Estimate of Adult Mental Health Need

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Number of persons with serious mental illness, age18 and older, by State, 2000

Nebraska's estimate of persons needing mental health services.

Nebraska Performance Partnership Plan for Mental Health Services provides for an estimate of the numbers of people who are experiencing mental health problems including adult severe mental illness and children and adults with serious emotional disturbance (SED).

Numerator = Number of persons served, unduplicated count, in Nebraska HHS Behavioral Health (community mental health funded only) in reporting period who are reported as YES for having a severe and persistent mental illness (excludes those served in the three Regional Centers, private hospitals). Data source: for FY 97 CDS; for FY98 CMG

Denominator = Adults in Nebraska who are disabled by severe and persistent mental illness

(DSPMI) 7,815 Adults in Nebraska have a severe and persistent mental illness (SPMI) 31,033 (2.7% of the adults with a diagnosable mental disorder) Data source: Estimates of Prevalence and Treated Prevalence and Mental Health Systems Data - 1998 (see below)

Step 1:
Estimates of prevalence and treated prevalence and mental health systems data - 1998
[Consolidation of former criterion 2 and 11]
Methodology for developing planning estimates for mental health services
(Initially developed April 1996; revised July 1998)
The initial phase of the planning process was to develop reasonable demand estimates for the behavioral health service system. Below is a proposed methodology for estimating the number of persons likely to demand specialized, publicly-funded, mental health services.

Results of the Epidemiologic Catchment Area (ECA) Study, and the National Comorbidity Survey, indicate that approximately 24.1% of adults have a diagnosable DSM-III-R mental disorder (not including substance use disorders); 5.4*% have a serious mental illness; and 2.7% have a severe and persistent mental illness. In addition, the Department estimates that 0.68% of adults are disabled by severe and persistent mental illness. Applying these prevalence estimates to the Nebraska adult population results in the following estimates of need:

Total adult (18+) population: 1,149,373*
Adults in Nebraska with a diagnosable mental disorder (DMD): 27,699
Adults in Nebraska with a serious mental illness (SMI): 62,066*
Adults in Nebraska with a severe and persistent mental illness (SPMI): 31,033
Adults in Nebraska disabled by severe and persistent mental illness (DSPMI): 7,815
*Source: Federal Register / Vol. 62, No. 60 / Friday, March 28, 1997; page 14931

Each of these groups is a subset of the next larger group. For example, the DSPMI population is a subset of the SPMI population, which is a subset of the SMI population, which is a subset of the DMD population.

Because each group has a different likelihood to demand specialized services, it is useful to develop demand estimates for each of the four groups individually, which can be combined to represent a total demand estimate. To do this, however, it is first necessary to develop four mutually exclusive categories:
These four, mutually exclusive, categories total 276,999 which represents the number of people estimated to have a diagnosable mental disorder and, presumably, to be "in need" of mental health services.

Step 2:
Estimate of adults likely to demand mental health services during a one-year period
The methodology for estimating the number of adults likely to demand mental health services during a one-year period is based upon the following assumption:

Not all persons with a diagnosable mental disorder will demand services.

Results of the ECA study indicate that 27.9% of those with a mental disorder, excluding substance use disorders, will demand professional treatment for their mental disorder during a one-year period. This means that, state-wide, around 77,283 adults will demand professional treatment for their mental disorder during a one-year period. This leads to the second assumption:

The proportion of people demanding mental health services increases with the severity of the mental illness (i.e., the more serious the mental illness, and the more discomfort the individual experiences as a result of the mental illness, the more likely he or she will be to demand services).

This assumption is supported by the ECA study, which estimates a demand rate of 62.9% for persons with schizophrenia and 58.9% for persons with bipolar disorder.

Step 3:
Estimate of adults likely to demand mental health services from the specialty mental health sector
Not all people in need of, and demanding, mental health services, will demand services from the specialty mental health sector. Many people will receive mental health services from their primary care physician; others will receive services from clergy or other non-specialty mental health provider. Results of the ECA study indicate that slightly over half (52%) of those demanding mental health services turn to the specialty mental health sector. For Nebraska, this means that around 40,000 adults can be expected to demand services from the specialty mental health sector during a one-year period.

Step 4:
Estimate of adults likely to demand publicly-funded specialty mental health services
The final assumption is:

Only a portion of people demanding specialty mental health services will receive publicly-funded mental health services. In addition, the proportion of people demanding publicly-funded mental health services increases with the severity of the mental illness.

Of the four steps in the prevalence-demand estimation process, this step is the most difficult to estimate for a number of reasons. Because states have very different service delivery models in place, it is difficult to extrapolate national data to Nebraska. Compounding the issue is the reality that estimates are likely to vary by region.

Under previous planning models, where a clearer distinction existed between the "public" and "private" sectors, the availability of private sector services was an a important factor to take into consideration. It is still an important factor to consider. Additional factors, however, are also important to consider (e.g., factors related to an individual's ability to pay for services and/or the availability of insurance coverage for behavioral health services).

For more information contact:

Jim Harvey
Behavioral Health Housing Manager
Nebraska Department of Health and Human Services
Division of Behavioral Health
P.O. Box 98925
Lincoln, NE 68509-8925
Phone: (402) 471-7824