The Impact of Serious Mental Illness in the Community: by the Numbers

CONSENSUS STATEMENT

We, the National Alliance on Mental Illness (NAMI) and the National Council for Behavioral Health (National Council), along with Otsuka America Pharmaceutical, Inc. and Lundbeck, affirm the need for localized, innovative, effective and sustainable approaches to address serious mental illness.

It has been well documented that many individuals living with serious mental illness may experience cycles of hospitalizations.1 In addition, some individuals may also incur jail sentences and/or homelessness, which impacts them, their families and their communities.2, 3, 4, 5 We believe that greater collaboration among the mental health community and other community-based organizations – such as emergency service, law enforcement and public housing – to improve care and support services for these individuals may result in better outcomes for them and for the community at large.

By reinforcing the importance of broader community intervention and support, we hope to bring about change that will benefit the estimated 1 in 17 Americans who live with serious mental illness.6

The Impact of Serious Mental Illness in the Community: By the Numbers

According to results from a 2011 National Survey on Drug Use and Health, approximately 40 percent of adults living with serious mental illness do not receive the mental health services they need.7

Other sobering facts that highlight the burden of unaddressed serious mental illness for individuals and communities include:

· More than 63 million visits to physician offices, hospital outpatient facilities and emergency departments are associated with mental health disorders annually.8

· Among hospitalized adults up to age 65, schizophrenia is the fourth most commonly diagnosed illness and has the seventh longest mean length of hospital stay (13 days).9

· Between one-fourth and one-third of homeless individuals have a serious mental illness such as schizophrenia, bipolar disorder or major depression.10

· More than half of prison and jail inmates (approximately 1.25 million) reported symptoms of mental health problems in a 2006 report from the Bureau of Justice Statistics.11 Less than half of inmates who reported a mental health problem had ever received treatment, and only a third or fewer received mental health treatment after admission to jail or prison. 12

· Rates of relapse, or a re-emergence or worsening of psychotic symptoms, vary from 50-92 percent for individuals with schizophrenia, a severe form of mental illness.13,14

Furthermore, mental health disorders are costly to the U.S. economy and society as a whole, and have been associated with healthcare expenditures that have been estimated to be similar to cancer.15 In fact, the economic cost of mental illness is estimated to be $300 billion.16 Despite this, mental health has been regularly allocated between six and seven percent of all federal health funding, and average healthcare expenditures per person with mental disorders has decreased between 1996 and 2006.17

Models for Change

In this era of cost-constrained state and federal resources, we believe locally driven strategies are a critical component to meet the needs of those living with serious mental illness.18 While there is no “one size fits all” approach to addressing mental health care locally, we have identified four strategies for community intervention that show promise. These are:

1) Early intervention

2) Creative use of technology

3) Service integration

4) Enhanced continuity of care

Communities across the country are already pioneering creative, individualized programs and services using at least one of these four strategies to help improve the way they address serious mental illness. Examples of this innovative programming include:

· Advancing Early Intervention After First Episode Psychosis in South Florida: Henderson Behavioral Health in Fort Lauderdale, FL, aims to reduce the likelihood of long-term disability for those with serious mental illness by enhancing community understanding and prioritization of early intervention tactics. Henderson is currently developing its own evidence-based early intervention program focused on promoting recovery after a first episode of psychosis – the first program of its kind in Florida.19

· Advancing Creative Use of Technology in Massachusetts: Vinfen in Boston, MA, is leveraging technology that integrates care for individuals with chronic medical illnesses and co-existing psychiatric illnesses to help encourage medication adherence and avert emergency room visits, among improving other outcomes. The organization estimates that use of this technology coupled with other interventions may save the health care system $3.79 million over a three-year period.20

· Advancing Service Integration in Bexar County, TX: The Center for Health Care Services in San Antonio, TX, has partnered with law enforcement, fire and emergency response teams in Bexar County to successfully divert non-violent individuals with serious mental illness from jails and hospitals, improving care and saving the community an estimated $9 million annually.21

· Advancing Continuity of Care in Los Angeles, CA: MHA (Mental Health America) Village in Los Angeles, CA, focuses on care coordination for individuals with serious mental illness by providing employment assistance, substance abuse recovery, housing and education, among other services. The Village’s approach to providing continuity of care was incorporated into the Mental Health Services Act of California. The Village was also selected by President Bush’s New Freedom Commission as a promising model of study, and by former President Bill Clinton as a program that “exemplifies best employment practices for people with psychiatric disabilities.”22

Be a Part of the Solution

We encourage communities across the country to prioritize serious mental illness and, through greater collaboration, advocate for new approaches to help improve the lives of people with these conditions AND positively impact the communities in which they live. It is our hope that this collaborative approach may lead to greater opportunities for these individuals to participate more fully and productively in society while reducing the burdens on jails, hospitals, emergency rooms, public housing centers and other vital community resources.

