# ![](media/image1.wmf){width="2.3986111111111112in" height="2.2930555555555556in"} {#section .Chapter-#}

# 18 {#section-1 .Chapter-#}

# Mental Health and Mental Disorders

Co-Lead Agencies: National Institutes of Health\
Substance Abuse and Mental Health Services\
Administration

## Summary of Objectives

### Mental Health and Mental Disorders {#mental-health-and-mental-disorders-1 .Heading-Special-Sub}

**Goal:** Improve mental health and ensure access to appropriate,\
quality mental health services.

+--------+-------------------------------------------------------------+
| **Nu   | **Objective Short Title**                                   |
| mber** |                                                             |
+--------+-------------------------------------------------------------+
| **     |                                                             |
| Mental |                                                             |
| Health |                                                             |
| Status |                                                             |
| I      |                                                             |
| mprove |                                                             |
| ment** |                                                             |
+--------+-------------------------------------------------------------+
| 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                                    |
+--------+-------------------------------------------------------------+
| **Tre  |                                                             |
| atment |                                                             |
| Expan  |                                                             |
| sion** |                                                             |
+--------+-------------------------------------------------------------+
| 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                  |
+--------+-------------------------------------------------------------+
| 18-10  | Treatment for co-occurring disorders                        |
+--------+-------------------------------------------------------------+
| 18-11  | Adult jail diversion programs                               |
+--------+-------------------------------------------------------------+
| #      |                                                             |
| ###### |                                                             |
| # Stat |                                                             |
| e Acti |                                                             |
| vities |                                                             |
+--------+-------------------------------------------------------------+
| 18-12  | State tracking of consumer satisfaction                     |
+--------+-------------------------------------------------------------+
| 18-13  | State plans addressing cultural competence                  |
+--------+-------------------------------------------------------------+
| 18-14  | State plans addressing elderly persons                      |
+--------+-------------------------------------------------------------+

## Healthy People 2010 Objectives

### Mental Health Status Improvement

18-1. Reduce the suicide rate.

**Target**: 5.0 suicides per 100,000 population.

**Baseline:** 11.3 suicides per 100,000 population occurred in 1998 (age
adjusted to the year 2000 standard population).

**Target setting method:** Better than the best.

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

Note: The table below may continue to the following page.

+------------------------------------------------+---------------------+
| **Total Population, 1998**                     | **Suicides**        |
+================================================+=====================+
|                                                | Rate per 100,000    |
+------------------------------------------------+---------------------+
| > **TOTAL**                                    | 11.3                |
+------------------------------------------------+---------------------+
| **Race and ethnicity**                         |                     |
+------------------------------------------------+---------------------+
| > American Indian or Alaska Native             | 12.6                |
+------------------------------------------------+---------------------+
| > Asian or Pacific Islander                    | 6.6                 |
+------------------------------------------------+---------------------+
| > Asian                                        | DNC                 |
+------------------------------------------------+---------------------+
| > Native Hawaiian and other Pacific Islander   | DNC                 |
+------------------------------------------------+---------------------+
| > Black or African American                    | 5.8                 |
+------------------------------------------------+---------------------+
| > White                                        | 12.2                |
+------------------------------------------------+---------------------+
|                                                |                     |
+------------------------------------------------+---------------------+
| > Hispanic or Latino                           | 6.3                 |
+------------------------------------------------+---------------------+
| > Not Hispanic or Latino                       | 11.8                |
+------------------------------------------------+---------------------+
| > Black or African American                    | 6.0                 |
+------------------------------------------------+---------------------+
| > White                                        | 12.8                |
+------------------------------------------------+---------------------+
| **Gender**                                     |                     |
+------------------------------------------------+---------------------+
| > Female                                       | 4.3                 |
+------------------------------------------------+---------------------+
| > Male                                         | 19.2                |
+------------------------------------------------+---------------------+
| **Education level** (aged 25 to 64 years)      |                     |
+------------------------------------------------+---------------------+
| > Less than high school                        | 17.9                |
+------------------------------------------------+---------------------+
| > High school graduate                         | 19.2                |
+------------------------------------------------+---------------------+
| > At least some college                        | 10.0                |
+------------------------------------------------+---------------------+
| ###### Age (not age adjusted)                  |                     |
+------------------------------------------------+---------------------+
| > 10 to 14 years                               | 1.6                 |
+------------------------------------------------+---------------------+
| > 15 to 19 years                               | 8.9                 |
+------------------------------------------------+---------------------+
| > 20 to 24 years                               | 13.6                |
+------------------------------------------------+---------------------+

DNA = Data have not been analyzed. DNC = Data are not collected. DSU =
Data are statistically unreliable.

