September 25, 2008

Mental Health Service Use among Youths Aged 12 to 17: 2005 and 2006

Mental health services for children and youths are provided in a variety of settings, including specialty mental health service settings, such as community mental health centers, as well as nonspecialty settings, such as schools¹ and general medical practice settings.² For youths, nonspecialty settings, particularly schools, may be especially important in accessing mental health services. As a result, many leading youth mental health service delivery models call for the coordination of care provided in specialty and nonspecialty settings^2,3 and adopting a "no wrong door" approach to accessing mental health services. This report examines data on youth mental health service utilization from the 2005 and 2006 National Surveys on Drug Use and Health (NSDUH), applying the categories for specialty and nonspecialty settings commonly used in the youth mental health services literature.^4,5

NSDUH includes questions for youths aged 12 to 17 about mental health treatment or counseling received in the past 12 months for emotional or behavioral problems not caused by alcohol or drugs.⁶ In NSDUH, settings for services related to emotional or behavioral problems among youths include the following: (1) specialty mental health services delivered in outpatient settings, including a private therapist, psychologist, psychiatrist, social worker, or counselor; a mental health clinic or center; a partial day hospital or day treatment program; or an in-home therapist, counselor, or family preservation worker; (2) specialty mental health services delivered in inpatient or residential settings during an overnight or longer stay in a hospital, a residential treatment center, or a foster care or therapeutic foster care home; (3) mental health services delivered in school-based settings, including those provided by a school counselor, school psychologist, or in regular meetings with a teacher about emotional or behavioral problems; special education services provided in a regular classroom or in a special classroom or placement in a special program or special school for emotional or behavioral problems; and (4) services delivered in a general medical setting by a pediatrician or other family doctor.

This issue of The NSDUH Report examines the numbers and percentages of youths aged 12 to 17 receiving mental health services (one or more contacts) in the past year for emotional or behavioral problems by setting. All findings presented in this report are annual averages based on combined 2005 and 2006 NSDUH data.

Combined 2005 and 2006 data indicate that an annual average of 13.3 percent of youths aged 12 to 17 (an estimated 3.3 million persons annually) received specialty mental health services for emotional or behavioral problems in the 12 months prior to the survey (Table 1). Almost one in eight (11.9 percent) received outpatient mental health services. The most commonly used outpatient services were those provided by private therapists, psychologists, psychiatrists, social workers, or counselors (9.9 percent of youths). An estimated 2.7 percent of persons in this age group received inpatient mental health services. The most commonly used inpatient service for emotional or behavioral problems was staying overnight or longer in a hospital (2.1 percent).

Twelve percent of youths aged 12 to 17 (3.0 million) received mental health services for emotional or behavioral problems in a school-based setting. Among these youths, 9.9 percent received mental health services from a school counselor, school psychologist, or through regular meetings with a teacher for emotional or behavior problems in the past 12 months, and 3.9 percent received special educational services for emotional or behavior problems while in a regular classroom or when placed in a special classroom or school.

Three percent of youths (an estimated 752,000) received services for emotional or behavioral problems from a pediatrician or other family doctor.

The percentages of youths aged 12 to 17 receiving services for emotional or behavioral problems in the past year in the specialty mental health and education settings varied by age. Youths aged 14 or 15 were more likely to receive specialty mental health services than were youths aged 12 or 13 (14.0 vs. 12.5 percent). Services in an education setting were more common among 12 or 13 year olds (12.8 percent) and 14 or 15 year olds (12.5 percent) than among 16 or 17 year olds (10.8 percent) (Figure 1). The percentage of youths who received services for emotional or behavioral problems in a general medical setting did not vary by age.

Figure 1. Percentages of Youths Aged 12 to 17 Who Received Services for Emotional or Behavioral Problems in the Past Year, by Setting and Age Group: 2005 and 2006

Female youths aged 12 to 17 were more likely than their male counterparts to receive specialty mental health services in the past year (14.9 vs. 11.8 percent) and more likely to receive school-based services for emotional or behavioral problems in the past year (13.2 vs. 10.9 percent) (Figure 2). There was no difference between male and female youths in their use of general medical services for emotional or behavioral problems.

Figure 2. Percentages of Youths Aged 12 to 17 Who Received Services for Emotional or Behavioral Problems in the Past Year, by Setting and Gender: 2005 and 2006