Section 5: Hospital Care for Mental Health and Substance Abuse Conditions (PDF)

EXHIBIT 5.1 Characteristics of U.S. Community Hospitals for MHSA Stays (PDF)
EXHIBIT 5.2 Reasons for MHSA Inpatient Hospital Stays (PDF)
EXHIBIT 5.3 MHSA Hospitalizations and Average Length of Stay (PDF)
EXHIBIT 5.4 MH and SA Inpatient Hospital Discharges Against Medical Advice (PDF)
EXHIBIT 5.5 MHSA Inpatient Hospital Discharges by Age (PDF)
EXHIBIT 5.6 Most Frequent Principal MHSA Diagnoses by Age (PDF)
EXHIBIT 5.7 MHSA Inpatient Discharges by Gender (PDF)
EXHIBIT 5.8 Principal Diagnoses with a Secondary MH or SA Condition (PDF)
EXHIBIT 5.9 Inpatient Discharges for MH and SA Conditions by Payer (PDF)
EXHIBIT 5.10 Costs for MH and SA Discharges by Payer (PDF)
EXHIBIT 5.11 Inpatient Discharges for MH and SA Conditions by Community Income (PDF)
EXHIBIT 5.12 Emergency Department Visits for MH and SA Conditions (PDF)

This section focuses on inpatient stays and emergency department (ED) visits in community hospitals for mental health (MH) and substance abuse (SA) treatment, providing details on principal conditions of:

• anxiety disorders
• adjustment disorders
• attention-deficit, conduct, and disruptive behavior disorders
• developmental disorders
• autism and other childhood disorders
• impulse control disorders
• mood disorders
• personality disorders
• schizophrenia and other psychotic disorders
• alcohol-related disorders
• drug-related disorders
• pregnancy and other miscellaneous mental health disorders

Dementia and other cognitive disorders are excluded because they are often characterized by multiple cognitive problems that result from a condition that requires medical instead of psychiatric treatment. Screenings for mental health (MH) and substance abuse (SA) conditions are also excluded because they may not result in a MHSA diagnosis. In addition, suicide and intentional self-inflicted injury is excluded from analyses of principal reasons for inpatient MH stays because it occurs less than 2,000 times in 2008; however, this diagnosis is included in analysis of secondary diagnoses for inpatient MH stays and for emergency department visits where it appears more frequently as a reason for the stay/visit.

This analysis reflects care only in community hospitals and thus excludes MHSA stays in specialty psychiatric and chemical dependency hospitals.

• Of the 39.9 million community hospital discharges in 2008, about 5 percent had a principal diagnosis of a MH or SA disorder.
• An additional 13.6 percent of all hospital discharges had a secondary MH diagnosis and 5.4 percent had a secondary SA diagnosis.
• Depression was responsible for 24 percent of MHSA stays and bipolar disorders for another 20 percent of MHSA stays.
• Hospital stays with MH and SA diagnoses were more commonly uninsured (12 percent) or insured by Medicaid (27 percent) than were hospital stays overall (5 percent uninsured and 18 percent insured by Medicaid).
• In 2008, the average cost for a MHSA hospital stay was $5,500, compared to an average of $9,100 for all stays and $6,700 for all stays without a major operating room procedure.
• Non-elderly adults (18-64 years old) accounted for a disproportionate share of all MHSA hospitalizations (83 percent) relative to their share of the total population (63 percent) and all hospitalizations (49 percent).
• From 1997 to 2008, the MHSA discharge rate for adults 65 years and older has fallen appreciably—from 55 to 43 discharges per 10,000.

• In 2008, patients living in the poorest communities experienced MH hospitalization rates 44 percent higher than patients living in higher income communities—5.8 stays per 1,000 compared to 4.0 stays per 1,000 in higher income communities.
• Hospitalizations for schizophrenia and other psychotic disorders for residents in the poorest communities (1.9 discharges per 1,000) occurred at twice the rate of all other communities (0.9 discharges per 1,000).

• Patients residing in the poorest communities experienced similar overall rates of hospitalization for SA as patients residing in higher income communities.
• Between 1997 and 2008, the number of hospital stays for drug-related conditions rose rapidly among 45-64 year olds (117-percent increase), 65-84 year olds (96-percent increase), and adults 85 and older (87-percent increase) while remaining relatively stable (11-percent decline) among adults 18-44 years.
• Rapid growth in drug-induced delirium and in poisonings by opiate-based pain medications was primarily responsible for the increase in drug-related hospitalizations for patients 65 years and older. In 2008, these two conditions accounted for 60 percent of drug-related stays for patients 65-84 years old and 78 percent of the drug-related stays in patients 85 years and older.
• Alcohol-related disorders accounted for 12 percent of MHSA hospital stays among 18-44 year olds, 21 percent of MHSA stays among 45-64 year olds, and 12 percent of MHSA stays for 65-84 year olds.

• In 2007, there were 122.3 million emergency department visits. Of those ED visits, 9.9 million had an all-listed MH diagnosis, 2.8 million had an all-listed alcohol-related diagnosis, and 2.2 million had an all-listed drug-related diagnosis. (All-listed diagnoses include all diagnoses listed on the discharge record.)
• A diagnosis of depression was the most frequently noted MHSA diagnosis (4.2 million ED visits), and the second most frequent MHSA diagnosis was anxiety (3.3 million ED visits).
• About one in five of all ED visits (20.4 million, or 17 percent of all ED visits) in 2007 resulted in inpatient hospital admission. In comparison, ED visits were much more likely to result in inpatient admission for MHSA conditions:
  • 42 percent of all MH ED visits resulted in hospitalization.
  • 44 percent of alcohol-related ED visits resulted in hospitalization.
  • 49 percent of all drug-related ED visits resulted in hospitalization.
• Three-quarters of ED visits for personality disorders led to an inpatient admission in 2007 and another 4 percent in a transfer to another facility such as a psychiatric hospital or to a skilled nursing or intermediate care facility. Among ED visits for suicide or intentional self-inflicted injury, 42 percent resulted in inpatient admission and another 28 percent resulted in transfer to another facility.

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