Assessing the Burden of Mental Illness in Jackson County

Jackson Health Network

Assessing the Burden of Mental Illness among Adults in Jackson County, Michigan

March 28, 2014

Prepared by:

Richard J. Thoune, RS, MS, MPH County Health Officer

2

Table of Contents

I. Introduction………………………………………………………………………………… 2

II. Background………………………………………………………………………………… 2

III. Community Characteristics..……………………………………………………………..… 4

IV. Assumptions……………...………………………………………………………………… 4

V. Prevalence Rates Applied to the Community Adult Population.…………….……..……… 5

VI. Discussion……………………………………..……………….…………………………… 6

VII. Current Service Delivery …………….……………………………………………..……… 8

VIII. Accessibility of Service Providers…………………………………………………..……… 8

IX. Current Network Characteristics………………………………………………….………… 9

X. Limitations of this Assessment..…………………………………………………….……… 9

XI. Conclusions……………………………….………………………………………..……….10

XII. Recommendations and Next Steps………………………….………………………………10

Appendix A……………………….………………………………………. ….……………11

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I. Introduction.

This assessment has been developed to support the clinical integration efforts of the Jackson

Health Network (JHN). It focuses on adults aged ≥18 years residing in Jackson County,

Michigan. A subsequent assessment will focus on children <18 years of age. The network

has developed and is implementing a comprehensive health assessment tool through care

coordination/management that will assess the health needs of patients across 5 domains:

social (social problems), biological (medical), psychological (mental health), functional

status, and self-management. Understanding the burden of mental illness present in the

community is essential for service delivery system planning, clinically integrated care

coordination efforts, treatment at the primary care provider level, and any necessary capacity

building.

II. Background.

Mental illness is defined as “collectively all diagnosable mental disorders” or “health

conditions that are characterized by alterations in thinking, mood, or behavior (or some

combination thereof) associated with distress and/or impaired functioning.”1 Depression is

the most common type of mental illness, affecting more than 26% of the U.S. adult

population.2 It has been estimated that by the year 2020, depression will be the second

leading cause of disability throughout the world, trailing only ischemic heart disease.3

Serious mental illness is defined by the Substance Abuse and Mental Health Services

Administration (SAMHSA) as having a diagnosable mental, behavioral, or emotional

disorder that met the criteria found in the 4th edition of the Diagnostic and Statistical

Manual of Mental Disorders (DSM-IV) and resulted in functional impairment that

substantially interfered with or limited one or more major life activities.

Evidence has shown that mental disorders, especially depressive disorders, are strongly

related to the occurrence, successful treatment, and course of many chronic diseases

including diabetes, cancer, cardiovascular disease, asthma, and obesity4 and many risk

behaviors for chronic disease; such as, physical inactivity, smoking, excessive drinking, and

insufficient sleep.

Back to Table of Contents

1 U.S. Department of Health and Human Services. Mental Health: A Report of the Surgeon General. Rockville, MD: U.S.

Department of Health and Human Services; Substance Abuse and Mental Health Services Administration, Center for Mental

Health Services, National Institutes of Health, National Institute of Mental Health, 1999. 2 Kessler RC, Chiu WT, Demler O, Walters EE. Prevalence, severity, and co-morbidity of 12-month DSM-IV disorders in

the National Co-morbidity Survey Replication. Arch Gen Psychiatry 2005;62:617–627. 3 Murray CJL, Lopez AD. The Global Burden of Disease: A Comprehensive Assessment of Mortality and Disability from

Diseases, Injuries and Risk Factors in 1990 and Projected to 2020. Geneva, Switzerland;World Health Organization, 1996. 4 Chapman DP, Perry GS, Strine TW.The vital link between chronic disease and depressive disorders. Prev Chronic Dis

2005;2(1):A14.

4

A current Michigan behavioral risk factor analysis indicates that the prevalence of current

smoking and SHS exposure is significantly different by mental health status, ranging from

1.35 to 2.5 times more likely.5

Mental disorders are common in the United States and internationally. An estimated 26.2

percent of Americans ages 18 and older – about one in four adults – suffer from a

diagnosable mental disorder in a given year.6 Even though mental disorders are widespread

in the population, the main burden of illness is concentrated in a much smaller proportion –

about 6 percent, or 1 in 17 – who suffer from a serious mental illness.

