What are the current costs and outcomes related to mental health and substance abuse disorders?


This collection of charts (updated July 31, 2017) explores trends in the prevalence, outcomes, costs, and access to care associated with mental health and substance abuse disorders in the United States and comparably wealthy countries. A related brief offers discussion of data available as of May 5, 2016.

Eighteen percent of adults in the United States have a mental, behavioral, or emotional disorder


The 2015 National Survey on Drug Use and Health (NSDUH) found that about 43.4 million adults (17.9%) in the United States had any mental illness in the past year (including mental, behavioral, or emotional disorders, but excluding developmental and substance use disorders). Mental illness was more prevalent among women (21.2%) than men (14.3%), and occurred among more than a fifth of adults ages 18 to 25, as well over a fifth of adults ages 26 to 49.

The prevalence of mental illness among adults has been relatively stable


Between 2008 and 2015, the percentage of adults with any mental illness remained generally stable across all age groups, with the highest prevalence among those ages 26 to 49, and the lowest among those age 50 and older.

Phobias and major depression are the most common mental health disorders among adults in the U.S.


Most available data about the prevalence of mental disorders among adults comes from surveys done in the early 2000s, which found that phobias were the most commonly reported disorders among adults, with 8.7% of adults reporting having a past-year specific phobia, and 6.8% reporting having social phobia. The 2015 NSDUH found that almost 7% of adults reported experiencing major depression within the year.

Major depression occurs relatively more often among women, young adults, American Indians and Alaska Natives


Major depression is one the of the most commonly diagnosed mental disorders among adults in the U.S. and accounts for 3.3% of all age-standardized Disability Adjusted Life-Years (DALYs). The NSDUH found that In 2015, 6.7% of U.S. adults had a past-year major depressive episode.

Serious mental illness is more prevalent among adults who are uninsured and those who are poor


The 2015 NSDUH also found that 9.8 million adults (4.0% of all adults, and 22.5% of adults with any mental illness) had a serious mental illness – one causing substantial functional impairment. Twelve-month prevalence was higher among uninsured adults (4.7%), compared to insured adults (3.9%), and far higher among those below 100% of the federal poverty level (6.8%) compared to those at or above the federal poverty level (3.5%).

Adults with a serious mental illness have a shorter life expectancy, on average 25 years less than those without such an illness, and serious mental illness is linked to increased risk of chronic medical conditions.

ADHD is the most prevalent mental health disorder among children in the United States


The 2001 – 2004 National Health and Nutrition Examination Survey found that 13% of children ages 8 to 15 had a diagnosable mental disorder within the year. Attention deficit hyperactivity disorder (ADHD) was the most prevalent mental health disorder among children in this age range (8.6%), followed by mood disorders (3.7%) and major depression (2.7%). It is important to note that there is substantial variation in mental illness prevalence measured by different surveys, depending on survey methods and age range.

Alcohol dependence or abuse is the most commonly reported substance use disorder


When surveyed in 2015, about 21 million people aged 12 or older (8%) reported having at least one substance use disorder within the year. Of those, nearly 16 million (75%) reported having an alcohol use disorder, and almost 8 million (38%) reported an illicit drug use disorder. Within those reporting an illicit drug use disorder, 4 million (19% of all those reporting a disorder) reported a marijuana use disorder, and 2 million (10%) reported a pain reliever use disorder.

Alcohol dependence or abuse is relatively high among those ages 18-25 and more prevalent among males


Six percent of respondents age 12 or older reported alcohol dependence or abuse in the 2015 NSDUH. About 7.8% of surveyed males reported alcohol use or dependence, compared to 4.1% of females, and prevalence was most concentrated among those ages 18 to 25 (10.9%).

Three percent of people age 12 or older reported illicit drug dependence or abuse in the past year


The 2015 NSDUH found that 2.9% of the population age 12 and older had illicit drug dependence or abuse in 2015. The prevalence of illicit drug dependence or abuse is higher among males (3.8%) compared to females (2.0%), higher among Blacks (3.5%) than among Whites (2.8%) and Asians (1.2%), and highest among those aged 18 to 25 (7.2%) relative to other age groups.

The U.S. suicide rate has grown since 2006


A recent CDC data brief indicates that the U.S. suicide rate reached 13 per 100,000 people in 2014, the highest it has been since 1986. The report finds that after almost steadily declining between 1986 and 1999, the national suicide rate increased a startling 24% between 1999 and 2014, with a 2% increase per year beginning in 2006. The suicide rate for young women aged 10-14 increased the most in that time, jumping 200% from 0.5 suicides per 100,000 to 1.5 suicides per 100,000. Among women, the highest suicide rate has long been among those ages 45-64; the rate for this group increased 63% between 1999 and 2014, rising from 6.0 per 100,000 to 9.8 per 100,000. The highest rates are seen in men ages 75 and over. This group saw an 8% decrease in suicides during the fifteen-year period, dropping from 42.4 per 100,000 in 1999 to 38.8 per 100,000 in 2014.

