# 18 {#section .Chapter-# .unnumbered}

# Mental Health and Mental Disorders

#### Mental Health Status Improvement

18-1 Suicide

18-2 Adolescent suicide attempts

18-3 Serious mental illness (SMI) among homeless adults

18-4 Employment of persons with SMI

18-5 Eating disorder relapses

#### Treatment Expansion

18-6 Primary care screening and assessment

18-7 Treatment for children with mental health problems

18-8 Juvenile justice facility screening

18-9 Treatment for adults with mental disorders

18-9a Adults aged 18 to 54 years with serious mental illness

18-9b Adults aged 18 years and older with recognized depression

18-9c Adults aged 18 years and older with schizophrenia

18-9d Adults aged 18 years and older with generalized anxiety disorder

18-10 Treatment for co-occurring disorders

18-11 Adult jail diversion programs

#### State Activities

18-12 State tracking of consumer satisfaction

18-13 State plans addressing cultural competence

18-14 State plans addressing elderly persons

### Mental Health Status Improvement

  ----------------------- -----------------------------------------------
  18-1. Reduce the        
  suicide rate.           

  **National Data         National Vital Statistics System (NVSS), CDC,
  Source**                NCHS.

  **State Data Source**   National Vital Statistics System (NVSS), CDC,
                          NCHS.

  **Healthy People 2000   6.1 (Mental Health and Mental Disorders) (also
  Objective**             7.2), age adjusted to 2000 standard population.

  **Measure**             Rate per 100,000 (age adjusted, see Comments).

  **Baseline**            11.3 (1998).

  **Numerator**           Number of deaths due to suicide (ICD-9 codes
                          E950-E959).

  **Denominator**         Number of persons.

  **Population Targeted** U.S. resident population.

  **Questions Used To     Not applicable.
  Obtain the National     
  Data**                  

  **Expected              Annual.
  Periodicity**           

  **Comments**            Suicides may be undercounted because of
                          difficulty in the determination of suicidal
                          intent by coroner or medical examiner.

                          Data are age adjusted to the 2000 standard
                          population. Age-adjusted rates are weighted
                          sums of age-specific rates. For a discussion on
                          age adjustment, see Part A, section 5.

                          This objective differs from Healthy People 2000
                          objective 6.1, which was age adjusted to the
                          1940 standard population. See Appendix C for
                          comparison data.

                          See Part C for a description of NVSS and
                          Appendix A for focus area contact information.
  ----------------------- -----------------------------------------------

  

+----------------------+-----------------------------------------------+
| 18-2. Reduce the     |                                               |
| rate of suicide      |                                               |
| attempts by          |                                               |
| adolescents.         |                                               |
+======================+===============================================+
| **National Data      | Youth Risk Behavior Surveillance System       |
| Source**             | (YRBSS), CDC, NCCDPHP.                        |
+----------------------+-----------------------------------------------+
| **State Data         | Youth Risk Behavior Surveillance System       |
| Source**             | (YRBSS), CDC, NCCDPHP.                        |
+----------------------+-----------------------------------------------+
| **Healthy People     | 7.8 (Violent and Abusive Behavior) (also      |
| 2000 Objective**     | 6.2).                                         |
+----------------------+-----------------------------------------------+
| **Measure**          | Percent.                                      |
+----------------------+-----------------------------------------------+
| **Baseline**         | 2.6 (1999).                                   |
+----------------------+-----------------------------------------------+
| **Numerator**        | Number of students in grades 9 through 12 who |
|                      | reported suicide attempts that required       |
|                      | medical attention in the 12 months preceding  |
|                      | the survey.                                   |
+----------------------+-----------------------------------------------+
| **Denominator**      | Number of students in grades 9 through 12.    |
+----------------------+-----------------------------------------------+
| **Population         | Students in grades 9 through 12.              |
| Targeted**           |                                               |
+----------------------+-----------------------------------------------+
| **Questions Used To  | From the 1999 Youth Risk Behavior Survey:     |
| Obtain the National  |                                               |
| Data**               |                                               |
+----------------------+-----------------------------------------------+
|                      | -   If you attempted suicide during the past  |
|                      |     12 months, did any attempt result in an   |
|                      |     injury, poisoning or overdose that had to |
|                      |     be treated by a doctor or a nurse?        |
|                      |                                               |
|                      |     1\) I did not attempt suicide during the  |
|                      |     past 12 months\                           |
|                      |     2) Yes\                                   |
|                      |     3) No                                     |
+----------------------+-----------------------------------------------+
| **Expected           | Biennial.                                     |
| Periodicity**        |                                               |
+----------------------+-----------------------------------------------+
| **Comments**         | See Part C for a description of YRBSS and     |
|                      | Appendix A for focus area contact             |
|                      | information.                                  |
+----------------------+-----------------------------------------------+

