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Mental Health Client-Level Data (MH-CLD) 2021: Data on Clients Receiving Mental Health Treatment 

Services Through State Mental Health Agencies 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Acknowledgments 

Mental Health Client-Level Data (MH-CLD) 2021: Data on Clients Receiving Mental Health Treatment Services 

Through State Mental Health Agencies was prepared for the Substance Abuse and Mental Health Services 

Administration (SAMHSA) under Contract No. 75S20320C00001 with SAMHSA, U.S. Department of Health and 

Human Services (HHS). Heydy Juarez served as the Contracting Officer’s Representative. 

Disclaimer 

The views, opinions, and content of this publication are those of the author and do not necessarily reflect the views, 

opinions, or policies of SAMHSA. Nothing in this document constitutes a direct or indirect endorsement by 

SAMHSA or HHS of any non-federal entity’s products, services, or policies. 

Public Domain Notice 

All material appearing in this publication is in the public domain and may be reproduced or copied without 

permission from SAMHSA. Citation of the source is appreciated. However, this publication may not be reproduced 

or distributed for a fee without the specific, written authorization of the Office of Communications, SAMHSA, 

HHS. 

Electronic Access and Printed Copies 

Products may be downloaded or ordered at https://store.samhsa.gov or by calling SAMHSA at 1-877-SAMHSA-7 

(1-877-726-4727). 

Recommended Citation 

Substance Abuse and Mental Health Services Administration: Mental Health Client-Level Data (MH-CLD) 2021: 

Data on Clients Receiving Mental Health Treatment Services Through State Mental Health Agencies. Publication

No. PEP23-07-00-003 MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental 

Health Services Administration, 2023. 

Originating Office 

Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration, 

5600 Fishers Lane, Rockville, Maryland 20857, SAMHSA Publication Number PEP23-07-00-003. Released 2023 

Nondiscrimination Notice 

The Substance Abuse and Mental Health Services Administration (SAMHSA) complies with applicable federal civil 

rights laws and does not discriminate on the basis of race, color, national origin, age, disability, religion, or sex 

(including pregnancy, sexual orientation, and gender identity). SAMHSA does not exclude people or treat them 

differently because of race, color, national origin, age, disability, religion, or sex (including pregnancy, sexual 

orientation, and gender identity). 

Publication Number PEP23-07-00-003 

Released 2023 

U.S. Department of Health and Human Services 

Substance Abuse and Mental Health Services Administration 

Center for Behavioral Health Statistics and Quality 

Office of Treatment Services 

Publication Number PEP23-07-00-003 

Mental Health Client Level Data (MH-CLD) Annual Report 2021 | ii 
 

 

 

Table of Contents 

Executive Summary ...................................................................................................................................1 

Section 1. Introduction ..............................................................................................................................3 

MH-CLD Overview.............................................................................................................................................. 3 

MH-CLD Background.......................................................................................................................................... 3 

Section 2. Methodology and Data .............................................................................................................4 

Data Presented in the 2021 MH-CLD Annual Report.......................................................................................... 4 

Reporting Exclusions and Periods........................................................................................................................ 4 

Data Notes ............................................................................................................................................................ 4 

Section 3. Characteristics of Clients Receiving Mental Health Treatment Services............................5 

Section 4. National Outcome Measures Among Clients Receiving Mental Health Treatment 

Section 5. Mental Health Diagnoses Among Clients Receiving Mental Health Treatment 

Services .....................................................................................................................................................10 

Services .....................................................................................................................................................12 

Section 6. Limitations ..............................................................................................................................22 

Endnotes ...................................................................................................................................................23 

Appendix A. Definitions ........................................................................................................................A.1 

Appendix B. Data Tables Corresponding to Figures Included in the Report ..................................B.1 

Appendix C. Mental Health Client-Level Data (MH-CLD) Detailed Overview ..............................C.1 

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List of Figures 

Figure 3.1.1: Percentages and Rates of Clients Receiving Mental Health Treatment Services by 

Age Group, 2021............................................................................................................................ 6 

Figure 3.2.1: Percentages and Rates of Clients Receiving Mental Health Treatment Services by 

Sex, 2021 ........................................................................................................................................ 6 

Figure 3.3.1: Percentages of Clients Receiving Mental Health Treatment Services by Race, 2021 ............. 7 

Figure 3.3.2: Rates of Clients Receiving Mental Health Treatment Services by Race, 2021 ........................ 7 

