Mental Health in America - Glossary and Citations

Indicator	Description of Measure	Source
Adults with Any Mental Illness (AMI)	Any mental illness (AMI) is defined as having a diagnosable mental, behavioral, or emotional disorder, other than a developmental or substance use disorder, assessed by the Mental Health Surveillance Study (MHSS) Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders—Fourth Edition—Research Version—Axis I Disorders (MHSS-SCID), which is based on the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). Three categories of mental illness severity are defined based on the level of functional impairment: mild mental illness, moderate mental illness, and serious mental illness. AMI includes individuals in any of the three categories. For details on the methodology, see Section B.4.3 in Appendix B of the Results from the 2013 National Survey on Drug Use and Health: Mental Health Findings. http://www.samhsa.gov/data/. Data survey years: 2013-2015.	SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, https://www.samhsa.gov/data/nsduh/reports-detailed-tables-2017-NSDUH
Adults with AMI Reporting Unmet Need	Adults with AMI reporting unmet need is defined as feeling a perceived need for mental health treatment/counseling that was not received. This is often referred to as "unmet need." Mental Health Treatment/Counseling is defined as having received inpatient treatment/counseling or outpatient treatment/counseling or having used prescription medication for problems with emotions, nerves, or mental health. Respondents were not to include treatment for drug or alcohol use. Respondents with unknown treatment/counseling information were excluded. Data survey years:2013-2015.	SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health. https://www.samhsa.gov/data/nsduh/reports-detailed-tables-2017-NSDUH
Adults with AMI Who are Uninsured	Adults with AMI who are uninsured is calculated from variable IRINSUR4 and AMIYR_U. AMIYR_U is defined as above in Adults with AMI. A respondent is classified as NOT having any health insurance (IRINSUR4=2) if they meet EVERY one of the following conditions. (1) Not Covered by private insurance (IRPRVHLT=2) (2) Not Covered by Medicare (IRMEDICR=2) (3) Not Covered by Medicaid/CHIPCOV (IRMCDCHP=2) (4) Not Covered by Champus, ChampVA, VA, or Military (IRCHMPUS=2) (5) Not Covered by other health insurance (IROTHHLT=2). Data survey year: 2013-2015.	SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health. https://www.samhsa.gov/data/nsduh/reports-detailed-tables-2017-NSDUH

Indicator	Description of Measure	Source
Adult with Substance Abuse Disorder in the Past Year.	Substance Use Disorder is defined as meeting criteria for illicit drug or alcohol dependence or abuse. Dependence or abuse is based on definitions found in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). Illicit Drug Use includes the misuse of prescription psychotherapeutics or the use of marijuana, cocaine (including crack), heroin, hallucinogens, inhalants, or methamphetamine. Misuse of prescription psychotherapeutics is defined as use in any way not directed by a doctor, including use without a prescription of one's own; use in greater amounts, more often, or longer than told; or use in any other way not directed by a doctor. Prescription psychotherapeutics do not include over-the-counter drugs.	SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, https://www.samhsa.gov/data/nsduh/reports-detailed-tables-2017-NSDUH
Adults with Disability Who Could Not See a Doctor Due to Costs	Disability questions were added to the Behavioral Risk Factor Surveillance System (BRFSS) core questionnaire in 2004. Disability was determined using the following BRFSS question: “Are you limited in any way in any activities because of physical, mental or emotional problems?” (QLACTLM2). Respondents were defined as having a disability if they answered “Yes” to this question. Respondents were also asked: “Was there a time in the past 12 months when you needed to see a doctor but could not because of cost?” (MEDCOST). The measure was calculated based on individuals who answered Yes to MEDCOST among those who answered Yes to QLACTLM2. Data survey year 2015.	Centers for Disease Control and Prevention (CDC). Behavioral Risk Factor Surveillance System Survey Data. Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2016. http://www.cdc.gov/brfss/annual_data/annual_2014.html Downloaded and calculated on 8/24/17.
Adults with Serious Thoughts of Suicide	Adults aged 18 or older were asked whether they had seriously thought about, made any plans, or attempted to kill themselves at any time during the past 12 months, or if they had received medical attention from a health professional or stayed overnight in a hospital in the past 12 months because of a suicide attempt. Data survey year: 2013-2015.	SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, https://www.samhsa.gov/data/nsduh/reports-detailed-tables-2017-NSDUH
Children with private insurance that did not cover mental or emotional problems	Children with private insurance that did not cover mental or emotional problems is defined as any child age 0-17 responding YES to HLTINMNT. HLTINMNT is defined as: “Does [SAMPLE MEMBER POSS] private health insurance include coverage for treatment for mental or emotional problems?	SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, https://www.samhsa.gov/data/nsduh/reports-detailed-tables-2017-NSDUH