  

  -----------------------------------------------------------------------
  18-3. Reduce the        
  proportion of homeless  
  adults who have serious 
  mental illness (SMI).   
  ----------------------- -----------------------------------------------
  **National Data         Projects for Assistance in Transition from
  Source**                Homelessness (PATH) Annual Application, SAMHSA,
                          CMHS.

  **State Data Source**   Projects for Assistance in Transition from
                          Homelessness (PATH) Annual Application, SAMHSA,
                          CMHS.

  **Healthy People 2000   Not applicable.
  Objective**             

  **Measure**             Percent.

  **Baseline**            25 (1996).

  **Numerator**           Sum of State estimates of the number of people
                          aged 18 years and older who have a serious
                          mental illness and are homeless.

  **Denominator**         Sum of State estimates of the number of people
                          aged 18 years and older who are homeless.

  **Questions Used To     Not applicable.
  Obtain the National     
  Data**                  

  **Expected              Annual.
  Periodicity**           

  **Comments**            The Federal definition of serious mental
                          illness (SMI) specifies that the mental
                          condition interfered with the person's ability
                          to work or find work. State definitions of SMI
                          may vary. States provide estimates of the
                          number of homeless persons and the number of
                          homeless persons with SMI in their annual PATH
                          grant applications. The procedures used to
                          estimate the numbers of homeless people and
                          homeless people with SMI vary considerably
                          across States.

                          See Appendix A for focus area contact
                          information.
  -----------------------------------------------------------------------

  