Figure 3.4.1: Percentages and Rates of Clients Receiving Mental Health Treatment Services by 

Ethnicity, 2021............................................................................................................................... 8 

Figure 3.5.1: Percentages of Clients Receiving Mental Health Treatment Services by SMI/SED, 

2021 ................................................................................................................................................ 8 

Figure 3.6.1: Percentages of Clients Receiving Mental Health Treatment Services by Education, 

2021 ................................................................................................................................................ 9 

Figure 4.1.1: Percentages of Clients Receiving Mental Health Treatment Services by 

Residential Status, 2021.............................................................................................................. 10 

Figure 4.2.1: Percentages of Clients Receiving Mental Health Treatment Services by 

Employment Status, Age 18 and Older, 2021 ........................................................................... 11 

Figure 4.3.1: Percentages of Clients Receiving Mental Health Treatment Services by Service 

Setting, 2021................................................................................................................................. 11 

Figure 5.1.1: Percentages Distribution of Top 5 Mental Health Diagnoses Among All Clients, 

2021 .............................................................................................................................................. 13 

Figure 5.1.2: Percentages Distribution of Top 5 Mental Health Diagnoses Among Children, 

2021 .............................................................................................................................................. 14 

Figure 5.1.3: Percentages Distribution of Top 5 Mental Health Diagnoses Among Adults, 2021 .............. 14 

Figure 5.2.1: Counts and Rates of Clients with Mental Health Diagnoses Receiving Mental 

Health Treatment Services by State, 2021 ................................................................................ 15 

Figure 5.3.1: Counts and Rates of Children with Trauma and Stressor-Related Disorders 

Diagnoses Receiving Mental Health Treatment Services by State, 2021................................ 16 

Figure 5.3.2: Counts and Rates of Children with Attention-Deficit/Hyperactivity Disorders 

Diagnoses Receiving Mental Health Treatment Services by State, 2021................................ 16 

Figure 5.3.3: Counts and Rates of Children with Anxiety Disorders Diagnoses Receiving 

Mental Health Treatment Services by State, 2021 ................................................................... 17 

Figure 5.3.4: Counts and Rates of Children with Depressive Disorders Diagnoses Receiving 

Mental Health Treatment Services by State, 2021 ................................................................... 17 

Figure 5.3.5: Counts and Rates of Children with Other Mental Health Disorder Diagnoses 

Receiving Mental Health Treatment Services by State, 2021.................................................. 18 

Figure 5.4.1: Counts and Rates of Adults with Depressive Disorder Diagnoses Receiving Mental 

Health Treatment Services by State, 2021 ................................................................................ 19 

Figure 5.4.2: Counts and Rates of Adults with Anxiety Disorder Diagnoses Receiving Mental 

Health Treatment Services by State, 2021 ................................................................................ 19 

Figure 5.4.3: Counts and Rates of Adults with Trauma and Stressor-Related Disorders 

Diagnoses Receiving Mental Health Treatment Services by State, 2021................................ 20 

Figure 5.4.4: Counts and Rates of Adults with Schizophrenia and Other Psychotic Disorders 

Diagnoses Receiving Mental Health Treatment Services by State, 2021................................ 20 

Figure 5.4.5: Counts and Rates of Adults with Bipolar Disorders Diagnoses Receiving Mental 

Health Treatment Services by State, 2021 ................................................................................ 21 

Mental Health Client Level Data (MH-CLD) Annual Report 2021 | iv 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

List of Tables 

Table B-1. Characteristics of Clients Receiving Mental Health Treatment Services, by Age 

Group, 2021 (Section 3) ............................................................................................................ B.1 

Table B-2. National Outcome Measures Among Clients Receiving Mental Health Treatment 

Services, by Age Group, 2021 (Section 4)................................................................................ B.3 

Table B-3. Mental Health Diagnoses Among Clients Receiving Mental Health Treatment 

Services, by Age Group, 2021 (Section 5)................................................................................ B.4 

Table B-4. Characteristics of Clients Receiving Mental Health Treatment Services by State 

and Age Group, 2021 (Section 5) ............................................................................................. B.5 

Table B-5. 

Table B-6. 

