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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
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
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))
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
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
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