+----------------------+-----------------------------------------------+
| 18-4. Increase the   |                                               |
| proportion of        |                                               |
| persons with serious |                                               |
| mental illness (SMI) |                                               |
| who are employed.    |                                               |
+----------------------+-----------------------------------------------+
| **National Data      | National Health Interview Survey (NHIS), CDC, |
| Source**             | NCHS.                                         |
+----------------------+-----------------------------------------------+
| **State Data         | Not identified.                               |
| Source**             |                                               |
+----------------------+-----------------------------------------------+
| **Healthy People     | Not applicable.                               |
| 2000 Objective**     |                                               |
+----------------------+-----------------------------------------------+
| **Measure**          | Percent.                                      |
+----------------------+-----------------------------------------------+
| **Baseline**         | 43 (1994).                                    |
+----------------------+-----------------------------------------------+
| **Numerator**        | Number of persons aged 18 years and older who |
|                      | report having either a serious mental         |
|                      | illness; having Diagnostic Interview Schedule |
|                      | (DIS) or Composite International Diagnostic   |
|                      | Interview (CIDI) symptoms; or having used     |
|                      | prescription medicine for mental disorders in |
|                      | the past 12 months, and who also report that  |
|                      | the symptoms "seriously interfere" with work, |
|                      | school, or day-to-day activities, and report  |
|                      | being employed in the past 12 months.         |
+----------------------+-----------------------------------------------+
| **Denominator**      | Number of persons aged 18 years and older who |
|                      | report having either a serious mental         |
|                      | illness; having Diagnostic Interview Schedule |
|                      | (DIS) or Composite International Diagnostic   |
|                      | Interview (CIDI) symptoms; or having used     |
|                      | prescription medicine for mental disorders in |
|                      | the past 12 months, and who also report that  |
|                      | the symptoms "seriously interfere" with work, |
|                      | school, or day-to-day activities.             |
+----------------------+-----------------------------------------------+
| **Population         | U.S. civilian, noninstitutionalized           |
| Targeted**           | population.                                   |
+----------------------+-----------------------------------------------+
| **Questions Used To  | From the 1994 National Health Interview       |
| Obtain the National  | Survey:                                       |
| Data**               |                                               |
+----------------------+-----------------------------------------------+
|                      | \[NUMERATOR:\]                                |
|                      |                                               |
|                      | -   During the past 12 months was             |
|                      |     ([Names]{.underline}) employed?           |
+----------------------+-----------------------------------------------+
|                      | \[DENOMINATOR:\]                              |
|                      |                                               |
|                      | -   During the past 12 months did ([Name of   |
|                      |     persons 18 years and older]{.underline})  |
|                      |     have --                                   |
|                      |                                               |
|                      |     Schizophrenia?\                           |
|                      |     Paranoid or delusional disorder other     |
|                      |     than schizophrenia?\                      |
|                      |     Manic episodes or manic depression, also  |
|                      |     called bipolar disorder?\                 |
|                      |     Major depression? (Major depression is a  |
|                      |     depressed mood and loss of interest in    |
|                      |     almost all activities for at least 2      |
|                      |     weeks)\                                   |
|                      |     Anti-social personality, obsessive        |
|                      |     compulsive personality or any severe      |
|                      |     personality disorder?\                    |
|                      |     Alzheimer's disease or another type of    |
|                      |     senile disorder?                          |
+----------------------+-----------------------------------------------+
|                      | -   Are ([Names]{.underline}) FREQUENTLY      |
|                      |     depressed or anxious?                     |
+----------------------+-----------------------------------------------+
|                      | -   Do ([Names]{.underline}) have a lot of    |
|                      |     trouble making or keeping friendships?    |
+----------------------+-----------------------------------------------+
|                      | -   Do ([Names]{.underline}) have a lot of    |
|                      |     trouble getting along with other people   |
|                      |     in social or recreational settings?       |
+----------------------+-----------------------------------------------+
|                      | -   Do ([Names]{.underline}) have a lot of    |
|                      |     trouble concentrating long enough to      |
|                      |     complete everyday tasks?                  |
+----------------------+-----------------------------------------------+
|                      | -   Do ([Names]{.underline}) have SERIOUS     |
|                      |     difficulty coping with day-to-day         |
|                      |     stresses?                                 |
+----------------------+-----------------------------------------------+
|                      | -   Are ([Names]{.underline}) FREQUENTLY      |
|                      |     confused, disoriented or forgetful?       |
+----------------------+-----------------------------------------------+
|                      | -   Do ([Names]{.underline}) have phobias or  |
|                      |     UNREASONABLY strong fears, that is, a     |
|                      |     fear of something or some situation where |
|                      |     most people would not be afraid?          |
+----------------------+-----------------------------------------------+
|                      | -   During the past 12 months, did any of     |
|                      |     these problems SERIOUSLY interfere with   |
|                      |     ability to work or attend school or to    |
|                      |     manage day-to-day activities?             |
+----------------------+-----------------------------------------------+
| **Expected           | Periodic.                                     |
| Periodicity**        |                                               |
+----------------------+-----------------------------------------------+
| **Comments**         | Persons are considered to have a serious      |
|                      | mental illness if they respond "yes" to       |
|                      | [any]{.underline} of the questions designated |
|                      | as DENOMINATOR questions above.               |
+----------------------+-----------------------------------------------+
|                      | The baseline for this objective came from the |
|                      | disability supplement to the 1994 NHIS; there |
|                      | are currently no plans to repeat this         |
|                      | supplement, so an alternative source will     |
|                      | have to be identified for updates.            |
+----------------------+-----------------------------------------------+
|                      | See Part C for a description of NHIS and      |
|                      | Appendix A for focus area contact             |
|                      | information.                                  |
+----------------------+-----------------------------------------------+

  

  ----------------------- -----------------------------------------------
  18-5. (Developmental)   
  Reduce the relapse      
  rates for persons with  
  eating disorders,       
  including anorexia      
  nervosa and bulimia     
  nervosa.                

  **Comments**            An operational definition could not be
                          specified at the time of publication. The
                          proposed national data source is the
                          Prospective Studies of Patients with Anorexia
                          or Bulimia Nervosa, NIH, NIMH.