Ten percent of adults who have suicidal thoughts report using an illicit drug


Use of alcohol, antidepressants, or opiates is often linked to suicides. Four percent of adults reported having suicidal thoughts in the past year when surveyed in 2015. Of these, 9.8% reported using an illicit drug, most often methamphetamine (21.6% of illicit drug users among adults reporting having suicidal thoughts) or inhalants (19.2%).

Drug or alcohol dependence or abuse is linked to higher likelihood of suicidal thoughts and behavior


Compared to adults with no drug or alcohol problem, more adults with drug or alcohol dependence or abuse reported having serious thoughts of suicide, making suicide plans, or attempting suicide.

Over 4 in 10 Americans know someone who has been addicted to prescription painkillers


An April 2016 Kaiser Family Foundation Tracking Poll found that 44% of Americans report a personal connection to prescription drug addiction. Among those reporting knowing someone who has been addicted to prescription painkillers, 26% report knowing an acquaintance who has been addicted, 21% report a close friend with addiction, 20% report a close family member with addiction, and two percent report experiencing prescription painkiller addiction themselves.

When deaths from mental and behavioral problems are caused by underlying opioid use, it is largely among people age 25 to 64


In 2015, among people ages 15 to 84, the majority of deaths due to a mental or behavioral problem with opioid use as the underlying cause (such as acute intoxication, harmful use, dependence syndrome, or withdrawal) were people between the ages of 25 and 64.

Serious mental illness, substance abuse, or both may affect up to half of adults in homeless shelters


A 2010 point-in-time study by the U.S. Department of Housing and Urban Development found that 26% of adults living in homeless shelters had a serious mental illness, while 35% faced chronic substance abuse, resulting in an estimated 46% of homeless adults in shelters facing either mental illness or chronic substance abuse, or both. This finding is based on the 53% prevalence of mental illness and/or chronic substance abuse the study observed among adults in permanent supportive housing.

In the early 2000s, over half of those incarcerated in state and local prisons had a mental health problem within the year


The most recent available data regarding the mental health of U.S. comes from surveys conducted by the Department of Justice in 2002 and 2004, which found high prevalence of mental health problems among inmates in the U.S.: 56% of inmates in state prisons, 45% of inmates in federal prisons, and 64% in local jails reported any mental health problem within the year. The Bureau of Justice Statistics further reported that of those inmates with a mental health problem, about 74% of state prison inmates and 76% of local jail inmates had a substance use problem.

One in five Americans report they or a family member did not receive needed mental health services


An April 2016 Kaiser Family Foundation Tracking Poll found that a fourth of Americans report that they or someone in their household has been diagnosed with serious mental illness. One in five reported that there was a time when they or their family member thought they needed mental health care, but did not receive it.

Thirteen percent of those reporting foregoing mental health care said they could not afford the cost


Of those reporting foregoing mental health care for themselves or a family member, 13% said they could not afford the cost of care, 12% reported that their insurance would not cover it, 10% indicated that fear or embarrassment kept them from seeking care, and 8% reported that they did not know where to get care.

Fewer adults experiencing serious psychological distress are seeing or speaking with a mental health professional


National Health Interview Survey findings indicate that in the first nine months of 2015, 20% of adults ages 16 to 64 reported having serious psychological distress within 30 days of their interview, a decline from 28% reporting so in 2012. The percent of adults with serious psychological distress who report seeing or talking to a mental health professional has declined as well, with 42% reporting seeing or talking to a mental health care provider in 2012, and 34% reporting so in 2015.

About 35 percent of adults with serious mental illness are not receiving mental health treatment


In 2015, 14.2% of adults in the U.S. received past-year inpatient, outpatient, or prescription drug treatment for a mental health problem, and 1.4% of the U.S. population received substance use treatment. Of all adults with any mental illness in 2015, 43% received mental health services. Among adults with a serious mental illness, 65% received treatment. Of people age 12 and older who were in need of treatment for illicit drug use, 18% received care, and 8% of those needing alcohol use treatment received care.

67 percent of adults in the United States with major depression receive mental health treatment


In 2015, of adults who experienced at least one major depressive episode within the year, an estimated 67 percent received mental health treatment.

Utilization of mental health services is relatively low among Blacks, Asians, and Hispanics


Use of mental health services is reportedly similar among Whites, American Indian and Alaska Natives, and those of mixed race, with about 16% to 17% percent of each group reporting any use of mental health services. Utilization is lower among Blacks (9%) and Hispanics (7%), and lowest among Asians (5%).

Cost is the most commonly reported barrier to using mental health services


Adults who have any mental illness and report an unmet need for care most often report not using care due to the cost, or to having either no insurance or inadequate coverage. Relative to Black and Hispanic adults, white adults surveyed in the NSDUH more often reported not receiving care due to cost or insurance, as well as not thinking services would help.

Among poor adults with a mental illness, Whites use mental health services more than those who are Black or Hispanic


White adults with a mental illness who were below the federal poverty level reported greater use of mental health services than their Black and Hispanic counterparts, regardless of poverty status.

