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the proportion of children and adolescents, birth to age 18, with
serious emotional disturbances who receive treatment.
Increase
the proportion of adults with mental illnesses who receive treatment.
Target:
162,228 adults with mental illnesses will receive treatment.
Baseline, July 1998-June 1999: 141,068 adults with mental
illnesses receive treatment from Division of Mental Health/Developmental
Disabilities/ Substance Abuse Services.
Target Setting Method: 15 percent improvement. Increase
the proportion of adults, over the age of 65, with mental illness
who receive treatment.
Increase
the proportion of adults over age 65 with mental illness who receive
treatment.
Target:
14,566 adults over age 65 with mental illness will receive treatment.
Baseline, July 1998-June 1999: 12,666 adults over age
65 with mental illnesses received treatment from Division of Mental
Health/Developmental Disabilities /Substance Abuse Services.
Target Setting
Method: 15 percent improvement.
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Mental
Health
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Mental health is a component of overall health.
For most people, health and a sense of well being are characterized
by three basic elements: 1) how one feels about oneself, 2) how one
feels about other people, and 3) how one is able to meet the demands
of life. It is estimated that more than 51 million people in the United
States are affected by mental illness during a given year. The estimated
number of North Carolinians affected by mental illness in 1995 were:
118,579 major depression; 125, 274 obsessive-compulsive disorder;
and 99,146 other serious mental illness. Less than half of these mental
illnesses were treated. Depression is associated with other medical
conditions such as heart disease, cancer, and diabetes as well as
anxiety and eating disorders. Co-occurrence of addictive disorders
among persons with mental disorders is an emerging issue. In the United
States, among adults age 18 years and older with a lifetime history
of any mental disorder, 20 percent have a history of an addictive
disorder. Having both mental and addictive disorders within the same
time period presents a challenge for treatment.
Children
In 1999, National prevalence indicate that 10 to
12 percent (between 173,069 and 207,683 children) of the total child
population (birth-17 years) in North Carolina will experience serious
emotional disturbances. Mental disorders and mental illnesses occur
across the life span, often beginning as serious emotional disturbances
in children and adolescents. Children who have problems in one or
more of these areas may or may not be diagnosed with mental health
problems. Yet it is important to focus on the mental health of all
children, whether or not they have been diagnosed. Identifying and
providing services to children who are at risk may prevent some
children from developing more severe mental health or substance
abuse conditions. Diagnosable conditions range from learning disabilities,
attention deficit and hyperactivity disorder, and mild depression
to more severe conditions such as bipolar disorder or schizophrenia.
One recent North Carolina study, focused
on childhood mental health needs, found that approximately 40 percent
of all children received some mental health services, most often
from school counselors and psychologists. More than 75 percent of
those children received mental health services in the education
sector and 12 percent received services from the specialty mental
health sector (generally public mental health centers or private
professionals). Only six percent of the children in the study received
services from the general medical sector such as the child’s
primary care physician. During FY 98-99, North Carolina’s 39
Area Mental Health Programs served 76,485 children and adolescents
with or at risk of, serious emotional disturbance. The numbers served
have doubled in the past five years.
Adults
It is estimated that between 15 to 25 percent
of adults suffer from significant mental illness. This includes
people with serious and persistent mental illness, those who develop
mental illness in later in life, as well as those who have mental
health problems and need treatment but are not diagnosed. Nationally,
it is estimated that only one-third of the individuals in need of
treatment actually receive mental health treatment. The economic
cost of mental illness in the United States in 1996 was estimated
to be $150 billion including the cost of days lost from work. In
North Carolina, it is estimated that at least 50,000 adults in need
of mental health treatment are not receiving care. Most adults who
have a diagnosable mental illness never seek or receive treatment.
Modern treatments for mental disorders are highly effective, with
a variety of treatment options available. Treatment for mental illness
continues to present substantial barriers and challenges. Many primary
care providers are not skilled in recognizing mental illness and
referring patients for treatment. Lack of parity in insurance coverage
for treatment disorders is another barrier.
Older Adults: Nationally, five to eight million older adults suffer
from mental illness. North Carolina data to estimate the prevalence
of mental illness in this age group are not available. Literature
documents that mental health treatment of older adults with mental
illness is substantially low for all states. Older adults, regardless
of living arrangements, are more likely to receive mental health
treatment from their primary care practitioner than from the specialty-trained
mental health care providers, which results in mental illness being
under-recognized and under-treated. In 1999, the North Carolina
Division of Mental Health, Developmental Disabilities, and Substance
Abuse Services served 14,391 adults over the age of 65. These individuals
included persons treated by public mental health staff at area mental
health programs across the state, as well as residents in adult
care homes and nursing care facilities.
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Disparities
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The prevalence of mental illness varies by
gender and socio-economic status. Major depression affects approximately
twice as many women as men. Women who are poor, have little formal
schooling, and on welfare, or are unemployed are more likely to experience
depression than women in the general population. Anxiety, panic, and
phobic disorders affect two to three times as many women as men. Eating
disorders, affecting up to 2 percent of the population often arise
in adolescent and young adult women; the median age of onset is age
17 years. Eating disorders can persist into adulthood and are associated
with the highest death rates of any mental disorder.
Older
Adults
Depression and anxiety are seen more frequently
among people with disabilities than those without disabilities.
Depression rates are much higher among older persons who experience
physical health problems (hip fractures, heart disease, etc.)
Dementia illnesses such as Alzheimer’s disease are as high
as 12 percent among persons age 65 years, and by age 85 years, the
rate grows to 25 percent. Additionally, there is insufficient attention
given to the mental health needs of older adults as a result of
societal perceptions and biases; lack of knowledge and training
within the health, mental health, and aging service systems; and
reluctance by older people to seek mental health treatment.
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Determinants/Risk
Factors
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Children
Living in poverty, parents with substance abuse
problems, mothers who are depressed, parents who did not finish high
school, unemployed parents, dysfunctional family situations, family
with other than two biological or adoptive parents (e.g., single parents),
inadequate or inappropriate health care, lack of health insurance
coverage, and child abuse and neglect.
Adults/Older
Adults
Older age, inadequate or inappropriate health care,
physical disabilities and health problems (hip fractures, heart
disease, etc.) , reluctance to seek mental health treatment (especially
true of older adults), lack of access to early diagnosis and treatment.
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