                          See Appendix A for focus area contact
                          information.
  ----------------------- -----------------------------------------------

  

### Treatment Expansion

  ----------------------- -----------------------------------------------
  18-6. (Developmental)   
  Increase the number of  
  persons seen in primary 
  health care who receive 
  mental health screening 
  and assessment.         

  **Comments**            An operational definition could not be
                          specified at the time of publication.

                          The proposed national data source is the
                          Primary Care Data System/Federally Qualified
                          Health Centers, HRSA.

                          See Appendix A for focus area contact
                          information.
  ----------------------- -----------------------------------------------

  

  ----------------------- -----------------------------------------------
  18-7. (Developmental)   
  Increase the proportion 
  of children with mental 
  health problems who     
  receive treatment.      

  **Comments**            An operational definition could not be
                          specified at the time of publication.

                          The proposed national data source is the
                          National Household Survey on Drug Abuse
                          (NHSDA), SAMHSA.

                          See Appendix A for focus area contact
                          information.
  ----------------------- -----------------------------------------------

**  **

  ----------------------- -----------------------------------------------
  18-8. (Developmental)   
  Increase the proportion 
  of juvenile justice     
  facilities that screen  
  new admissions for      
  mental health problems. 

  **Comments**            An operational definition could not be
                          specified at the time of publication.

                          The proposed national data source is the
                          Inventory of Mental Health Services in Juvenile
                          Justice Facilities, SAMHSA.

                          See Appendix A for focus area contact
                          information.
  ----------------------- -----------------------------------------------

  

18-9. Increase the proportion of adults with mental disorders who
receive treatment.

  ----------------------- -----------------------------------------------
  18-9a. Adults aged 18   
  to 54 years with        
  serious mental illness. 

  **National Data         National Comorbidity Survey (NCS), SAMHSA,
  Source**                CMHS; NIH, NIMH.

  **State Data Source**   Not identified.

  **Healthy People 2000   Not applicable.
  Objective**             

  **Measure**             Percent.

  **Baseline**            47 (1991).

  **Numerator**           Number of adults aged 18 to 54 years who report
                          symptoms of serious mental illness and that
                          they received help from a mental health
                          professional.

  **Denominator**         Number of adults aged 18 to 54 years who report
                          symptoms of serious mental illness.

  **Population Targeted** U.S. civilian, noninstitutionalized coterminous
                          population.

  **Questions Used To     See Comments.
  Obtain the National     
  Data**                  

  **Expected              Periodic.
  Periodicity**           

  **Comments**            The National Comorbidity Survey (NCS) used a
                          modified version of the Composite International
                          Diagnostic Interview (CIDI) to collect data for
                          this objective.

                          The SMI definition required at least one
                          DSM-IIIR disorder other than substance use
                          disorders in the past 12 months and serious
                          impairment. Severe mental illness is defined
                          as: 1) a diagnosis of schizophrenia,
                          schizoaffective disorder, manic depressive
                          disorder, autism, severe forms of major
                          depression, panic disorder, and obsessive
                          compulsive disorder; 2) 12-month prevalence of
                          nonaffective psychosis or mania; 3) lifetime
                          prevalence of nonaffective psychosis or mania;
                          or 1-2-month prevalence of either major
                          depression or panic disorder with evidence of
                          severity. The SMI definition included those
                          with a 12-month mental disorder that interfered
                          with their vocational capacity, their main
                          productive role, or was associated with serious
                          interpersonal impairment.

                          See Appendix A for focus area contact
                          information.
  ----------------------- -----------------------------------------------

  

