6 to 35 (12)
35 to 51 (12)
 Individuals Served by State
Mental Health Authority
SMHAs provided mental health services to
over 7.5 million individuals during FY 2015
2.3% of the US Population
68% of Adults served had a Serious
Mental Illness (SMI)
70% of Children served had a Serious
Emotional Disturbance
 Percent of Clients Served, by Service
Setting: 2014 Uniform Reporting
System
98% of clients received community-based mental
health services
o 22.3 per 1,000 population (range from 0.8 to 51.2
per 1,000)
2% of clients received services in state psychiatric
hospitals
o Range from less than 1% of clients (in 11 states) to
12% in (2 states) of total clients served
4.6% of clients received services in other psychiatric
inpatient settings (37 states reporting on OPI)
Trends in Financing
Behavioral Health
Services
 State Mental Health Agency Controlled
Expenditures for State Psychiatric Hospital
Inpatient and Community-Based Services as a
Percent of Total Expenditures: FY'81 to FY'14
80%
Community Mental Health

74% 74% 74% 75%

70% 73%
71% 72% 72%
70% 70% 70%
63% 69%
67%
60% 60% 66%
59%
60% 58%

54%

50% 48%

49%
State Mental Hospital Inpatient
39%
40% 43%

37% 32%
35% 36% 30%
29%
30%33% 28% 27% 28%
26% 26% 26% 25%
24% 23% 24% 23%

20%

10%

0%
81 83 85 87 99
0 93 97 00
1 02 00
3 04 00
5 06 07 08 09 01
0 11 01
2 13 01
4
19 19 19 19 1 19 19 2 20 2 20 2 20 20 20 20 2 20 2 20 2
1/ 1/ 1/ 1/ 1/ 1/ 1/ 1/ 1/ 1/ 1/ 1/ 1/ 1/ 1/ 1/ 1/ 1/ 1/ 1/ 1/
7/ 7/ 7/ 7/ 7/ 7/ 7/ 7/ 7/ 7/ 7/ 7/ 7/ 7/ 7/ 7/ 7/ 7/ 7/ 7/ 7/
 SMHA-Controlled Revenues for Mental
Health Services: FY 1981 to FY 2014

$45,000,000,000
Other Funds
$40,000,000,000 Other Federal
MH Block Grant
$35,000,000,000
Federal Medicaid
State Medicaid Match
$30,000,000,000
State General Funds

$25,000,000,000
Mental Health Block
Grant
$20,000,000,000

$15,000,000,000

$10,000,000,000

$5,000,000,000

$-
 2015 URS Summary Results

69% of SMHA consumers had Medicaid pay for

some or all of their mental health services

22% of Adult mental health consumers were

competitively employed during the year
6.6% of consumers with a diagnosis of
schizophrenia were competitively employed

3% of Adult mental health consumers were

homeless
 Change in Medicaid Status of
SMHA Consumers Since ACA
Since states began expanding Medicaid, the states that
expanded Medicaid have seen an increase in the percent of
their consumers served who have Medicaid paying for some or
all of their mental health services

In the 24 states that Expanded Medicaid in 2014, they had

an average increase of 10.3% in the number of consumers
with Medicaid coverage.
In the 4 states that Expanded Medicaid in 2015, they had an
average increase of 7.5% in consumers with Medicaid
The 20 states that had not Expanded Medicaid had no
change (0%).
Source: SAMHSA 2015 URS
 Goals for a good and modern system,
Its not just about beds:
Health, wellness, and resiliency
Integrated care and parity
Prevention and Early Intervention
Suicide Prevention
trauma-informed approaches
Interventions that minimize individuals contact with
police, jails, prisons, juvenile correctional facilities, and
courts. Sequential intercept.
Workforce Development
Employment, housing and reducing homelessness
Data and Health Information Technology
 Thank you!
Brian Hepburn
Brian.Hepburn@nasmhpd.org