2005-2009 Statewide Comprehensive Plan for Mental Health Service Services
Chapter 2: Who is Served

This Chapter provides the latest data available from the 2003 Patient Characteristics Survey (PCS).¹ This system-wide data is two years more current than the 2001 data provided in the 2004 Comprehensive Plan, and can be compared to that data to look for emerging trends. As one might expect, changes over a two-year period may not be striking, but can provide an indication of potential trends that may require continued monitoring. Chapter 2 presents PCS data using a population-based approach to describe sub-populations of interest by demographics and diagnosis.

The Statewide Perspective

Each year, more than 600,000 persons receive services in New York’s public mental health system.² Of this total, approximately 22% are children aged 17 years or younger. At least two-thirds of all individuals served have both a mental disorder and severe functional impairment resulting from their disorder. This combination of a mental disorder and severe functional impairment is referred to as serious mental illness. In the U.S., mental illnesses rank first among illnesses that cause disability. The disabling effects of mental illness in adults can result in homelessness, joblessness, health problems, and social isolation. In children, the effects are often serious and long lasting, leading to poor academic achievement, failure to complete high school, substance abuse, involvement with the correctional system, lack of vocational success, inability to live independently, and health problems. Additional information about the disease burden and costs of mental illness is included in Chapter 4.

Specifically, in New York State 66% of adults served have serious mental illness and 72% of children and adolescents served have serious emotional disturbance. These proportions are consistent with reported U.S. averages of 65% and 62% respectively.

The diversity of the population served in New York’s public mental health system emphasizes the need for population-based planning. Twenty two percent of this population is under 18 years of age, 9% are young adults aged 18-24, 13% are adults aged 25-34, 29% are aged 35-49, 17% are aged 50-64, 9% are over 65 years of age, and for 1%, the age is unknown. Across age groups, approximately 50% are male and 50% female. This racially diverse population is 55% White, 24% Black, 17% unknown race, 2% Asian, and 2% another race or multi-racial. Hispanic ethnicity is reported separately from race. Twenty-one percent (21%) are ethnically Hispanic, including many of those whose reported race was unknown.

How do the demographic characteristics of individuals served in the public mental health system compare with those of New York’s general population? Figure 2.1 describes persons served annually in the public mental health system with a population-based approach that utilizes 2003 U.S. Census data.³ On an annual basis, 31.63 females per 1,000 females in the general population and 33.15 males per 1,000 males in the general population receive services in our public mental health system. By age group, the rates are highest among 13-17 year olds (51.71) and 35-49 year olds (40.82), and lowest among children aged 12 years or younger (21.59) and those 65 years and older (21.48). By race, the rates are highest among individuals who are Multi-racial (43.05) and Black (42.23), and lowest among Asians (7.36) and American Indian or Alaskan Natives (9.44). Rates for persons with Hispanic ethnicity were nearly as high as the Black and Multi-racial groups (41.55). These data show that although individuals who are 35-49 years old comprise the largest group of service recipients and that the majority of service recipients are White, services are delivered at the highest rate to individuals who are 13-17 years of age and to members of the Black and Hispanic populations.

Figure 2.1
Number of Persons Served Annually, Rate per 1,000 Persons in the General Population

Age Groups Served

Children Aged 17 and Under

By diagnosis among children served, the largest proportions have attention deficit disorder (24%) or adjustment disorder (19%). Smaller numbers have conduct disorder or bipolar disorder/ major depressive disorder (16% each), 12% have some other disorder, 8% have anxiety disorder, and 3% each have either schizophrenia/ psychotic or personality or impulse control disorder.

Young Adults, Aged 18-24

Among individuals served who are aged 18-24, 36% are diagnosed with bipolar disorder or major depression, 22% with some other disorder, 13% each with schizophrenia and related disorders or an adjustment disorder, 8% with an anxiety disorder, 5% with a delusional or psychotic disorder, and 3% with a personality or impulse control disorder.

Adults Aged 25-64

Among adults served who are aged 25-64, 40% have either bipolar disorder or major depression, 24% have schizophrenia and related disorders, 15% have some other disorder, 9% have anxiety disorder, 6% have adjustment disorder, 4% have delusional and other psychotic disorder, and 2% personality or impulse control disorder.

Older Adults

Among adults served who are aged 65 and over, 40% are diagnosed with either bipolar disorder or major depression, 18% with schizophrenia and related disorders, 13% with organic brain disorder, 10% with some other disorder, 7% each with an adjustment or anxiety disorder, and 5% with a delusional or psychotic disorder.

These data show that bipolar disorder is the most common diagnosis among adults served regardless of age group. In each adult population, diagnoses of bipolar disorder and schizophrenia together comprise nearly half or more of all diagnoses: 49% of all diagnoses among adults aged 18-24; 64% among adults aged 25-64; and 58% among adults aged 65 and over.

Figure 2.2
Primary Mental Disorders Among People Served in the Public Mental Health System

Where are People Served?

To live successfully in our communities, most individuals with serious mental illness need both treatments that control or eliminate their psychiatric symptoms and a range of support services that meet the complex needs caused by the disabling effects of their illness. Public mental health services are grouped in four major categories across the health care continuum: community support, outpatient, inpatient, and emergency services.

• Community support helps individuals diagnosed with serious mental illness live as independently as possible in the community, and helps children with serious emotional disturbance to remain with their families. These programs provide case management, vocational, self-help, residential and other support services. Although the specific array of community support services differs for adults and children, the goal is always to support successful and full community living.

• Outpatient services provide treatment and rehabilitation in an ambulatory setting, including clinics, partial hospitalization, day treatment for children, continuing day treatment for adults, Assertive Community Treatment (ACT), Prepaid Mental Health Plan (PMHP) and the soon to be implemented Personalized Recovery-Oriented Services (PROS).