Top 5 Mental Health Diagnoses Counts Among Children by State, 2021 (Section 5).........B.7

Top 5 Mental Health Diagnoses Percentages Among Children by State, 2021

(Section 5) .................................................................................................................................. B.9 

Table B-7. Top 5 Mental Health Diagnoses Rates per 100,000 Population Among Children by 

State, 2021 (Section 5)............................................................................................................. B.11 

Table B-8. Top 5 Mental Health Diagnoses Counts Among Adults by State, 2021 (Section 5)........... B.13 

Table B-9. Top 5 Mental Health Diagnoses Percentages Among Adults, by State, 2021 

(Section 5) ................................................................................................................................ B.15 

Table B-10. Top 5 Mental Health Diagnoses Rates per 100,000 Population Among Adults by 

State, 2021 (Section 5)............................................................................................................. B.17 

Table B-11. Overall Missing Counts and Percentages by Key Characteristics, 2021............................ B.19 

Table C-1. State and Territory Reporting Methods and Periods, 2021 .................................................. C.3 

Table C-2. Mental Health Diagnosis Groups and International Classification of Diseases 

(ICD) Codes Crosswalk ............................................................................................................ C.5 

Mental Health Client Level Data (MH-CLD) Annual Report 2021 | v 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Executive Summary 

Mental Health Client-Level Data (MH-CLD) are currently collected for and reported by the Substance Abuse and 

Mental Health Services Administration’s (SAMHSA) Center for Behavioral Health Statistics and Quality (CBHSQ) 

in collaboration with state mental health agencies (SMHAs). MH-CLD provides demographic, clinical, and National 

Outcome Measures (NOMs) data on clients receiving publicly funded mental health treatment services to behavioral 

health service providers; researchers; the public; and federal, state, and local governments. The NOMs presented in 

this report include stability in housing/residential status, adult employment, and access to services/capacity. 

Characteristics of Clients Receiving Mental Health Treatment Services in 2021 

• In the 2021 reporting period (henceforward referred to as “2021”)

1

, a total of 6,509,025 clients received mental 

health treatment services provided or funded by SMHAs. The data were provided by 46 states, the District of 

Columbia, and 3 territories (Puerto Rico, the Commonwealth of Northern Mariana Islands, and the Republic of 

Palau). Four states (Florida, Maine, Ohio, and South Dakota) and five territories (American Samoa, Federated 

States of Micronesia, Guam, Marshall Islands, and the U.S. Virgin Islands) did not submit data for 2021 and are 

therefore excluded from this report.2 

• Among clients receiving mental health treatment services in 2021, 27.0% (N = 1,752,884) were children (age 0 

to 17) and 73.0% (N = 4,749,485) were adults (age 18 and older). The rate per 100,000 population of clients in 

2021 by age group was 2,626 per 100,000 for children and 2,042 per 100,000 for adults. 

• Among children receiving mental health treatment services in 2021, 53.5% (N = 936,379) were males and 

46.5% (N = 815,090) were females. Among adults receiving mental health treatment services in 2021, 55.2% 

(N = 2,615,391) were females and 44.8% (N = 2,126,432) were males. The rate per 100,000 population of 

children by sex was 2,742 for males and 2,500 for females. The rate per 100,000 population of adults by sex 

was 1,863 for males and 2,208 for females. 

• Among children receiving mental health treatment services in 2021, the top two race groups were White 

(59.8%, N = 892,182) and Black or African American (18.2%, N = 271,702). The race groups with the two 

highest rates per 100,000 population receiving mental health treatment services were American Indian or 

Alaska Native (5,341 per 100,000; N = 35,844) and Native Hawaiian or Other Pacific Islander (4,648 per 

100,000; N = 6,157). 

• Among adults receiving mental health treatment services in 2021, the top two race groups were White (66.1%, 

N = 2,825,902) and Black or African American (20.4%, N = 870,932). The race groups with the two highest 

rates per 100,000 population receiving mental health treatment services were American Indian or Alaska Native 

(4,124 per 100,000; N = 96,160) and Black or African American (3,144 per 100,000; N = 870,932). 

• Among children receiving mental health treatment services in 2021, 75.0% (N = 1,256,378) had a serious 

emotional disturbance (SED) diagnosis. Among adults receiving mental health treatment services in 2021, 

75.5% (N = 3,393,217) had a serious mental illness (SMI) diagnosis. 

• Among children receiving mental health treatment services in 2021, 75.2% (N = 527,426) were in Grade 8 or 

lower. Among adults receiving mental health treatment services in 2021, 47.2% (N = 1,086,156) had graduated 

from high school or had a general equivalency diploma (GED). 