+----------------------+-----------------------------------------------+
| 18-9b. Adults aged   |                                               |
| 18 years and older   |                                               |
| with recognized      |                                               |
| depression.          |                                               |
+======================+===============================================+
| **National Data      | National Household Survey on Drug Abuse       |
| Source**             | (NHSDA), SAMHSA.                              |
+----------------------+-----------------------------------------------+
| **State Data         | National Household Survey on Drug Abuse       |
| Source**             | (NHSDA), SAMHSA.                              |
+----------------------+-----------------------------------------------+
| **Healthy People     | Adapted from 6.7 (Mental Health and Mental    |
| 2000 Objective**     | Disorders).                                   |
+----------------------+-----------------------------------------------+
| **Leading Health     | Mental Health.                                |
| Indicator**          |                                               |
+----------------------+-----------------------------------------------+
| **Measure**          | Percent.                                      |
+----------------------+-----------------------------------------------+
| **Baseline**         | 23 (1997).                                    |
+----------------------+-----------------------------------------------+
| **Numerator**        | Number of adults aged 18 years and older who  |
|                      | report symptoms of depression and that they   |
|                      | received help from a mental health            |
|                      | professional.                                 |
+----------------------+-----------------------------------------------+
| **Denominator**      | Number of adults aged 18 years and older who  |
|                      | report symptoms of depression.                |
+----------------------+-----------------------------------------------+
| **Population         | U.S. civilian, noninstitutionalized           |
| Targeted**           | population.                                   |
+----------------------+-----------------------------------------------+
| **Questions Used To  | From the 1997 National Household Survey of    |
| Obtain the National  | Drug Abuse:                                   |
| Data**               |                                               |
+----------------------+-----------------------------------------------+
|                      | \[NUMERATOR:\]                                |
|                      |                                               |
|                      | -   During the past 12 months, how many       |
|                      |     different times have you stayed overnight |
|                      |     or longer in a hospital to receive        |
|                      |     treatment for psychological or emotional  |
|                      |     difficulties?                             |
+----------------------+-----------------------------------------------+
|                      | -   Have you received treatment for           |
|                      |     psychological problems or emotional       |
|                      |     difficulties at a mental health clinic or |
|                      |     by a mental health professional on an     |
|                      |     outpatient basis in the past 12 months?   |
+----------------------+-----------------------------------------------+
|                      | \[DENOMINATOR:\]                              |
|                      |                                               |
|                      | -   During the past 12 months, was there ever |
|                      |     a time when you felt sad, blue, or        |
|                      |     depressed for 2 weeks or more in a row?   |
+----------------------+-----------------------------------------------+
|                      | For the next few questions, please think of   |
|                      | the 2-week period when these feelings were    |
|                      | worst.                                        |
|                      |                                               |
|                      | -   During that time, did the feeling of      |
|                      |     being sad, blue, or depressed usually     |
|                      |     last:                                     |
|                      |                                               |
|                      |     All day long?\                            |
|                      |     Most of the day?\                         |
|                      |     About half the day?\                      |
|                      |     Less than half the day?                   |
+----------------------+-----------------------------------------------+
|                      | -   Did you feel this way:                    |
|                      |                                               |
|                      |     Every day?\                               |
|                      |     Almost every day?\                        |
|                      |     Less often?                               |
+----------------------+-----------------------------------------------+
|                      | -   During those 2 weeks, did you lose        |
|                      |     interest in most things?                  |
+----------------------+-----------------------------------------------+
|                      | -   Did you feel tired or low on energy all   |
|                      |     of the time?                              |
+----------------------+-----------------------------------------------+
|                      | -   Did you gain weight, lose weight or       |
|                      |     stayed about the same?                    |
|                      |                                               |
|                      |     Gained weight?\                           |
|                      |     Lost weight?\                             |
|                      |     Both gained and lost weight\              |
|                      |     Stayed the same                           |
+----------------------+-----------------------------------------------+
|                      | -   About how much weight did you gain/lose?  |
+----------------------+-----------------------------------------------+
|                      | -   Did you have more trouble falling asleep  |
|                      |     than you usually do?                      |
+----------------------+-----------------------------------------------+
|                      | -   Did that happen every night, nearly every |
|                      |     night or less often during those 2 weeks? |
|                      |                                               |
|                      |     Every night?\                             |
|                      |     Nearly every night?\                      |
|                      |     Less often?                               |
+----------------------+-----------------------------------------------+
|                      | -   Did you have a lot more trouble           |
|                      |     concentrating than usual?                 |
+----------------------+-----------------------------------------------+
|                      | -   At these times, people sometimes feel     |
|                      |     down on themselves, no good or worthless. |
|                      |     Did you feel this way?                    |
+----------------------+-----------------------------------------------+
|                      | -   Did you think a lot about death---either  |
|                      |     your own, someone else's, or death in     |
|                      |     general?                                  |
+----------------------+-----------------------------------------------+
| **Expected           | Annual.                                       |
| Periodicity**        |                                               |
+----------------------+-----------------------------------------------+
| **Comments**         | This objective differs from Healthy People    |
|                      | 2000 objective 6.7 in that it uses a          |
|                      | different age group and data source;          |
|                      | objective 6.7 limited the data to persons     |
|                      | aged 18 to 54 years and used data from the    |
|                      | ECA and NCS.                                  |
+----------------------+-----------------------------------------------+
|                      | This objective is one of the measures used to |
|                      | track the Mental Health Leading Health        |
|                      | Indicator. See Appendix H for a complete      |
|                      | listing.                                      |
+----------------------+-----------------------------------------------+
|                      | See Part C for a discussion of NHSDA and      |
|                      | Appendix A for focus area contact             |
|                      | information.                                  |
+----------------------+-----------------------------------------------+