Within the state of Michigan, an estimated 20.6% of Michigan adults reported ever being told

by a doctor that they had a depressive disorder including depression, major depression,

dysthymia, or minor depression.7

The most recent community health assessment report (2012) completed by the Health

Improvement Organization for Jackson County indicates that approximately 17% of residents

self-report having had mental health problems within the past 12 months. The most

prevalent disorders were depression (25%) and anxiety (17%).

The Centers for Disease Control and Prevention has described the burden of mental illness on

an international and national basis by type of illness.8 It has also estimated the prevalence of

mental illness among US adults aged ≥18 years by sociodemographic characteristics from

multiple population based, ambulatory medical care and hospital discharge surveys.9

III. Community Characteristics

a. Current Community Population

The Jackson County 2010 population is 160,248.10

Within the county, 71% of the residents

are over age 18, resulting in a total of 123,053 adults. An estimated 18% of these adults are


5 Fussman C, Shamo F, Kiley J. Cigarette Smoking and Secondhand Smoke Exposure among Michigan Adults by Mental

Health Status. Michigan BRFSS Surveillance Brief. Vol. 7, No. 6. Lansing, MI: Michigan Department of Community

Health, Lifecourse Epidemiology and Genomics Division, Surveillance and Program Evaluation Section, Chronic Disease

Epidemiology Unit, December 2013. 6 Kessler, Chiu, Demler, Walters, op. cit., p. 617-27.

7 Fussman C. 2013. Health Risk Behaviors in the State of Michigan: 2012 Behavioral Risk Factor Survey. 26th Annual

Report. Lansing, MI: Michigan Department of Community Health, Lifecourse Epidemiology and Genomics Division,

Surveillance and Program Evaluation Section, Chronic Disease Epidemiology Unit. 8 http://www.cdc.gov/mentalhealth/basics/burden.htm

9 Centers for Disease Control and Prevention, Mental Illness Surveillance Among Adults in the United States, MMWR

2011;60(Suppl), pages 1-32. 10

http://factfinder.census.gov

5

62 years of age or older, resulting in a total of 22,149 elderly persons living in Jackson

County.

IV. Assumptions

This assessment incorporates the most current network capacity evaluation completed by the

community mental health agency for Jackson County, LifeWays.11

a. LifeWays is funded to provide the necessary access and care for that proportion of their

priority adult population (Medicaid and Uninsured) with serious mental illness,

developmental disabilities, substance use disorder, and co-occurring mental illness and

substance use disorder. Estimated potentially served adult population: 45,962

b. The JHN, with 75% of community health care providers as members, expects to provide

access, care, and/or referral to community based resources for 75% of the adult

population (92,289) in the community. The JHN would provide care for serious mental

illness to 46,237 (92,289-45,962) adults. JHN would also provide mental health services

for 75% of the total adult population (92,289) for any mental illness not considered

serious.

V. Prevalence Rates Applied to the Community Adult Population

The assessment begins with the application of the overall estimate of the percent of Michigan

adults who reported ever being told by a doctor that they had a depressive disorder and the

percent of Jackson County residents who self-reported having had mental health problems

within the past 12 months. (Appendix A, Table 1)

This will be followed by applying the prevalence rates of each serious and other mental

illness to the adult population of interest. Mental illnesses will be further stratified within the

expected care levels of the JHN.

The assessment concludes with data that document the number and rate of patients who were

screened for depression within selected primary care practices in Jackson County, and

number and percent referred for health coaching assistance.

Adults with Serious Mental Illness (SMI). Serious mental illnesses include major depression,

schizophrenia, bipolar disorder, obsessive compulsive disorder, panic disorder, post-

traumatic stress disorder and borderline personality disorder.12

SAMHSA estimated past


11 LifeWays Community Mental Health, Network Capacity Evaluation of Fiscal Years 2009-2011, December 15, 2011 12

http://www.nami.org/Template.cfm?Section=By_Illness, retrieved December 19,3013

6

past year SMI among adults aged 18 or older at 3.9 percent (9.0 million adults).13

This

revised estimate is lower than the 7.3% estimate used by LifeWays in their most recent

Network Capacity Evaluation. SAMHSA’s revisions are due to improvements in methods

for estimating mental illness that are more accurate. The estimates of mental illness for those

aged 18 to 25 are most impacted by the revisions. It is also important to recognize that

although there is a generally accepted definition of serious mental illness that includes

specific disorders, any mental illness can be serious.