Indicator

Description of Measure

Source

Mental Health Workforce Availability

Mental health workforce availability is the ratio of the county population to the number of mental health providers including psychiatrists, psychologists, licensed clinical social workers, counselors, marriage and family therapists and advanced practice nurses specializing in mental health care. In 2015, marriage and family therapists and mental health providers that treat alcohol and other drug abuse were added to this measure.

Survey data year: 2017.

County Health Rankings & Roadmaps. http://www.countyhealthrankings.org/

This data comes from the National Provider Identification data file, which has some limitations. Providers who transmit electronic health records are required to obtain an identification number, but very small providers may not obtain a number. While providers have the option of deactivating their identification number, some mental health professionals included in this list may no longer be practicing or accepting new clients.

Students Identified with Emotional Disturbance for Individualized Education Program Individualized Education Program

Percent of Children Identified as having a Emotional Disturbance among enrolled students Grade 1-12 and Ungraded. This measure was calculated from data provided by IDEA Part B Child Count and Educational Environments, Common Core of Data. Under IDEA regulation, Emotional Disturbance is identified as a condition exhibiting one or more of the following characteristics over a long period of time and to a marked degree that adversely affects a child's educational performance: (A) An inability to learn that cannot be explained by intellectual, sensory, or health factors. (B) An inability to build or maintain satisfactory interpersonal relationships with peers and teachers. (C) Inappropriate types of behavior or feelings under normal circumstances. (D) A general pervasive mood of unhappiness or depression. (E) A tendency to develop physical symptoms or fears associated with personal or school problems. Emotional disturbance includes schizophrenia. The term does not apply to children who are socially maladjusted, unless it is determined that they have an emotional disturbance under paragraph (c)(4)(i) of this section. Data year 2015-2016

IDEA Data Center, 2015 – 2016 IDEA Section 618, State Level Data Files, Child Count and Educational Environments. http://www2.ed.gov/programs/osepidea/618-data/state-level-data-files/index.html#bccee .

US Department of Education, National Center for Education Statistics, Common Core of Data. http://nces.ed.gov/ccd/stnfis.asp

Downloaded and calculated on 7/31/2018.

Indicator	Description of Measure	Source
Youth with At Least One Past Year Major Depressive Episode (MDE)	Among youth age 12-17, major depressive episode (MDE) is defined as in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), which specifies a period of at least 2 weeks when a person experienced a depressed mood or loss of interest or pleasure in daily activities and had a majority of specified depression symptoms. For details, see Section B of the "2011-2012 NSDUH: Guide to State Tables and Summary of Small Area Estimation Methodology" at http://www.samhsa.gov/data/population-data-nsduh/reports?tab=33. Data survey year 2014-2015.	SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2014-2015. https://www.samhsa.gov/data/nsduh/reports-detailed-tables-2017-NSDUH
Youth with Substance Abuse Disorder in the Past Year.	Substance Use Disorder is defined as meeting criteria for illicit drug or alcohol dependence or abuse. Dependence or abuse is based on definitions found in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). Illicit Drug Use includes the misuse of prescription psychotherapeutics or the use of marijuana, cocaine (including crack), heroin, hallucinogens, inhalants, or methamphetamine. Misuse of prescription psychotherapeutics is defined as use in any way not directed by a doctor, including use without a prescription of one's own; use in greater amounts, more often, or longer than told; or use in any other way not directed by a doctor. Prescription psychotherapeutics do not include over-the-counter drugs.	SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, https://www.samhsa.gov/data/nsduh/reports-detailed-tables-2017-NSDUH
Youth with MDE who Did Not Receive Mental Health Services	Youth with Past Year MDE who Did Not Receive Treatment is defined as those who apply to having Past Year MDE as defined above (“Youth with At Least One Past Year Major Depressive Episode”) and respond NO to ANYSMH. ANYSMH indicates whether a youth reported receiving specialty mental health services in the past year from any of 7 specific inpatient/residential or outpatient specialty sources for problems with behavior or emotions that were not caused by alcohol or drugs. This variable was created based on the following 7 source of treatment variables: stayed overnight in a hospital (YHOSP), stayed in a residential treatment facility (YRESID), spent time in foster care (YFOST), spent time in a day treatment facility (YDAYTRT), received treatment from a mental health clinic (YCLIN), from a private therapist (YTHER), and from an in-home therapist (YHOME). Youths who reported a positive response (source variable=1) to one or more of the 7 questions were included in the yes category regardless of how many of the 7 questions they answered. Youths who did not report a positive response, but answered all 7 of the questions were included in the no category. Youths who did not report a positive response and did not answer all the questions, and adults were included in the unknown/18+ category. Data survey year 2014-2015.	SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health https://www.samhsa.gov/data/nsduh/reports-detailed-tables-2017-NSDUH