National Outcome Measures Among Clients Receiving Treatment in 2021 

• Among children receiving mental health treatment services in 2021, 92.6% (N = 883,227) lived in a private 

residence and 0.4% (N = 3,543) were experiencing homelessness. Among adults receiving mental health 

treatment services in 2021, 83.5% (N = 2,431,293) lived in a private residence and 5.5% (N = 160,945) were 

experiencing homelessness. 

• Among adults receiving mental health treatment services in 2021, 44.3% (N = 1,014,269) were not participating 

in the labor force, 29.7% (N = 679,974) were unemployed, and 25.9% (N = 593,677) were employed. 

• Among children receiving mental health treatment services in 2021, 99.4% (N = 1,741,638) received treatment 

at community-based programs. Among adults receiving mental health treatment services in 2021, 97.1% 

(N = 4,610,662) received treatment at community-based programs. 

Mental Health Diagnoses Among Clients Receiving Treatment in 2021 

• Among all clients receiving mental health treatment services in 2021 with at least one mental health diagnosis, 

the most common diagnosis was depressive disorders (31.6%, N = 1,790,346) followed by anxiety disorders 

(26.6%, N = 1,507,425). The rates per 100,000 population were 598 per 100,000 for depressive disorders and 

504 per 100,000 for anxiety disorders. 

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• Among children receiving mental health treatment services in 2021 with at least one mental health diagnosis, 

the most common diagnosis was trauma and stressor-related disorders (31.4%, N = 479,622) followed by 

attention-deficit hyperactivity disorders (29.1%, N = 444,432). The rates per 100,000 population by mental 

health diagnosis for children were 719 per 100,000 for trauma and stress-related disorders and 666 per 100,000 

for attention-deficit/hyperactivity disorders. 

• Among adults receiving mental health treatment services in 2021 with at least one mental health diagnosis, the 

most common diagnosis was depressive disorders (36.1%, N = 1,490,752) followed by anxiety disorders 

(28.3%, N = 1,169,209). The rates per 100,000 population by mental health diagnosis for adults were 641 per 

100,000 for depressive disorders and 503 per 100,000 for anxiety disorders. 

• In 2021, 10 states (California, Pennsylvania, Arizona, New Jersey, Texas, Minnesota, Michigan, Washington, 

Maryland, and Iowa) accounted for 58.2% (N = 3,290,165) of clients with mental health diagnoses receiving 

mental health treatment services in the United States. 

• The states of Vermont, New Mexico, Iowa, Minnesota, Montana, Oregon, Arizona, New Hampshire, 

Pennsylvania, and Maryland had higher rates per 100,000 population (between 1,450 and 3,950) of children 

with trauma and stressor-related disorders receiving mental health treatment services. 

• The District of Columbia, and the states of Iowa, Minnesota, Montana, New Mexico, Arizona, Rhode Island, 

Washington, Pennsylvania, and Maryland had higher rates per 100,000 population (between 1,100 and 2,800) of 

adults with depressive disorders receiving mental health treatment services. 

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Section 1. Introduction 

MH-CLD Overview 

Mental Health Client-Level Data (MH-CLD) are currently collected for and reported by the Substance Abuse and 

Mental Health Services Administration’s (SAMHSA) Center for Behavioral Health Statistics and Quality (CBHSQ). 

State mental health agencies (SMHAs) are state entities with the primary responsibility for reporting data in 

accordance with the reporting terms and conditions of the Behavioral Health Services Information System (BHSIS) 

Agreements funded by SAMHSA. The BHSIS Agreement stipulates that SMHAs submit data in compliance with 

the Community Mental Health Services Block Grant (MHBG) reporting requirements.

3 SAMHSA’s MHBG 

program funds a total of 59 SMHAs in all 50 states, the District of Columbia, and 8 territories.4 

MH-CLD provides demographic, clinical, and National Outcome Measures (NOMs) data on clients receiving 

publicly funded mental health treatment services to behavioral health service providers; researchers; the public; and 

federal, state, and local governments. The NOMs presented in this report include stability in housing/residential 

status, adult employment, and access to services/capacity. For the purposes of this report, hereafter mentions of 

NOMs refer to the NOMs data presented in this report only. 

SAMHSA uses the MH-CLD data to enhance the understanding of publicly funded mental health treatment service 

systems. The data are used to inform decisions about SAMHSA’s use of its mental health block grant funds; and to 

better understand the technical assistance and support needs of mental health providers and the communities they 

serve. 