The 3.9% revised estimate results in an estimated 4,779 adults in Jackson County who may

have a serious mental illness. (Appendix A, Table 2) Individual estimates of the prevalence

of each of these serious mental illnesses are also available from other sources.14,15

The

application of these estimates is shown in Appendix A (Table 3).

Adults with Any Mental Illnesses (AMI). SAMHSA has established a definition for AMI as

having at least one mental disorder, other than a developmental or substance-use disorder, in

the past 12 months, regardless of the level of impairment. Other mental illnesses include

dysthymic disorder (chronic, mild depression), generalized anxiety disorder, social phobia,

eating disorders, attention deficit hyperactivity disorder, and personality disorders. Estimates

of the prevalence of these other mental illnesses have been applied to the Jackson County

adult population in Appendix A, Table 4.

Table 5 applies the SMI and AMI prevalence rates to the proportion of the 18 and older

population expected to be served by the JHN.

By applying twelve-month prevalence and severity of DSM-IV diagnoses for which estimates

are available16

, Tables 6 and 7 stratify the number of persons potentially affected by each

disorder by severity (serious, moderate, mild) and places them into care levels of the JHN.

Estimates for any disorder, and serious, moderate and mild severity levels by co-morbidity

levels in the Kessler et. al. study are presented in Table 8. The application of these co-

morbidity estimates in tables 9 and 10 redistributes the number of persons who may have a

serious, moderate or mild severity level mental illness by disorder.

Finally, some local data is available regarding screening for depression through a current

pilot screening project in selected primary care practices (Albion, Leslie, Spring Arbor, East

Michigan) of the JHN. These data are presented in Table 11. Practices screen using the

PHQ-2 depression screening tool. Practices may follow up a positive PHQ-2 screen by


13 http://www.samhsa.gov/data/2k13/NSDUH148/sr148-mental-illness-estimates.htm, retrieved December 14, 2013 14 http://www.cdc.gov/mentalhealth/basics/burden.htm 15

Kessler, Chiu, Demler, Walters, op. cit., p. 617-27. 16

Kessler, Chiu, Demler, Walters, op. cit., p. 617-27.

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administering the PHQ-9, or initiating a referral for further screening and follow up with

JHN’s health coaching staff. The PHQ-9 screens for generalized anxiety disorder, bipolar

disorder, substance abuse, and schizophrenia. Referrals for health coaching are made at the

discretion of the primary care provider.

VI. Discussion

Published research demonstrates that prevalence estimates of mental illness vary widely due

to the methodologies employed (self-report versus in person interview), question content

(specific versus broad), settings, sampling frames, age ranges and diagnostic systems used to

define disorders. However, some overall correlations between population level estimates can

be seen.

Michigan’s most recent BRFS estimates 20.6% of Michigan adults reported ever being told

by a doctor that they had a depressive disorder including depression, major depression,

dysthymia, or minor depression. Although the BRFS question is more narrowly focused on

physician diagnosed depressive disorders and is not an estimate of having been diagnosed

with any mental illness within the past 12 months, it is relatively close to the national

estimate that 26.2 percent of Americans ages 18 and older – about one in four adults – suffer

from a diagnosable mental disorder in a given year.

The most recent community health assessment report for the county indicates that

approximately 17% of residents self-report having had mental health problems within the

past 12 months. The most prevalent disorder, depression (25%), correlates well with the

26.2% national estimate. As previously stated, even though mental disorders are widespread in the

population, the main burden of illness is concentrated in a much smaller proportion – about 6 percent,

or 1 in 17 – who suffer from a serious mental illness.

Estimates of serious mental illness also vary and have changed over time. Refinements in

methodology generally result in more precise, and lower, prevalence estimates. LifeWays

Network Capacity Evaluation utilized SAMHSA’s prevalence estimate of 7.3% available at

the time the 2011 evaluation was completed; SAMHSA has now revised the prevalence

estimate down to 3.9%, which theoretically cuts in half the number of adults 18 and over

estimated to have a serious mental illness in Jackson County from 8,983 to 4,779.

However, the overall estimate of 4,779 adults with a serious mental illness is dwarfed when

individual estimates of each serious mental illness disorder are applied and totaled for either

the adult county population, or JHN covered lives. Applying these individual estimates

shows that up to 19% and 26%, respectively, of the adult population that would be cared for

by the JHN, may have a serious mental illness or any mental illness (Table 5).