Note: Age adjusted to the year 2000 standard population.

Note: The table above may have continued from the previous page.

18-2. Reduce the rate of suicide attempts by adolescents.

**Target:** 12-month average of 1 percent.

**Baseline:** 12-month average of 2.6 percent of adolescents in grades 9
through 12 attempted suicide in 1999.

**Target setting method:** Better than the best.

**Data source:** Youth Risk Behavior Surveillance System (YRBSS), CDC,
NCCDPHP.

Note: The table below may continue to the following page.

+------------------------------------------------+---------------------+
| **Students in Grades 9 Through 12, 1999**      | **Suicide           |
|                                                | Attempts**          |
+================================================+=====================+
|                                                | Percent             |
+------------------------------------------------+---------------------+
| > **TOTAL**                                    | 2.6                 |
+------------------------------------------------+---------------------+
| **Race and ethnicity**                         |                     |
+------------------------------------------------+---------------------+
| > American Indian or Alaska Native             | DSU                 |
+------------------------------------------------+---------------------+
| > Asian or Pacific Islander                    | DSU                 |
+------------------------------------------------+---------------------+
| > Asian                                        | DSU                 |
+------------------------------------------------+---------------------+
| > Native Hawaiian and other Pacific Islander   | DSU                 |
+------------------------------------------------+---------------------+
| > Black or African American                    | 3.1                 |
+------------------------------------------------+---------------------+
| > White                                        | 2.2                 |
+------------------------------------------------+---------------------+
|                                                |                     |
+------------------------------------------------+---------------------+
| > Hispanic or Latino                           | 3.0                 |
+------------------------------------------------+---------------------+
| > Not Hispanic or Latino                       | 2.6                 |
+------------------------------------------------+---------------------+
| > Black or African American                    | 2.9                 |
+------------------------------------------------+---------------------+
| > White                                        | 1.9                 |
+------------------------------------------------+---------------------+
| **Gender**                                     |                     |
+------------------------------------------------+---------------------+
| > Female                                       | 3.1                 |
+------------------------------------------------+---------------------+
| > Male                                         | 2.1                 |
+------------------------------------------------+---------------------+
| **Parents' education level**                   |                     |
+------------------------------------------------+---------------------+
| > Less than high school                        | DNC                 |
+------------------------------------------------+---------------------+
| > High school graduate                         | DNC                 |
+------------------------------------------------+---------------------+
| > At least some college                        | DNC                 |
+------------------------------------------------+---------------------+
| ###### Sexual orientation                      | DNC                 |
+------------------------------------------------+---------------------+

DNA = Data have not been analyzed. DNC = Data are not collected. DSU =
Data are statistically unreliable.

Note: The table above may have continued from the previous page.

18-3. Reduce the proportion of homeless adults who have\
serious mental illness (SMI).

**Target:** 19 percent.

**Baseline:** 25 percent of homeless adults aged 18 years and older had
SMI in 1996.

**Target setting method:** 24 percent improvement. (Better than the best
will be used when data are available.)

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

> **Data for population groups currently are not collected.**

18-4. Increase the proportion of persons with serious mental\
illness (SMI) who are employed.

