Full impact of mental health and substance abuse disorders on U.S. community hospitals

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.