  

  ----------------------- -----------------------------------------------
  18-9c. Adults aged 18   
  years and older with    
  schizophrenia.          

  **National Data         Epidemiologic Catchment Area (ECA) Program,
  Source**                NIH, NIMH.

  **State Data Source**   Not identified.

  **Healthy People 2000   Not applicable.
  Objective**             

  **Measure**             Percent.

  **Baseline**            60 (1984).

  **Numerator**           Adults aged 18 years and older who were
                          diagnosed with schizophrenia and who received
                          treatment.

  **Denominator**         Adults 18 years and older who were diagnosed
                          with schizophrenia.

  **Population Targeted** U.S. civilian, noninstitutionalized population.

  **Questions Used To     See Comments.
  Obtain the National     
  Data**                  

  **Expected              Periodic.
  Periodicity**           

  **Comments**            The Epidemiologic Catchment Area (ECA), NIMH,
                          NIH study provided the baseline for this
                          objective; there are currently no plans to
                          repeat this 1984 study.

                          The ECA used the Diagnostic Interview Schedule
                          (DIS) to collect the data. The data are limited
                          to: 1) persons who were diagnosed with DSM-IIIR
                          schizophrenia within the last year or, 2)
                          persons who were diagnosed with DSM-IIIR
                          schizophrenia at some other point during their
                          life with evidence of severity, including use
                          within the past year of any inpatient
                          psychiatric hospitalization or nursing home
                          placement; any outpatient mental health
                          treatment in a specialty mental health or
                          general medical setting; or psychotic symptoms.
                          Treatment questions included use of inpatient
                          or ambulatory service sectors in the last 12
                          months.

                          See Appendix A for focus area contact
                          information.
  ----------------------- -----------------------------------------------

  

