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

3
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
16

7
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).

8
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.

9
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

10
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.

12
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
21
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
24
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

16
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%)

Assessing the Burden of Mental Illness in Jackson County

Recommended

Recommended

More Related Content

What's hot

What's hot (20)

Viewers also liked

Viewers also liked (20)

Similar to Assessing the Burden of Mental Illness in Jackson County

Similar to Assessing the Burden of Mental Illness in Jackson County (20)

Assessing the Burden of Mental Illness in Jackson County