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Stratifying the number of persons potentially affected by each disorder by severity level

(serious, moderate, mild) and placing them into care levels of the JHN suggests that a

majority of care needs will fall within care coordination levels 3 and 4 of the JHN care

model, versus level 2 health coaching (Tables 6 and 7).

The difference between the overall 3.9% estimate and aggregate 19% and 26% estimates for

serious mental illness, and any mental illness, must take into consideration a number of

factors. First, severity of illness is strongly related to co-morbidity. In the Kessler et. al.

study, more than 49% of respondents with 3 or more diagnoses were classified as serious.

Fifty-five percent carried only a single diagnosis; 22%, two diagnoses; and 23%, three or

more diagnoses. The distribution of severity was quite different from the distribution of

prevalence across classes of disorder; mood disorders had the highest percentage of serious

classifications (45%) and anxiety disorders, the lowest (22.8%). The 12 highest correlations,

each exceeding 0.60, were bipolar disorder (major depressive episode with

mania/hypomania), double depression (major depressive episode with dysthymia), anxious

depression (major depressive episode with generalized anxiety disorder), comorbid

mania/hypomania and attention-deficit/hyperactivity disorder, panic disorder with

agoraphobia, comorbid social phobia with agoraphobia, and comorbid substance disorders

(both alcohol abuse and dependence with drug abuse and dependence). The prevalence of

any disorder was estimated at 26.2%, which is very consistent with other national overall

estimates of mental illness in the general adult population.

Although the application of co-morbidity estimates in tables 9 and 10 redistributes the

number of persons who may have a serious, moderate or mild severity level mental illness by

disorder, it only reduces the overall estimated number of persons who may need treatment for

each respective disorder by 4%- 5%. It does not significantly change the distribution within

care coordination levels of the JHN care model.

After applying estimates of co-morbidity, the total number of persons that may need care for

a serious mental illness is 8,839 (19% of 46,237 covered lives), and for any mental illness

24,026 (26% of 92,289 covered lives), within a 12 month period

Table 11 captures some local data on screening for depression in four primary care practices

of the Jackson Health Network, and follow up health coaching referrals. From March 2013-

March 2014, a total of 5,046 patients were screened from an attributed patient population of

6,044, for an overall screening rate of 83%. A total of 131 (2.6%) referrals were made for

health coaching assistance. The JHN health coaching staff enrolled 62 (47%) of these

referred patients into the program.


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VII. Current Service Delivery

This assessment incorporates service delivery provided by Lifeways to the Medicaid and

uninsured populations in Jackson County. In 2011, LifeWays served 6,676 individuals of the

11,508 persons in the two counties they estimated to have a serious mental illness, serious

emotional disturbance, developmental disability, substance use disorder, or co-occurring

mental illness and substance use disorder. With 78% of persons served located in Jackson

County, it is estimated that 61% of the Jackson County need of 8,542 was met. The overall

penetration rate of 58.01% is less than the 2008 rate of 73.97%. LifeWays reports that the

service needs of the developmentally disabled and those with a substance use disorder were

not met, with penetration rates of 64% and 12%, respectively.

VIII. Accessibility of Service Providers

a. LifeWays reports many referrals are made out of county because their current provider

network does not have the capacity to serve consumers in need of specialized residential

services. LifeWays is reviewing their network’s current bed capacity and plans to make

recommendations to address the need for more specialized beds in the catchment area to

prevent the need to move consumers out of county.

b. They also report an unmet need for psychological testing which is resulting in out of

network referrals. LifeWays contracts with one provider for this service, but the provider

does not maintain the equipment needed to perform certain tests. When this need arises,

they send the referral to Allegiance Health under a single-case agreement to perform the

required tests. However, LifeWays reports that Allegiance Health is not interested in

adding this to their service array as they report not having capacity to accept routine

referrals from LifeWays.

c. LifeWays also reports that a children’s psychiatric inpatient provider is not available

within their two county service area. Concerns were also expressed about the availability

of crisis residential and intensive crisis stabilization services, or alternative housing

services for children whose home environment is unsafe.