+----------------------+-----------------------------------------------+
| 18-9d. Adults aged   |                                               |
| 18 years and older   |                                               |
| with generalized     |                                               |
| anxiety disorder.    |                                               |
+----------------------+-----------------------------------------------+
| **National Data      | National Household Survey on Drug Abuse       |
| Source**             | (NHSDA), SAMHSA.                              |
+----------------------+-----------------------------------------------+
| **State Data         | National Household Survey on Drug Abuse       |
| Source**             | (NHSDA), SAMHSA.                              |
+----------------------+-----------------------------------------------+
| **Healthy People     | Not applicable.                               |
| 2000 Objective**     |                                               |
+----------------------+-----------------------------------------------+
| **Measure**          | Percent.                                      |
+----------------------+-----------------------------------------------+
| **Baseline**         | 38 (1997).                                    |
+----------------------+-----------------------------------------------+
| **Numerator**        | Number of adults aged 18 years and older who  |
|                      | report symptoms of anxiety disorders and that |
|                      | they received help from a mental health       |
|                      | professional.                                 |
+----------------------+-----------------------------------------------+
| **Denominator**      | Number of adults aged 18 years and older who  |
|                      | report symptoms of anxiety disorders.         |
+----------------------+-----------------------------------------------+
| **Population         | U.S. civilian, noninstitutionalized           |
| Targeted**           | population.                                   |
+----------------------+-----------------------------------------------+
| **Questions Used To  | From the 1997 National Household Survey on    |
| Obtain the National  | Drug Abuse:                                   |
| Data**               |                                               |
+----------------------+-----------------------------------------------+
|                      | \[NUMERATOR:\]                                |
|                      |                                               |
|                      | -   During the past 12 months, how many       |
|                      |     different times have you stayed overnight |
|                      |     or longer in a hospital to receive        |
|                      |     treatment for psychological or emotional  |
|                      |     difficulties?                             |
+----------------------+-----------------------------------------------+
|                      | -   Have you received treatment for           |
|                      |     psychological problems or emotional       |
|                      |     difficulties at a mental health clinic or |
|                      |     by a mental health professional on an     |
|                      |     outpatient basis in the past 12 months?   |
+----------------------+-----------------------------------------------+
|                      | \[DENOMINATOR:\]                              |
|                      |                                               |
|                      | -   During the past 12 months, did you ever   |
|                      |     have a period lasting 1 month or longer   |
|                      |     when most of the time you felt worried or |
|                      |     anxious?                                  |
+----------------------+-----------------------------------------------+
|                      | \[If yes:\]                                   |
|                      |                                               |
|                      | -   Has that period ended or is it still      |
|                      |     going on?                                 |
|                      |                                               |
|                      |     Ended\                                    |
|                      |     Still going on                            |
+----------------------+-----------------------------------------------+
|                      | -   How many months or years did it go on     |
|                      |     before it ended?                          |
+----------------------+-----------------------------------------------+
|                      | -   During that period, did you worry about   |
|                      |     things that were not likely to happen?    |
+----------------------+-----------------------------------------------+
|                      | -   Did you worry a great deal about things   |
|                      |     that were not really serious?             |
+----------------------+-----------------------------------------------+
|                      | -   During this period of worry or anxiety,   |
|                      |     did you have different worries that were  |
|                      |     on your mind at the same time?            |
+----------------------+-----------------------------------------------+
|                      | -   How many years or months has it been      |
|                      |     going on?                                 |
+----------------------+-----------------------------------------------+
|                      | -   Do you worry about things that are not    |
|                      |     likely to happen?                         |
+----------------------+-----------------------------------------------+
|                      | -   Do you worry a great deal about things    |
|                      |     that are not really serious?              |
+----------------------+-----------------------------------------------+
|                      | -   Do you have different worries on your     |
|                      |     mind at the same time?                    |
+----------------------+-----------------------------------------------+
|                      | -   When you (are/were) worried or anxious    |
|                      |     (are/were) you also---                    |
|                      |                                               |
|                      |     Restless?\                                |
|                      |     Keyed up or on edge?\                     |
|                      |     Particularly irritable?\                  |
|                      |     Aware of your heart pounding or racing?\  |
|                      |     Easily tired?\                            |
|                      |     Have trouble falling asleep or staying    |
|                      |     asleep?\                                  |
|                      |     Feel faint or unreal?                     |
+----------------------+-----------------------------------------------+
| **Expected           | Annual.                                       |
| Periodicity**        |                                               |
+----------------------+-----------------------------------------------+
| **Comments**         | See Part C for a description of NHSDA and     |
|                      | Appendix A for focus area contact             |
|                      | information.                                  |
+----------------------+-----------------------------------------------+

-    

  ----------------------- -----------------------------------------------
  18-10. (Developmental)  
  Increase the proportion 
  of persons with         
  co-occurring substance  
  abuse and mental        
  disorders who receive   
  treatment for both      
  disorders.              

  **Comments**            An operational definition could not be
                          specified at the time of publication.

                          Proposed national data sources are the National
                          Health Interview Survey (NHIS), CDC, NCHS; the
                          National Household Survey on Drug Abuse
                          (NHSDA), SAMHSA; or the Replication of National
                          Comorbidity Survey, NIH, NIMH.

                          See Appendix A for focus area contact
                          information.
  ----------------------- -----------------------------------------------

  

  ----------------------- -----------------------------------------------
  18-11. (Developmental)  
  Increase the proportion 
  of local governments    
  with community-based    
  jail diversion programs 
  for adults with serious 
  mental illness (SMI).   

  **Comments**            An operational definition could not be
                          specified at the time of publication.

                          The proposed national data source is the
                          National Survey of Jail Mental Health Diversion
                          Programs, SAMHSA.

