One In Four Hospital Patients Is Admitted With A Mental Health Or Substance Abuse Disorder

Almost one-fourth
of all stays in U.S. community hospitals for patients age 18 and older --
7.6 million of nearly 32 million stays -- involved depressive, bipolar,
schizophrenia and other mental health disorders or substance use related
disorders in 2004, according to a new report by HHS' Agency for Healthcare
Research and Quality.


This study presents the first documentation of the full impact of
mental health and substance abuse disorders on U.S. community hospitals.
According to the report, about 1.9 million of the 7.6 million stays were
for patients who were hospitalized primarily because of a mental health or
substance abuse problem. In the other 5.7 million stays, patients were
admitted for another condition but they also were diagnosed as having a
mental health or substance abuse disorder.



Nearly two-thirds of costs were billed to the government: Medicare
covered nearly half of the stays, and 18 percent were billed to Medicaid.
Roughly 8 percent of the patients were uninsured. Private insurers were
billed for the balance. The study also found that one of every three stays
of uninsured patients was related to a mental health or substance abuse
disorder.



"Community hospitals play an important role in the treatment of people
with mental health and substance abuse disorders," said AHRQ Director
Carolyn M. Clancy, M.D. "This report gives health care policymakers an
in-depth look at the impact of mental health and substance abuse care on
the health care system."



Substance Abuse and Mental Health Services Administration Administrator
Terry Cline, Ph.D., said, "The significant number of hospital stays related
to mental health and substance use disorders signals the need for an
increased national effort to identify and intervene early before the
conditions require a hospital stay. Too often because of social stigma or
lack of understanding, individuals and health care providers don't
recognize the signs or treat mental health or substance use disorders with
the same urgency as other medical conditions."



AHRQ found that most patients with mental health and substance abuse
disorders were older. For example, although people age 80 and older
comprised only 5 percent of the U.S. population in 2004, they accounted for
nearly 21 percent of all hospital stays for these conditions -- principally
for dementia. There were also gender differences. The most frequent
admitting diagnosis for women was mood disorders, while that for men was
substance abuse.



AHRQ also found that patients who have been diagnosed with both a
mental health condition and a substance abuse disorder -- those with "dual
diagnoses" -- accounted for 1 million of the nearly 8 million stays. Nearly
half of these cases with dual diagnoses involved drug abuse, a third
involved alcohol abuse, and one in five involved both drug and alcohol
abuse.



In addition, 240,000 women hospitalized for childbirth or pregnancy
also had mental health or substance abuse problems. Four of every 10 of
these patients were between 18 and 24 years of age.



Suicide attempts accounted for nearly 179,000 hospital stays. Of these,
93 percent involved a mental health condition -- most commonly mood
disorders -- and/or substance abuse. Nearly three-quarters of these
patients were between ages 18 and 44 and more than half were women.
Poisoning, by overdosing prescription medicines or ingesting a toxic
substance was the most common way patients attempted suicide.



The report is based on 2004 data -- the latest currently available --
from AHRQ's Healthcare Cost and Utilization Project Nationwide Inpatient
Sample, a database of hospital inpatient stays that is nationally
representative of all short-term, non-federal hospitals. The data are drawn
from hospitals that comprise 90 percent of all discharges in the United
States and include all patients, regardless of insurance type, as well as
the uninsured. For details, see Care of Adults with Mental Health and
Substance Abuse Disorders in U.S. Community Hospitals, 2004 at
ahrq/data/hcup/factbk10/.


Agency for Healthcare Research and Quality

ahrq