**Target:** 51 percent.

**Baseline:** 43 percent of persons aged 18 years and older with SMI
were\
employed in 1994.

**Target setting method:** 19 percent improvement. (Better than the best
will be used when data are available.)

**Data source:** National Health Interview Survey (NHIS), CDC, NCHS.

> **Data for population groups currently are not analyzed.**

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

**Potential data source:** Prospective studies of patients with anorexia
or bulimia nervosa, NIH, NIMH.

### Treatment Expansion

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

**Potential data source:** Primary Care Data System/Federally Qualified
Health Centers, HRSA.

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

**Potential data source:** National Household Survey on Drug Abuse
(NHSDA), SAMHSA, OAS.

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

**Potential data source:** Inventory of Mental Health Services in
Juvenile Justice Facilities, SAMHSA

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

Target and baseline:

+------------+------------------------------+------------+------------+
| Objective  | Increase in Adults With      | 1997       | 2010\      |
|            | Mental\                      | Baseline\  | Target     |
|            | Disorders Receiving          | (unless    |            |
|            | Treatment                    | noted)     |            |
+------------+------------------------------+------------+------------+
|            |                              | #####      |            |
|            |                              | ## Percent |            |
+------------+------------------------------+------------+------------+
| **18-9a.** | Adults aged 18 to 54 years   | 47 (1991)  | 55         |
|            | with\                        |            |            |
|            | serious mental illness       |            |            |
+------------+------------------------------+------------+------------+
| **18-9b.** | Adults aged 18 years and     | 23         | 50         |
|            | older with recognized        |            |            |
|            | depression                   |            |            |
+------------+------------------------------+------------+------------+
| **18-9c.** | Adults aged 18 years and     | 60 (1984)  | 75         |
|            | older with schizophrenia     |            |            |
+------------+------------------------------+------------+------------+
| **18-9d.** | Adults aged 18 years and     | 38         | 50         |
|            | older with generalized       |            |            |
|            | anxiety disorder             |            |            |
+------------+------------------------------+------------+------------+

**Target setting method:** 17 percent improvement for 18-9a. (Better
than the best will be used when data are available.) Better than the
best for 18-9b, 18-9c, and 18-9d.

**Data sources**: Epidemiologic Catchment Area (ECA) Program, NIH,
NIMH;\
National Household Survey on Drug Abuse (NHSDA), SAMHSA, OAS; National
Comorbidity Survey, SAMHSA, CMHS; NIH, NIMH.

+----------------------------+-----------+---------+--------+--------+
| **Adults Aged 18 Years and | *         |         |        |        |
| Older With Mental          | *Received |         |        |        |
| Disorders, 1997 (unless    | Tr        |         |        |        |
| noted)**                   | eatment** |         |        |        |
+============================+===========+=========+========+========+
|                            | **18-9a.\ | **      | **1    | **1    |
|                            | Serious\  | 18-9b.\ | 8-9c.\ | 8-9d.\ |
|                            | Mental\   | Rec     | S      | Gener  |
|                            | Illness   | ognized | chizop | alized |
|                            | (aged 18  | Depre   | hrenia | A      |
|                            | to 54     | ssion** | (1     | nxiety |
|                            | years)    |         | 984)** | Diso   |
|                            | (1991)**  |         |        | rder** |
+----------------------------+-----------+---------+--------+--------+
|                            | Percent   |         |        |        |
+----------------------------+-----------+---------+--------+--------+
| > **TOTAL**                | 47        | 23      | 60     | 38     |
+----------------------------+-----------+---------+--------+--------+
| **Race and ethnicity**     |           |         |        |        |
+----------------------------+-----------+---------+--------+--------+
| > American Indian or       | DNA       | DSU     | DSU    | DSU    |
| > Alaska\                  |           |         |        |        |
| > Native                   |           |         |        |        |
+----------------------------+-----------+---------+--------+--------+
| > Asian or Pacific         | DNA       | DSU     | DSU    | DSU    |
| > Islander                 |           |         |        |        |
+----------------------------+-----------+---------+--------+--------+
| > Asian                    | DNA       | DNC     | DSU    | DNC    |
+----------------------------+-----------+---------+--------+--------+
| > Native Hawaiian and      | DNA       | DNC     | DSU    | DNC    |
| > other Pacific Islander   |           |         |        |        |
+----------------------------+-----------+---------+--------+--------+
| > Black or African         | DNA       | 16      | DNC    | 26     |
| > American                 |           |         |        |        |
+----------------------------+-----------+---------+--------+--------+
| > White                    | DNA       | 24      | DNC    | 39     |
+----------------------------+-----------+---------+--------+--------+
|                            |           |         |        |        |
+----------------------------+-----------+---------+--------+--------+
| > Hispanic or Latino       | DNA       | 20      | 42     | DSU    |
+----------------------------+-----------+---------+--------+--------+
| > Not Hispanic or Latino   | DNA       | DNC     | DNC    | 40     |
+----------------------------+-----------+---------+--------+--------+
| > Black or African         | DNA       | DNA     | 41     | DNA    |
| > American                 |           |         |        |        |
+----------------------------+-----------+---------+--------+--------+
| > White                    | DNA       | DNA     | 63     | DNA    |
+----------------------------+-----------+---------+--------+--------+
| **Gender**                 |           |         |        |        |
+----------------------------+-----------+---------+--------+--------+
| > Female                   | DNA       | 24      | 63     | 32     |
+----------------------------+-----------+---------+--------+--------+
| > Male                     | DNA       | 21      | 51     | 49     |
+----------------------------+-----------+---------+--------+--------+
| **Education level**        |           |         |        |        |
+----------------------------+-----------+---------+--------+--------+
| > Less than high school    | DNA       | 22      | 48     | 48     |
+----------------------------+-----------+---------+--------+--------+
| > High school graduate     | DNA       | 19      | 71     | 34     |
+----------------------------+-----------+---------+--------+--------+
| > At least some college    | DNA       | 28      | 66     | 32     |
+----------------------------+-----------+---------+--------+--------+
| ###### Sexual orientation  | DNC       | DNC     | DNC    | DNC    |
+----------------------------+-----------+---------+--------+--------+