Indicator

Description of Measure

Source

Youth with Severe MDE

Youth with severe MDE is defined as having had MDE in the past year were then asked questions from the SDS to measure the level of functional impairment in major life activities reported to be caused by the MDE in the past 12 months (Leon, Olfson, Portera, Farber, & Sheehan, 1997). The SDS measures mental health-related impairment in four major life activities or role domains. The following variable, YSDSOVRL, is assigned the maximum level of interference over the four role domains of SDS: chores at home (YSDSHOME), school or work (YSDSWRK), family relationships (YSDSREL), and social life (YSDSSOC). Each module consists of four questions that are assessed on a 0 to 10 visual analog scale with categories of "none" (0), "mild" (1-3), "moderate" (4-6), "severe" (7-9), and "very severe" (10). The four SDS role domain variables were recoded so that no interference = 1, mild = 2, moderate = 3, severe = 4, and very severe = 5. A maximum level of interference over all four domains was then defined as YSDSOVRL. A maximum impairment score (YSDSOVRL) is defined as the single highest severity level of role impairment across all four SDS role domains. Ratings greater than or equal to 7 on the scale YSDSOVRL=4, 5 were considered severe impairment.

“Youth with Severe MDE” is defined as the following variable MDEIMPY. MDEIMPY is derived from the maximum severity level of MDE role impairment (YSDSOVRL) and is restricted to adolescents with past year MDE (YMDEYR). Youth met criteria for MDEIMPY if they answered YES to YSDSOVRL and YES to YMDEYR. Data survey years 2010-2015 and 2013-2015.

SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health

https://www.samhsa.gov/data/nsduh/reports-detailed-tables-2017-NSDUH

Youth with Severe MDE who Received Some Consistent Treatment

The following variable calculated as how many youth who answered YES to MDEIMPY from “Youth with severe MDE” defined above and SPOUTVST. The variable SPOUTVST, indicates how many times a specialty outpatient mental health service was visited in the past year. The number of visits is calculated by adding the number of visits to a day treatment facility (YUDYTXNM), mental health clinic (YUMHCRNM), private therapist (YUTPSTNM), and an in-home therapist (YUIHTPNM). A value of 6 (No Visits) was assigned whenever a respondent said they had used none of the services (YUDYTXYR, YUMHCRYR, YUTPSTYR, YUIHTPYR all equal 2). A value of missing was assigned when the response to whether received treatment or number of visits was unknown for any of the 4 locations (any of YUDYTXYR, YUMHCRYR, YUTPSTYR, YUIHTPYR=85, 94, 97, 98 OR any of YUDYTXNM, YUMHCRNM, YUTPSTNM, YUIHTPNM=985, 994, 997, 998), unless sum of the visits for services with non-missing information was greater than or equal to 25, in which case a value of 5 (25 or more visits) was assigned. A missing value was also assigned for respondents aged 18 or older. The variable SPOUTVST was recoded for visit distribution as 0 Visits, 1-6 Visits, and 7-25+ Visits. Data survey years 2010-2013, 2010-2015, and 2013-2015