IX. Current Network Characteristics

a. The overall number of LifeWays network providers is 67, between Jackson County,

Hillsdale County, and out of county providers. This is an increase in the number of out

of county providers from 6 in 2007 to 14 in 2011. Twenty two (22) are providers of

behavioral health outpatient services, twelve (12) are residential service providers, two

(2) provide outpatient and residential services, eight (8) provide psychiatric inpatient

services, and two (2) provide co-occurring mental health and substance abuse disorder

services. Fourteen (14) providers offer services in both Jackson and Hillsdale counties,

five (5) providers offer services in Jackson County only, and three (3) providers offer


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services in Hillsdale County only. The JHN can reasonably expect that JHN providers

would use these same providers for referrals for mental health disorders.

b. Thirty (30) providers are accredited through various accrediting bodies. LifeWays

waives the accreditation requirement for providers having a contractual arrangement of

less than $200,000 per year.

X. Limitations of this Assessment

This assessment is subject to the limitations of the various peer reviewed published

research articles and sources cited throughout the assessment.

With regard to the National Comorbidity Survey Replication (NCS-R) study by Kessler

et. al., several important population segments are underrepresented. These include the

homeless, those in institutions, and those who cannot speak English. The first two

exclusions reduce prevalence estimates.

Those with mental illness might be more reluctant to participate in mental health surveys.

The 70.9% response rate in the NCS-R study means that nearly 30% of eligible

respondents are not represented in the study’s sample. Selection bias related to mental

illness has been reported in other community surveys. To the extent that bias exists, it

will make the prevalence estimates more conservative.

Participants might have underreported 12-month prevalence. This possibility is

consistent with evidence in the methodological evidence that embarrassing behaviors are

often underreported. Underreporting bias can be reduced by using strategies aimed at

decreasing embarrassment, a number of which were used in the NCS-R study.

The interview tool used in the NCS-R study is lay-administered. However, a clinical

reappraisal study found generally good individual-level concordance between the lay

interview and a Structured Clinical Interview for DSM-IV (SCID) disorders and

conservative estimates of prevalence compared with the SCID.

The NCS-R study did not include all DSM-IV diagnoses. Schizophrenia and other

nonaffective psychoses were excluded because previous studies have shown they are

dramatically overestimated in lay-administered interviews. The exclusion of these

disorders prohibited the distribution of the number of persons who could be diagnosed

with a serious, moderate and mild severity level disorder and an adjustment for

comorbidity in tables 9 and 10. However, the distribution of these disorders by co-

morbidity level is likely consistent with all other disorders in tables 9 and 10.

XI. Conclusions

a. Using national and state level prevalence estimates, this assessment provides a reasonably

accurate estimate of the number of adults aged 18-64 in Jackson County who may have a

DSM-IV diagnosable mental illness within any given 12-month period.


11

b. The total number of patients that may be diagnosed by JHN health care providers could

be as high as 23,264 in one year, or 26% of the JHN covered lives of 92,289.

c. Based on a distribution of severity level within care levels of the JHN, 9,735 (77%) of

these patients could be served by care coordinators, and 2,947 (23%) by health coaches.

d. The impact on health care providers and the JHN is not immediate, but can be expected

to scale up with full implementation of the comprehensive health assessment tool and

planned expansion in the number of covered lives in the network over the next 3 years.

e. The JHN needs to plan to provide screening, diagnosis, treatment and referral for

Medicaid and the uninsured that have a mental illness that is not classified as serious.

f. LifeWays reports, utilizing their array of network providers, that their overall penetration

rate for service to their priority population in 2011 was 58.01%. The only groups

identified as not having their service needs met were the developmentally disabled and

those with a substance use disorder.

g. LifeWays reports other unmet needs in the local provider network:

i. Psychological testing

ii. Children’s psychiatric inpatient provider

iii. Availability of crisis residential, intensive crisis stabilization services, and

alternative housing services for children whose home environment is unsafe.

h. The capacity of the local behavioral health/mental health provider network to meet

increased demand as a result of more screening, diagnosis, and referral is not accurately

known.

i. The current capacity and willingness of health care providers to screen, diagnose, and

treat mental illness in the practice setting is unknown, although some data from past

surveys focused on these topics may be available for review.

j. Although every effort was made to separate serious mental illness from any mental

illness in this assessment, it is likely that estimates of any mental illness includes serious

mental illness.

k. For service delivery planning and system capacity building purposes, the number of

persons with each respective disorder reflected in Tables 9 and 10 should be used.