DNA = Data have not been analyzed. DNC = Data are not collected. DSU =
Data are statistically unreliable.

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

**Potential data sources:** National Health Interview Survey (NHIS),
CDC, NCHS; National Household Survey on Drug Abuse (NHSDA), SAMHSA,
OAS;\
Replication of National Comorbidity Survey, NIH, NIMH.

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

**Potential data source:** National Survey of Jail Mental Health
Diversion\
Programs, SAMHSA.

### 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.

**Target:** 50 States and the District of Columbia.

**Baseline:** 36 States tracked consumers' satisfaction with the mental
health\
services they received in 1999.

**Target setting method:** Total coverage.

**Data source:** Mental Health Statistics Improvement Program, SAMHSA.

18-13. (Developmental) Increase the number of States, Territories, and
the District of Columbia with an operational mental health plan that
addresses cultural competence.

**Potential data source:** National Technical Assistance Center for
State Mental Health Systems, National Association of State Mental Health
Program Directors, National Research Institute; SAMHSA, CMHS.

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.

**Target:** 50 States and the District of Columbia.

**Baseline:** 24 States had an operational mental health plan that
addressed mental health crisis interventions, ongoing screening, and
treatment services for elderly persons in 1997.

**Target setting method:** Total coverage.

**Data source:** National Technical Assistance Center for State Mental
Health\
Systems, National Association of State Mental Health Program Directors,\
National Research Institute; SAMHSA, CMHS.

## Related Objectives From Other Focus Areas

1\. Access to Quality Health Services

1-1. Persons with health insurance

1-2. Health insurance coverage for clinical preventive services

1-3. Counseling about health behaviors

1-4. Source of ongoing care

1-5. Usual primary care provider

1-6. Difficulties or delays in obtaining needed health care

1-7. Core competencies in health provider training

1-8. Racial and ethnic representation in health professions

1-10. Delay or difficulty in getting emergency care

1-11. Rapid prehospital emergency care

1-12. Single toll-free number for poison control centers

1-13. Trauma care systems

1-14. Special needs of children

1-15. Long-term care services

2\. Arthritis, Osteoporosis, and Chronic Back Conditions

2-4. Help in coping

3\. Cancer

3-10. Provider counseling about cancer prevention

6\. Disability and Secondary Conditions

6-1. Standard definition of people with disabilities in data sets

6-2. Feelings and depression among children with disabilities

6-3. Feelings and depression interfering with activities among adults\
with disabilities

6-4. Social participation among adults with disabilities

6-5. Sufficient emotional support among adults with disabilities

6-6. Satisfaction with life among adults with disabilities

6-7. Congregate care of children and adults with disabilities

6-8. Employment parity

6-9. Inclusion of children and youth with disabilities in regular
education\
programs

