(July 11, 2017) Medicine and technology continue to improve treatment and outcomes for many medical conditions, but mental health and substance abuse disorders continue to be left behind. The latest evidence of the disparity can be found in the federal government's June 2017 statistical brief on trends in hospital inpatient stays.
From 2005 to 2014, the total number of hospital stays for mental health/substance use conditions rose 12.2% in the United States. This was the only category of hospitalization that increased in the time period. For all conditions, the number of inpatient stays dropped by 6.6% from 2005-2014. The largest reported decrease (12.0%) was for surgical stays, the smallest (4.3%), for injury stays.
Hospitalization is the most intensive and expensive intervention for any medical condition. Because prevention and community treatment often can avert the need for inpatient treatment, hospitalization is considered a poor outcome for many medical issues, including mental illness.
Overall, hospitalization associated with mental health or substance use accounted for nearly 6% of all hospital stays in 2014, a 20.1% increase in the share of such stays from 2005. At the same time, less money was spent per hospital stay for mental health/substance use in 2014 than in 2005, after adjusting for inflation. In every other category of hospitalization, spending increased.
The data were reported by the Agency for Healthcare Research and Quality's (AHRQ) Healthcare Cost and Utilization Project, known as H-CUP.
Hospitalization by Age and Diagnosis
The bulk of the increase in mental health hospitalizations was associated with mood disorders, which include bipolar disorder and major depression. The number of stays for this category rose by 23.2% in the 10-year period, from 690,900 stays in 2005 to 851,100 in 2014.
Driving the increase were hospitalizations for patients from 0-17 years and 45-64 years.
In 2005, mood disorders were not found among the top five reasons patients these ages became inpatients. By 2014, they had become the top non-maternal/non-neonatal reason children and adolescents were hospitalized (overtaking pneumonia, acute bronchitis, electrolyte disorders and appendicitis). They were the number three non-maternal/non-neonatal reason individuals aged 45-64 were hospitalized.
In both 2005 and 2014, mood disorders were the leading reason for hospitalization among patients from 18-44 years old, the age at which serious mental illness most commonly is diagnosed.
Schizophrenia and other psychotic disorders remained the number two reason for hospitalization in the 18-44 age range from 2005 to 2014. Psychotic conditions were not a leading reason for hospitalization in any other age group. While substance use was combined with mental health into a single category for general reporting purposes, the condition was not one of the top reasons for hospitalization in any age group.
Questions Requiring Answers
AHRQ's statistical brief provides no explanation for the dichotomy between the growing number of hospitalization stays for mental health/substance use and the shrinking number of stays for every other category. The numbers suggest questions that urgently need answers, among them:
- Why are so many more Americans being hospitalized for psychiatric conditions today than 10 years ago?
- What must change for people with psychiatric and substance use disorders to receive timely and effective interventions needed to avoid hospitalization?
- How is the increase in psychiatric hospital stays at a time when psychiatric beds is in decline affecting bed waits in emergency rooms and corrections facilities and having other impacts on mental health?
Doris A. Fuller
Chief of Research and Public Affairs
References:
- McDermott, K.W. et al. (June 2017). "Trends in hospital inpatient stays in the United States, 2005-2014." Agency for Healthcare Research and Quality
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