XII. Recommendations and Next Steps

a. The results of this assessment should be used by the JHN for service delivery system

planning, including clinically integrated care coordination efforts, and screening,

diagnosis, treatment, management, and referral at the primary care provider level.

b. An assessment should be conducted to determine the current level of professional training

and education, comfort and willingness of primary care providers to screen, diagnose,

treat, manage, and refer patients for mental illness.


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c. An assessment should be conducted among primary care providers to determine the

extent to which care for mental illness disorders is currently being provided.

d. Primary care providers should be approached to help establish the specific mental illness

disorders that can be successfully treated and managed at the primary care level, as well

as those that should be referred for further testing, evaluation, and inpatient care.

e. A study of current and future inpatient care utilization for mental illness disorders should

be undertaken and decisions should be made about where and how this care will be

delivered, as well as the medical specialties that may be needed.

f. The Health Officer should characterize the potential demand for mental illness care by

year for 2014-2016, based on the expected number of covered lives.

g. The Health Officer, Allegiance Health Behavioral Health, Allegiance Health Prevention

and Community Health, and the JHN and should engage with the Behavioral Health

Summit and Behavioral Health Action Team to conduct a system-wide scan of the

behavioral health services system in order to:

i. Fully assess the existing and future needed capacity of the local outpatient

behavioral health/mental health provider network.

ii. Address the psychological testing, psychiatric inpatient and crisis related

services needs identified in this assessment.

iii. Seek support for additional studies and assessments that need to be

completed.


APPENDIX A: Tables

A. Prevalence Rates

Table 1 Estimated Number of Jackson County Adults 18 and Older Reporting Depressive Disorders or Having Had Mental Health Problems

Within the Past 12 Months

Total General Population Jackson County 123,053

Prevalence Rate Estimate

Reporting Depressive Disorder17

20.6% 26,141

Reporting Mental Health Problems18

17.0% 20,919

Table 2 Estimated Prevalence of Serious Mental Illness (SMI) Among Adults 18 and Older in Jackson County

Total General Population Jackson County 123,053

Prevalence Rate Estimate

Serious Mental Illness19

3.9% 4,779

Table 3 Estimated Prevalence20

of SMI by Type of Disorder, Jackson County (N=123,053)

Major Depressioni

6.7% 8,244

Schizophrenia21

1.1% 1,354

Obsessive Compulsive Disorderii

1.0% 1,230

Bipolar Disorderiii

2.6% 3,199

Panic Disorderiv

2.7% 3,322

Posttraumatic Stress Disorderv

3.5% 4,307

Borderline Personality Disorder22

1.6% 1,969

Total 23,625

17

Fussman, op. cit., p.30 18

Health Improvement Organization, 2011 Community Health Assessment Survey 19 http://www.samhsa.gov/data/2k13/NSDUH148/sr148-mental-illness-estimates.htm 20


Regier DA, Narrow WE, Rae DS, Manderscheid RW, Locke BZ, Goodwin FK. The de facto mental and addictive disorders service system. Epidemiologic Catchment Area

prospective 1-year prevalence rates of disorders and services. Archives of General Psychiatry. 1993 Feb;50(2):85-94. 22

Lenzenweger, M.F., Lane, M.C., Loranger, A.W., Kessler, R.C. (2007). DSM-IV personality disorders in the National Co-morbidity Survey Replication. Biological Psychiatry,

62(6), 553-564.

14

Table 4 Estimated Prevalence23

of Any Mental Illness (excluding SMI) by Type of Disorder, Jackson County (N=123,053)

Dysthymic Disordervi

1.5% 1,845

Generalized Anxiety Disordervii

3.1% 3,814

Social Phobiaviii

6.8% 8,367

Eating Disorders24,ix

4.4% 5,414

Attention Deficit Hyperactivity Disorderx 4.1% 2,243

Personality Disorders25

9.1% 11,197

Total 32,880

i Leading cause of disability for ages 15-44; more prevalent in women than men. ii Median age of onset is 19 years.

iii Median age of onset is 25 years, more common in women than men.

iv Median age of onset is 24 years.

v Can develop at any age, but median age of onset is 23 years.

vi Symptoms must persist for at least two years in adults to meet criteria for diagnosis; median age of onset is 30 years.

vii Median age of onset is 31 years; most disorders are more prevalent in women than men.

viii Begins in childhood or adolescence, typically around 13 years of age.

ix Women are three times as likely as men to develop eating disorders.

xx Common mental disorder in children and adolescents, affects an estimated 4.1% of adults ages 18-44, in a given year. Prevalence rate applied to 54,716 adults, 18-44 years old,

2010 Census.

23


Hudson JI, Hiripi E, Pope HG, Kessler RC. The prevalence and correlates of eating disorders in the National Co-morbidity Survey Replication. Biol Psychiatry. 2007; 61:348-

58. 25

Lenzenweger, M.F., Lane, M.C., Loranger, A.W., Kessler, R.C. (2007). DSM-IV personality disorders in the National Co-morbidity Survey Replication. Biological Psychiatry,

62(6), 553-564.