6-10. Accessibility of health and wellness programs

6-11. Assistive devices and technology

6-12. Environmental barriers affecting participation in activities

6-13. Surveillance and health promotion programs

7\. Educational and Community-Based Programs

7-1. High school completion

7-2. School health education

7-3. Health-risk behavior information for college and university
students

7-4. School nurse-to-student ratio

7-5. Worksite health promotion programs

7-6. Participation in employer-sponsored health promotion activities

7-7. Patient and family education

7-9. Health care organization sponsorship of community health\
promotion activities

7-10. Community health promotion programs

7-11. Culturally appropriate and linguistically competent community
health\
promotion programs

7-12. Older adult participation in community health promotion activities

9\. Family Planning

9-1. Intended pregnancy

9-2. Birth spacing

9-3. Contraceptive use

9-4. Contraceptive failure

9-5. Emergency contraception

9-6. Male involvement in pregnancy prevention

9-7. Adolescent pregnancy

9-8. Abstinence before age 15 years

9-9. Abstinence among adolescents aged 15 to 17 years

9-10. Pregnancy prevention and sexually transmitted disease (STD)
protection

9-11. Pregnancy prevention education

9-13. Insurance coverage for contraceptive supplies and services

11\. Health Communication

11-1. Households with Internet access

11-2. Health literacy

11-3. Research and evaluation of communication programs

11-4. Quality of Internet health information sources

11-5. Centers for excellence

11-6. Satisfaction with health care providers' communication skills

13\. HIV

13-1. New AIDS cases

13-5. New HIV cases

13-13. Treatment according to guidelines

13-17. Perinatally acquired HIV infection

15\. Injury and Violence Prevention

15-10. Emergency department surveillance systems

15-11. Hospital discharge surveillance systems

15-12. Emergency department visits

15-33. Maltreatment and maltreatment fatalities of children

15-34. Physical assault by intimate partners

15-35. Rape or attempted rape

15-36. Sexual assault other than rape

15-37. Physical assaults

15-38. Physical fighting among adolescents

15-39. Weapon carrying by adolescents on school property

16\. Maternal, Infant, and Child Health

16-2. Child deaths

16-3. Adolescent and young adult deaths

16-4. Maternal deaths

16-5. Maternal illness and complications due to pregnancy

16-6. Prenatal care

16-14. Developmental disabilities

16-17. Prenatal substance exposure

16-18. Fetal alcohol syndrome

16-19. Breastfeeding

16-22. Medical homes for children with special health care needs

16-23. Service systems for children with special health care needs

20\. Occupational Safety and Health

20-5. Work-related homicides

20-6. Work-related assaults

20-7. Elevated blood lead levels from work exposure

20-9. Worksite stress reduction programs

23\. Public Health Infrastructure

23-1. Public health employee access to the Internet

23-2. Public access to information and surveillance data

23-3. Use of geocoding in health data systems

23-4. Data for all population groups

23-5. Data for Leading Health Indicators, Health Status Indicators, and
Priority Data Needs at Tribal, State, and local levels

23-6. National tracking of Healthy People 2010 objectives

23-7. Timely release of data on objectives

23-8. Competencies for public health workers

23-9. Training in essential public health services

23-10. Continuing education and training by public health agencies

23-11. Performance standards for essential public health services

23-12. Health improvement plans

23-13. Access to public health laboratory services

23-14. Access to epidemiology services

23-16. Data on public health expenditures

23-17. Population-based prevention research

25\. Sexually Transmitted Diseases

25-3. Primary and secondary syphilis

25-8. Heterosexually transmitted HIV infection in women

25-9. Congenital syphilis

25-10. Neonatal STDs

25-11. Responsible adolescent sexual behavior

25-12. Responsible sexual behavior messages on television

25-14. Screening in youth detention facilities and jails

25-15. Contracts to treat nonplan partners of STD patients

25-17. Screening of pregnant women

25-18. Compliance with recognized STD treatment standards

25-19. Provider referral services for sex partners

26\. Substance Abuse

26-7. Alcohol- and drug-related violence

26-8. Lost productivity

26-9. Substance-free youth

26-10. Adolescent and adult use of illicit substances

26-11. Binge drinking

26-12. Average annual alcohol consumption

26-13. Low-risk drinking among adults

26-14. Steroid use among adolescents

26-15. Inhalant use among adolescents

26-16. Peer disapproval of substance abuse

26-17. Perception of risk associated with substance abuse

26-18. Treatment gap for illicit drugs

26-22. Hospital emergency department referrals

26-23. Community partnerships and coalitions

## Terminology

(A listing of abbreviations and acronyms used in this publication
appears in Appendix H.)

