Treating Mental Illness Takes Resources

Mental illness is a major public health concern. One in six Idahoans has been diagnosed with a mental health disorder.

The National Survey on Drug Use and Health conducted by the Substance Abuse and Mental Health Services Administration[1] estimates 4.7 percent of Idahoans over age 17 – more than 53,000 – have a serious mental illness, a disorder that causes substantial functional impairment and urgently requires treatment.

The national average is 4 percent. Idaho ranks 10th in the highest share of adults with a serious mental illness based on annual averages from the 2011 and 2012 national surveys. New Jersey had the lowest rate of serious mental illness at 3.1 percent, and West Virginia was highest at 5.5 percent.

The study estimates another 229,000 Idahoans over age 17 have experienced any mental illness – the presence of a mental, behavioral or emotional disorder – in the past year that met the Diagnostic and Statistical Manual of Mental Disorders.

Idaho has a 20 percent rate for any mental illness compared with 18.2 percent nationally, ranking the state sixth. Utah had the highest rate at 22.4 percent and New Jersey remained the lowest at 14.7 percent.

Depression is one of the most common mental health diagnoses, affecting one in every four adults to some degree. According to data from the Behavioral Risk Factor Surveillance System of the Idaho Department of Health and Welfare, smoking, sedentary lifestyle, obesity and lack of dental and medical checkups were associated with higher rates of depression.

Idaho has one of the highest suicide rates in the nation, and suicide is the eighth leading cause of death in the state. More than 90 percent of those who commit suicide have a diagnosable mental disorder. Suicide was highest among men, especially veterans and among those 45 to 54 years old in 2012. A nationwide report indicated that male veterans are twice as likely to commit suicide as civilians.

cause of death chart

According to Idaho Vital Statistics, the suicide rate in Idaho was 49 percent higher than the national rate in 2010, the most recent year available for national statistics, and the sixth highest in the country at 18.5 suicides per 100,000 population. Since 2010, the rate has fluctuated, hitting 18.7 percent in 2012.

Lack of resources and the stigma of mental illness and seeking help are barriers to receiving treatment.

Idaho is divided into seven public health districts. Districts 1 and 2 in northern Idaho experience a wide range of mental health challenges. Over the past three years, District 2, which is north central Idaho, has the highest suicide rate, and District 3, which consists of the more rural southwestern part of the state, has the lowest.

Through the State Mental Health Agency’s Regional Mental Health Centers in each of the districts, Idaho offers state-operated, community-based mental health providers. Psychiatric patients eligible for inpatient care are referred to the state hospitals in Orofino and Blackfoot. There are also private facilities that provide services to the mentally ill.

The costs of treating mental illness are substantial. A report in 2010 from Gov. C.L. “Butch” Otter’s Behavioral Health Transformation Working Group estimated the cost at $91.1 million not including the $164.7 million provided through Medicaid. Idaho, however, spends more than the national average on mental health services in the country – $143.56 per capita compared with the national average of $120.56, according to the National Association of State Mental Health Program Directors’ Research Institute.

Not funding mental health treatment, however, also has costs, and they are shared by hospital emergency rooms, homeless shelters, police, local courts, jails and prisons.

The mental health community also must deal with the issue of a stable workforce. Although there are 5,300 licensed mental health professionals in multiple disciplines across the state, some areas are more underserved than others – both geographically and by discipline. According to the Health Resources and Services Administration, all seven health districts and their 40 facilities have been designated Health Professional Shortage Areas for mental health professionals. In some ways, the shortage of providers is understated since many providers do not accept Medicaid patients because of low reimbursement rates.

Shortages of psychiatrists, psychiatric nurses, psychologists and social workers along with inadequate financial resources are among the main barriers to providing treatment in rural Idaho.