Inpatient treatment is mostly for schizophrenia and mood disorders, such as major depression and bipolar disorder


Mental health services are largely outpatient treatment, prescription medication, or a combination of both. Among hospital stays related to mental health and substance abuse, discharges were highest in 2014 for mood disorders and schizophrenia.

At U.S. hospitals, about 13% of mental health discharges and 10% of substance use discharges are readmitted within 30 days


Data from the Healthcare Cost and Utilization Project (HCUP) shows that at U.S. hospitals, 12.8% of mental disorder discharges and 9.9% of substance abuse-related discharges are readmitted for the same type of diagnosis within 30 days. A 2013 study of Marketscan data found that risk of readmission was higher for patients with a prior inpatient stay, substance abuse disorder, psychosis, or medical comorbidities, and that follow-up at community mental health centers correlated with decreased readmissions.

Spending on mental illness treatment accounts for $89 billion of total health spending


In 2013, non-institutionalized spending on mental illness amounted to $89 billion, according to data from the Bureau of Economic Analysis’s Health Care Satellite Account. A 2008 study, found that serious mental illness results in $193 billion lost in earnings each year in the U.S.

The Health Care Satellite Account does not include spending on the institutionalized population, so it may disproportionately exclude people with severe mental illness.

The cost per case to treat mental illness grew about 3 percent between 2000 and 2012


The cost of treating mental illness has grown relatively slowly compared to other disease categories (the price index for this mental illness treatment grew at an average annual growth rate of 3.1% from 2000 to 2012, compared to an average of 4.4% across all disease categories).

Price indexes in the Health Care Satellite Account differ from official price indexes in that they are not only influenced by the price of a given treatment, but also by greater treatment intensity per visit, shifts from lower-cost to higher-cost treatments, and movement into less restrictive insurance plans.

The Health Care Satellite Account does not include spending on the institutionalized population, so it may disproportionately exclude people with severe mental illness.

The number of treated mental illness cases grew faster than the average number for all health treatments


The number of treated mental illness cases grew at an average annual growth rate of 2.8% from 2000-2012. (Because the spending changes above adjust for treatment cost, they primarily represent changes in the number of cases over the time period.)

The Health Care Satellite Account does not include spending on the institutionalized population, so it may disproportionately exclude people with severe mental illness.

Growth in per capita spending on mental illness slowed after the Great Recession, while treated prevalence rebounded


Our March 2016 analysis of new Bureau of Economic Analysis (BEA) data on spending on major disease categories found that across all disease categories (in aggregate), per capita spending for health care grew slower during the recession than it had during the pre-recession period. During the initial years following the recession (2010 – 2012), per capita spending growth remained low and similar to the level during the recession period. We found that for mental illness in particular, per capita spending grew 5.7% between 2005 and 2008, and 4.1% between 2010 and 2012. A rebound in treated prevalence also occurred post-recession in the aggregate, and was reflected in various magnitudes across all condition categories. Annual growth in treated prevalence for mental illness rose from 2.0% growth between 2005-2010 to 4.1% growth between 2010-2012.

Mental health and substance use disorders are the leading causes of disease burden in the U.S.


Mental health and behavioral disorders are among the top ten leading causes of death in the U.S., the leading cause of Years Lost to Disability (YLD), and the leading cause of disease burden. U.S. disease burden due to mental health disorders has increased in past two decades, from 2779 DALYs in 1990 to 3355 DALYs in 2015.

Mental health is leading cause of disease burden for females and the third leading cause for males


Although mental health and substance abuse conditions are among the leading contributors to DALYs for both sexes, males have higher rates of disease burden caused by circulatory diseases and cancers.

Among comparable countries, the U.S. has the highest rate of death from mental health and substance abuse disorders


The U.S. mortality rate for mental health and substance abuse disorders together is 12.0 per 100,000 population, compared to an average of 4.9 per 100,000 population in similarly wealthy countries.

Relative to comparable countries, the U.S. has higher rates of death from accidental poisonings, such as drug overdoses


External causes (such as accidents, suicides, and violence) are the fourth leading cause of death in the U.S., and are more common than in comparable countries. According to data from the Centers for Disease Control and Prevention, unintentional poisonings (often due to prescription drug overdose) are the leading cause of accidental death in the United States.

The U.S. had a higher than average mortality rate from accidental poisoning in 2000. Over time, the U.S. has become an outlier, now with far higher death rates from accidental poisoning than any comparable country. According to the CDC, in 2014, opioid pain killers were involved in 40% of drug poisoning deaths

Accidental poisonings also lead to more than twice the years of disability in the U.S. than in comparable countries.

Disease burden from drug abuse disorders is higher in the U.S. than in comparable countries


Data from the Institute for Health Metrics indicate that the U.S. has a higher rate of DALYs per 100,000 people due to drug abuse disorders than the comparable country average. Opioid use disorders in the U.S. result in more than triple the average rate of disease burden in comparable countries.

Disease burden from alcohol use disorders is higher than average in the U.S.


Alcohol use disorders have a higher than average impact on years of life lost to disability and death in the U.S. compared to other high-income countries.