**Anxiety disorders:** Anxiety disorders have multiple physical and
psychological symptoms, but all have in common feelings of apprehension,
tension, or uneasiness. Among the anxiety disorders are panic disorder,
agoraphobia, obsessive-compulsive disorder, posttraumatic stress
disorder, and generalized anxiety disorder.

**Case management:** Practice in which the service recipient is a
partner in his or her recovery and self-management of mental illness and
life.

**Co-occurring/comorbidity:** In general, the existence of two or more
illnesses---whether physical or mental---at the same time in a single
individual. In this chapter, comorbidity specifically means the
existence of a mental illness and a substance abuse disorder or a mental
and a physical illness in the same person at the same time.

**Consumer:** Any person using mental health services.

**Cultural competence:** In this chapter, a group of skills, attitudes,
and knowledge that allows persons, organizations, and systems to work
effectively with diverse racial, ethnic, and social groups.

**Depression**: A state of low mood that is described differently by
people who experience it. Commonly described are feelings of sadness,
despair, emptiness, or loss of interest or pleasure in nearly all
things. Depression also can be experienced in other disorders such as
bipolar disorder (manic-depressive disorder).

**Diagnosable mental illness:** Includes all people with a mental
illness in a specified population group, whether or not they have
received a formal diagnosis from a medical or mental health
professional.

**Homeless person:** A person who lacks housing. The definition also
includes a person living in transitional housing or a person who spends
most nights in a supervised public or private facility providing
temporary living quarters.

**Juvenile justice facility:** Includes detention centers, shelters,
reception or diagnostic centers, training schools, ranches, forestry
camps or farms, halfway houses and group homes, and residential
treatment centers for young offenders.

**Mental health services:** Diagnostic, treatment, and preventive care
that helps improve how persons with mental illness feel both physically
and emotionally as well as how they interact with other persons. These
services also help persons who have a strong risk of developing a mental
illness.

**Mental illness:** The term that refers collectively to all diagnosable
mental disorders. *Mental disorders* are health conditions characterized
by alterations in thinking, mood, or behavior (or some combination
thereof) that are all mediated by the brain and associated with distress
or impaired functioning or both. Mental disorders spawn a host of human
problems that may include personal distress, impaired functioning and
disability, pain, or death. These disorders can occur in men and women
of any age and in all racial and ethnic groups. They can be the result
of family history, genetics, or other biological, environmental, social,
or behavioral factors that occur alone or in combination.

**Parity, mental health parity:** Equivalent benefits and restrictions
in insurance coverage for mental health services and for other health
services.

**Resilience:** Manifested competence in the context of significant
challenges to adaptation or development.

**Schizophrenia:** A mental disorder lasting for at least 6 months,
including at least 1 month with two or more active-phase symptoms.
Active-phase symptoms include delusions, hallucinations, disorganized
speech, and grossly disorganized or catatonic behavior. Schizophrenia is
accompanied by marked impairment in social or occupational functioning.

**Screening for mental health problems:** A brief formal or informal
assessment to identify persons who have mental health problems or are
likely to develop such problems. The screening process helps determine
whether a person has a problem and, if so, the most appropriate mental
health services for that person.

**Serious emotional disturbance (SED):** A diagnosable mental disorder
found in persons from birth to age 18 years that is so severe and long
lasting that it seriously interferes with functioning in family, school,
community, or other major life activities.

**Serious mental illness (SMI):** A diagnosable mental disorder found in
persons aged 18 years and older that is so long lasting and severe that
it seriously interferes with a person's ability to take part in major
life activities.