15

Table 5. Estimated Prevalence of SMI in 18 and Older Population Expected to be Served by JHN (N=46,237)

Major Depression

6.7% 3,104

Schizophrenia

1.1% 509

Obsessive Compulsive Disorder

1.0% 462

Bipolar Disorder

2.6% 1,202

Panic Disorder

2.7% 1,248

Posttraumatic Stress Disorder

3.5% 1,618

Borderline Personality Disorder 1.6% 740

Total 8,883

Estimated Prevalence of AMI in 18 and Older Population Expected to be Served by JHN (N=92,289)

Dysthymic Disorder 1.5% 1,384

Generalized Anxiety Disorder 3.1% 2,860

Social Phobia 6.8% 6,275

Eating Disorders 4.4% 4,060

Attention Deficit Hyperactivity Disorder1 4.1% 1,054

Personality Disorders 9.1% 8,398

Total 24,031 1 Percentage applied to 44% of 57,818 adults age 18 and older: 25,709

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Table 6. Estimated Number of SMI DSM-IV Diagnosed Disorders by Severity (serious, moderate, mild) within Care Levels of the Jackson

Health Network N=8,883

JHN Level of

Care

Type of

Intervention

MD SZ OCD BD PD PTSD BPD Total

Severity & #

Affected

n=3,104

Severity & #

Affected

n=509

Severity & #

Affected

n=462

Severity & #

Affected

n=1,202

Severity & #

Affected

n=1,248

Severity & #

Affected

n=1,618

Severity &

# Affected

n=740

5 Special

Needs

Navigator

Assistance

4 Complex,

including

LTC

Care

Coordination

Serious

944 Not Avail

Serious

234

Serious

996

Serious

559

Serious

592

Not Avail

3,325*

3 More

Complex

Mix, Higher

Utilization,

Disease

Mgt

Care

Coordination

Moderate

1,555 Not Avail

Moderate

161

Moderate

206

Moderate

368

Moderate

536 Not Avail

2,826*

2 Moderate

Complexity

Health Coach

& Behavioral

Health Care

via PCP

Mild

605

Not Avail Mild

67

Mild

0

Mild

321

Mild

489 Not Avail

1,482*

1 Minor/No

Needs, 1st

Level

Prevention

Community

& Population

Based

Total 3,104 509 462 1,202 1,248 1,617 740 8,883

Key: MD - Major Depression

SZ - Schizophrenia

OCD - Obsessive-Compulsive Disorder

BD - Bipolar Disorder

PD - Panic Disorder

PTSD - Posttraumatic Stress Disorder

BPD - Borderline Personality Disorder

* - Row total does not include estimated number of persons with schizophrenia and borderline personality disorder

17

Table 7. Estimated Number of AMI DSM-IV Diagnosed Disorders by Severity (serious, moderate, mild) within Care Levels of the Jackson

Health Network N=24,031

JHN Level of

Care

Type of

Intervention

DD GAD SP ED ADHD PD Total

Severity & #

Affected

n=1,384

Severity & #

Affected

n=2,860

Severity & #

Affected

n=6,275

Severity & #

Affected

n=4,060

Severity & #

Affected

n=1,054

Severity & #

Affected

n=8,398

5 Special

Needs

Navigator

Assistance

4 Complex,

including

LTC

Care

Coordination

Serious

687

Serious

923

Serious

1,876

Not Avail

Serious

435

Not Avail

3,921*

3 More

Complex

Mix, Higher

Utilization,

Disease Mgt

Care

Coordination

Moderate

444

Moderate

1,275

Moderate

2,435

Not Avail

Moderate

371

Not Avail

6,401*

2 Moderate

Complexity

Health Coach &

Behavioral

Health Care via

PCP

Mild

251

Mild

660

Mild

1,964

Not Avail

Mild

247

Not Avail

3,122*

1 Minor/No

Needs, 1st

Level

Prevention

Community &

Population

Based

Total 1,382 2,858 6,275 4,060 1,053 8,398 24,026

Key: DD - Dysthymic Disorder

GAD - Generalized Anxiety Disorder

SP - Social Phobia

ED - Eating Disorder

ADHD- Attention Deficit Hyperactivity Disorder

PD - Personality Disorders

* - Row total does not include estimated number of persons with eating and personality disorders