• Inpatient services provide acute stabilization and intensive treatment and rehabilitation with 24-hour care in a controlled environment. They are the programs of choice only when the required services and supports cannot be delivered in community settings.

• Emergency services provide rapid psychiatric and/or medical stabilization and ensure the safety of individuals who present a risk to themselves or others. These programs include a range of crisis counseling and residential services, as well as comprehensive psychiatric emergency programs.

Figure 2.3
Persons Served Annually by Program

In New York State, both State and locally operated programs provide services in each of these categories. The overall goal is to promote recovery and full community living for individuals with serious mental illness, while preserving public safety, and ensuring that respect, empowerment, and quality of life are incorporated into every aspect of care.

On an annual basis, among persons receiving services in New York State’s public mental health system, 65% are served in outpatient programs, 22% in community support programs, 14% in emergency programs, and 15% in inpatient programs. Six percent are also served in residential programs, a community support service. The total exceeds 100% because individuals may receive services from more than one category depending upon need (Figure 2.3).

Figure 2.4 describes program participation by age group. Among children 17 or younger, 69% participate in outpatient, 17% in community support programs, 11% in inpatient, 16% in emergency, and 1% in residential programs. Among young adults aged 18-24, 60% participate in outpatient, 17% in community support programs, 19% in inpatient, 22% in emergency, and 4% in residential programs. Among adults aged 25-64, 66% participate in outpatient, 23% in community support programs, 16% in inpatient, 13% in emergency, and 8% in residential programs. Among adults 65 and over, 58% participate in outpatient, 23% in community support programs, 15% in inpatient, 12% in emergency, and 3% in residential programs. As depicted in Figure 2.4, the totals exceed 100% because individuals may receive services from more than one category depending upon need.

Figure 2.4
Program Participation by Age

Across age groups, the largest proportion of individuals (approximately 60% or more) participate in outpatient services.

Infrastructure Development to Support Local Planning

In 2000, OMH, New York City and Local mental hygiene directors formed a multi-year partnership to improve access to information systems and enhance data-driven decision making. The group targeted data systems that, given improved local access, could assist Local directors in managing service delivery and provider performance. In response, OMH initiated a Web-based information portal containing Medicaid services and expenditures, patient characteristics, and adult housing admissions. In addition, a State/Local workgroup collaborated to define the systems’ specifications for the Child and Adult Integrated Reporting System (CAIRS), a local management information system designed to track specialty, housing and case management services to high-need, high-risk populations.

CAIRS is a dynamically generated, Web-based application that enhances the ability of Local providers to access information, generate performance management reports, and carry out care coordination activities. By the end of 2004, more than 3,000 individuals from over 1,100 program units statewide were authorized to use CAIRS. Furthermore, nearly 140,000 records exist in the CAIRS system as of December 31, 2004. Children’s programs that are required to report on CAIRS information include residential treatment facilities, family-based treatment, teaching family homes, community and crisis residences, the Home and Community Based Services Waiver, Home-based Crisis Intervention, intensive, supportive, and blended case management, mobile mental health teams, and school-based mental health. Adult programs reporting include Assertive Community Treatment, Assisted Outpatient Treatment, adult housing, and family care providers.

OMH’s Enterprise Data Warehouse is a repository of data from a wide variety of sources and a cornerstone of the agency’s increasing capacities for data-driven performance-based management. Data marts in the Warehouse organize all relevant and available recipient level information to provide a comprehensive and integrated view of the needs and treatment of users of mental health services in New York State. Financial data marts provide reporting and analysis capability in the areas of payroll, personnel, and financial transactions. The Data Warehouse organizes and integrates these data to facilitate rapid ad-hoc analysis and reporting.

Due to successful data infrastructure development, OMH is able to track services across time and providers, enabling the agency to measure performance in such critical areas as inpatient readmissions and time to first outpatient service following discharge from hospital settings. By integrating data from a variety of sources, OMH is able to detect trends in services delivery.

For example, Figure 2.5 shows the increase in the number of persons served from the 1999 to 2003 surveys by age group. To control for differences in the general population by age, the figure shows rates of persons served per 1,000 persons of the same age group in the population. Increases were observed in the adolescent and young adult groups. These trends are notable and are one reason why adolescents and young adults are receiving focused attention. Further discussion of agency priorities regarding this population group is found in Chapter 3.

Figure 2.5
People Receiving Services During Patient Characteristics Survey Week
per 1,000 General Population. 1999 vs. 2003



Using Geographical Information Systems (GIS) to Support Population-based Planning

OMH population-based planning efforts are supported by a Geographic Information Systems (GIS) initiative, products of which include:

• A repository of geo-coded data (providers, location of services, recipients, prevalence estimates, census information).

• Easily reproducible “geomaps” that are used to describe and compare information across and between geographic areas (e.g., counties) including service use and expenditures and prevalence of mental illness versus treated prevalence. Geomaps are excellent tools for population-based planning and are also used to support analysis of “what-if” scenarios in addition to actual public mental health system characteristics and modeling.

An example of how population-based planning efforts can be supported by geo-mapping technology is presented in Figure 2.6, which uses 2004 U.S. Census estimates and prevalence rates of serious and persistent mental illness (SPMI) to describe the estimated number and locations of adults aged 18-54 with SPMI in New York State. Statewide the estimated prevalence of SPMI among adults ages 18-54 is 2.6%. The population’s density is plotted on the map by zip code. Using geomaps of this type, OMH is able to determine correlations between estimated SPMI prevalence and mental health program locations.

Figure 2.6
Geomap: Estimated Number of Adults with SPMI Ages 18-54 (Prevalence rate 2.6%)