Our call for community action is two-fold:

1. For Community Leaders: Challenge members of your community, service organizations and other civic leaders to work together to implement local programs and services to help improve lives and communities.

· While every community is different, leaders should consider developing task forces with representatives from the mental health community and other key stakeholders to take a fresh look at how to creatively and efficiently address serious mental illness.

2. For Individuals Living with Serious Mental Illness, Their Caregivers, Friends and Loved Ones and The Public At Large: Join the Connect 4 Mental Health initiative and advocate for change.

· Visit www.Connect4MentalHealth.com to show your support for increased understanding and awareness of serious mental illness, and the need for community-oriented approaches that provide additional support to individuals with serious mental illness and that also may produce healthier and stronger communities.

References:

1. Alwan, N., et al. (2010). Length of Hospitalisation for People with Severe Mental Illness. The Cochrane Library, 11, pp. 1-31.

2. Greenberg, G., & Rosenheck, R. (2008). Jail Incarceration, Homelessness and Mental Health: A National Study. Psychiatric Services, 59 (2), pp. 170-177.

3. Denckla, D. & Berman, G. (2001). Rethinking the Revolving Door, A Look at Mental Illness in the Courts. Center for Court Innovation, pp. 1-33.

4. Fujioka, J. (2001). Helping Mentally Ill People Break the Cycle of Jail and Homelessness. Psychiatric Services, 52 (10), pp. 1380-1382.

5. (2012). The Returning Home Initiative. The Robert Wood Johnson Foundation. Retrieved October 4, 2013, from http://www.rwjf.org/content/dam/farm/reports/program_results_reports/2012/rwjf73200.

6. (2013). The Numbers Count: Mental Disorders in America. National Institutes of Mental Health (NIMH). Retrieved October 4, 2013, from http://www.nimh.nih.gov/health/publications/the-numbers-count-mental-disorders-in-america/index.shtml.

7. U.S. Department of Health and Human Services. (2012). Results from the 2011 National Survey on Drug Use and Health: Mental Health Findings (HHS Publication No. (SMA) 12-4725). Rockville, MD: Substance Abuse and Mental Health Services Administration.

8. (2013, May 30). Mental Health. Centers for Disease Control and Prevention. Retrieved October 4, 2013, from: http://www.cdc.gov/nchs/fastats/mental.htm.

9. Fortney, J. C., et al. (2009). Community-Level Correlates of Hospitalizations for Persons with Schizophrenia. Psychiatric Services, pp. 772-78.

10. Folsom, D., et al. (2005). Prevalence and Risk Factors for Homelessness and Utilization of Mental Health Services Among 10,340 Patients With Serious Mental Illness in a Large Public Mental Health System. American Journal of Psychiatry, 162 (2), pp. 370-376.

11. U.S. Department of Justice. (2006). Bureau of Justice Statistics Special Report: Mental Health Problems of Prison and Jail Inmates (NCJ 213600). Washington, DC: Office of Justice Programs.

12. (2013). Inmate Mental Health. National Institutes of Health, National Institute of Mental Health. Retrieved October 4, 2013, from http://www.nimh.nih.gov/statistics/1DOJ.shtml.

13. Kazadi, NJB, et al. (2008). Factors Associated with Relapse in Schizophrenia. South African Journal of Psychiatry, 14 (2), pp. 52-62.

14. (2013). Mental Health: Schizophrenia. World Health Organization. Retrieved October 4, 2013, from www.who.int/mental_health/management/schizophrenia/en.

15. Soni, A. (July 2009). The Five Most Costly Conditions, 1996 and 2006: Estimates for the U.S. Civilian Noninstitutionalized Population. Statistical Brief #248. Agency for Healthcare Research and Quality, Rockville, MD.

16. (2011) U.S. Adult Mental Illness Surveillance Report. Centers for Disease Control and Prevention. Retrieved September 16, 2013 from http://www.cdc.gov/Features/MentalHealthSurveillance.

17. Levit K., et al. (2013). Federal Spending On Behavioral Health Accelerated During Recession As Individuals Lost Employer Insurance. Health Affairs, 32 (5), pp. 952-962.

18. (2013). Cuts, Consolidations, and Savings. Budget of the U.S. Government. Retrieved October 4, 2013 from http://www.whitehouse.gov/sites/default/files/omb/budget/fy2013/assets/ccs.pdf.

19. Information provided and confirmed by Henderson Behavioral Health in Fort Lauderdale, FL.

20. Information provided and confirmed by Vinfen in Boston, MA.

21. Information provided and confirmed by The Center for Health Care Services in San Antonio, TX.

22. Information provided and confirmed by MHA Village in Los Angeles, CA.