18

Table 8. Twelve-Month Prevalence Estimates for DSM-IV Disorders by Serious, Moderate and Mild Severity and Co-morbidity Levels

Total Serious Moderate Mild

Any Disorder 26.2% 22.3% 37.3% 40.4%

1 disorder 14.4% 9.6% 31.2% 59.2%

2 disorders 5.8% 25.5% 46.4% 28.2%

≥disorders 6.0% 49.9% 43.1% 7.0%

Table 9. Estimated Number of SMI DSM-IV Diagnosed Disorders Adjusted for Co-morbidity by Severity (serious, moderate, mild) within

Care Levels of the Jackson Health Network N=8,883

JHN Level of

Care

Type of

Intervention

MD SZ OCD BD PD PTSD BPD Total

Severity & #

Affected

n=3,104

Severity & #

Affected

n=509

Severity & #

Affected

n=462

Severity & #

Affected

n=1,202

Severity & #

Affected

n=1,248

Severity & #

Affected

n=1,618

Severity &

# Affected

n=740

5 Special

Needs

Navigator

Assistance

4 Complex,

including

LTC

Care

Coordination

Serious

802 Not Avail

Serious

199

Serious

847

Serious

475

Serious

503 Not Avail

2,826*

3 More

Complex

Mix, Higher

Utilization,

Disease Mgt

Care

Coordination

Moderate

1,555

Not Avail Moderate

201

Moderate

257

Moderate

368

Moderate

536 Not Avail

2,917*

2 Moderate

Complexity

Health Coach

& Behavioral

Health Care

via PCP

Mild

571

Not Avail Mild

62

Mild

0

Mild

302

Mild

462 Not Avail

1,397*

1 Minor/No

Needs, 1st

Level

Prevention

Community

& Population

Based

Total 2,928 509 462 1,104 1,145 1,501 740 8,389

* - Row total does not include estimated number of persons with schizophrenia and borderline personality disorder

19

Table 10. Estimated Number of AMI DSM-IV Diagnosed Disorders Adjusted for Co-morbidity by Severity (serious, moderate, mild) within

Care Levels of the Jackson Health Network N=24,031

JHN Level of

Care

Type of

Intervention

DD GAD SP ED ADHD PD Total

Severity & #

Affected

n=1,384

Severity & #

Affected

n=2,860

Severity & #

Affected

n=6,275

Severity & #

Affected

n=4,060

Severity & #

Affected

n=1,054

Severity & #

Affected

n=8,398

5 Special

Needs

Navigator

Assistance

4 Complex,

including

LTC

Care

Coordination

Serious

584

Serious

785

Serious

1,595

Not Avail

Serious

370

Not Avail

3,334

*

3 More

Complex

Mix, Higher

Utilization,

Disease Mgt

Care

Coordination

Moderate

444

Moderate

1,275

Moderate

2,435

Not Avail

Moderate

371

Not Avail

6,401*

2 Moderate

Complexity

Health Coach &

Behavioral

Health Care via

PCP

Mild

237

Mild

623

Mild

1,854

Not Avail

Mild

233

Not Avail

2,947*

1 Minor/No

Needs, 1st

Level

Prevention

Community &

Population

Based

Total 1,265 2,683 5,884 4,060 974 8,398 23,264

* - Row total does not include estimated number of persons with eating and personality disorders

20

Table 11. Depression screening rates in selected JHN primary care practices, March 2013-March 2014.

Attributed Number of Patients

(March 2012-March 2014)

Depression Screening

March 2013-March 2014 Referrals for Health Coaching

7,173

Attributed

Patients

#

Screened % Screened

# of

Referrals

# (%)

# of Referrals

Accepted

Enrollment

# (%)

6,044 5,046 83% 131 2.6% 131 62 (47%)

Documents

Assessing the Burden of Mental Illness in Jackson County