                          See Appendix A for focus area contact
                          information.
  ----------------------- -----------------------------------------------

-    

### State Activities

  ----------------------- -----------------------------------------------
  18-12. Increase the     
  number of States and    
  the District of         
  Columbia that track     
  consumers' satisfaction 
  with the mental health  
  services they receive.  

  **National Data         Mental Health Statistics Improvement Program
  Source**                (MHSIP), SAMHSA, CMHS.

  **State Data Source**   Mental Health Statistics Improvement Program
                          (MHSIP), SAMHSA, CMHS.

  **Healthy People 2000   Not applicable.
  Objective**             

  **Measure**             Number.

  **Baseline**            36 (1999).

  **Numerator**           Number of States and the District of Columbia
                          that report to MHSIP results of a consumer
                          satisfaction survey.

  **Denominator**         Not applicable.

  **Questions Used To     Not applicable.
  Obtain the National     
  Data**                  

  **Expected              Annual.
  Periodicity**           

  **Comments**            See Appendix A for focus area contact
                          information.
  ----------------------- -----------------------------------------------

  

+----------------------+---+-----------------------------------------------+
| 18-13.               |   |                                               |
| (Developmental)      |   |                                               |
| Increase the number  |   |                                               |
| of States,           |   |                                               |
| Territories, and the |   |                                               |
| District of Columbia |   |                                               |
| with an operational  |   |                                               |
| mental health plan   |   |                                               |
| that addresses       |   |                                               |
| cultural competence. |   |                                               |
+----------------------+---+-----------------------------------------------+
| **Comments**         | A |                                               |
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+----------------------+---+-----------------------------------------------+
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+----------------------+---+-----------------------------------------------+
|                      |  |                                               |
|                      |  |                                               |
|                      |  |                                               |
+----------------------+---+-----------------------------------------------+
| 18-14. Increase the  |   |                                               |
| number of States,    |   |                                               |
| Territories, and the |   |                                               |
| District of Columbia |   |                                               |
| with an operational  |   |                                               |
| mental health plan   |   |                                               |
| that addresses       |   |                                               |
| mental health crisis |   |                                               |
| interventions,       |   |                                               |
| ongoing screening,   |   |                                               |
| and treatment        |   |                                               |
| services for elderly |   |                                               |
| persons.             |   |                                               |
+----------------------+---+-----------------------------------------------+
| **National Data      |   | National Technical Assistance Center for      |
| Source**             |   | State Mental Health Systems, SAMHSA, CMHS.    |
+----------------------+---+-----------------------------------------------+
| **State Data         |   | National Technical Assistance Center for      |
| Source**             |   | State Mental Health Systems, SAMHSA, CMHS.    |
+----------------------+---+-----------------------------------------------+
| **Healthy People     |   | Not applicable.                               |
| 2000 Objective**     |   |                                               |
+----------------------+---+-----------------------------------------------+
| **Measure**          |   | Number.                                       |
+----------------------+---+-----------------------------------------------+
| **Baseline**         |   | 24 (1997).                                    |
+----------------------+---+-----------------------------------------------+
| **Numerator**        |   | Number of States and the District of Columbia |
|                      |   | that report an operational mental health plan |
|                      |   | that addresses mental health crisis           |
|                      |   | interventions, ongoing screening, and         |
|                      |   | treatment services for elderly persons.       |
+----------------------+---+-----------------------------------------------+
| **Denominator**      |   | Not applicable.                               |
+----------------------+---+-----------------------------------------------+
| **Questions Used To  |   | From the 1998 National Association of State   |
| Obtain the National  |   | Mental Health Program Directors' survey:      |
| Data**               |   |                                               |
+----------------------+---+-----------------------------------------------+
|                      |   | -   Does the Mental Health system operate a   |
|                      |   |     separate, specialized treatment           |
|                      |   |     unit/program for elderly clients?         |
+----------------------+---+-----------------------------------------------+
| **Expected           |   | Annual.                                       |
| Periodicity**        |   |                                               |
+----------------------+---+-----------------------------------------------+
| **Comments**         |   | Data for Territories are currently            |
|                      |   | unavailable.                                  |
+----------------------+---+-----------------------------------------------+
|                      |   | See Appendix A for focus area contact         |
|                      |   | information.                                  |
+----------------------+---+-----------------------------------------------+

  