MH-CLD Background 

The current MH-CLD system was developed by SAMHSA in collaboration with the MHBG recipients over the 

period of 2008 through 2010 and was launched in 2011. SAMHSA’s CBHSQ is responsible for collecting, 

analyzing, and reporting MH-CLD along with providing technical assistance to states. For more details on MH-CLD 

background and context, please see Appendix C. 

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Section 2. Methodology and Data 

Data Presented in the 2021 MH-CLD Annual Report 

This report presents aggregated data on 6,509,025 clients receiving mental health treatment services provided for the 

2021 reporting period. The data presented are organized as follows: 

• Key characteristics of clients receiving mental health treatment services (Section 3); 

• NOMs of clients receiving mental health treatment services (Section 4); and 

• The top 5 mental health diagnoses among clients receiving mental health treatment services and their 

accompanying geographic distribution (Section 5). 

Appendices include key definitions, tables corresponding to the visualizations presented in each of the sections 

mentioned above, and additional MH-CLD background and context. 

Reporting Exclusions and Periods 

The data presented in this report includes clients served through a 12-month reporting period as defined by each 

SMHA. 

• Reporting Periods: Thirty-seven states and Puerto Rico used the 2021 state fiscal year period (7/1/2020 to 

6/30/2021) as their reporting frame for MH-CLD in 2021. Other states and territories used different starting 

months (e.g., October) and/or lagged fiscal years; see Appendix C (Table C-1). 

• Exclusions: Four states (Florida, Maine, Ohio, and South Dakota) and five territories (American Samoa, 

Federated States of Micronesia, Guam, Marshall Islands, and the U.S. Virgin Islands) did not submit data 

for the 2021 reporting period and are therefore excluded from this report. 

Data Notes 

Data on key client characteristics (Section 3) are visualized as percentages of MH-CLD clients and rates per 100,000 

population. Data on NOMs (Section 4) are visualized as percentages of MH-CLD clients. For MH-CLD clients with 

at least one mental health diagnosis, data are visualized as percentages of MH-CLD clients and rates per 100,000 

population (Section 5). Wherever feasible, the narratives describing the key findings from the visualizations include 

counts of clients for reference. The data on geographic distribution for clients with mental health diagnoses are 

presented as counts and rates per 100,000. Definitions and specific values of key characteristics, such as race, 

ethnicity, and others are presented in Appendix A. 

The 2021 data for calculating rates per 100,000 population were drawn from the U.S. and Puerto Rico Census 

Population Estimates5,6

, American Communities Survey7 (ACS), and the Department of Housing and Urban 

Development

8 (HUD). These data were adjusted to (1) exclude populations for states not included in this report and 

(2) calculate subgroup population counts by applying Census subpopulation distribution ratios to observed totals. 

Rates per 100,000 were calculated using the corresponding population denominators. For example, rates for 

employed persons receiving mental health treatment services are per 100,000 employed persons estimated (via U.S. 

and Puerto Rico age distributions) to be ages 18 and older in states participating in MH-CLD. Likewise, U.S. Census 

population estimate ratios were applied to other ACS data to obtain the estimated population counts of, e.g., races or 

3 to 17-year-old school attendees across participating MH-CLD states including Puerto Rico. 

The data presented in Sections 3, 4, and 5 of this report were calculated after excluding the missing values (i.e., 

values that are missing, unknown, or not collected/applicable). For example, clients for whom employment status 

was not applicable (i.e., under 16 years of age) were excluded from the denominator when calculating percentages. 

Data tables corresponding to charts and/or maps presented in the report, including the missing value counts and 

percentages, are included in Appendix B. 

Finally, since MH-CLD only captures data on clients served through SMHAs using state-defined reporting periods, 

these data neither represent the total national demand for mental health treatment nor describe the mental health 

status of the national population. 

Mental Health Client-Level Data (MH-CLD) Annual Report 2021 | 4 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Section 3. Characteristics of Clients Receiving Mental Health Treatment Services 

This section presents data on key characteristics of clients receiving mental health treatment services through 

SMHAs during the 2021 reporting period. Wherever feasible, the data are visualized as percentages and rates per 

100,000 population, and narratives describing key findings from the graphs include client counts for reference. For 

definitions of key characteristics presented, please refer to Appendix A. For detailed data on counts, percentages, 

and rates corresponding to this section, including missing value counts and percentages, please refer to Appendix B. 

Key Takeaways 

• Among clients receiving mental health treatment services in 2021, 27.0% (N = 1,752,884) were children (age

0 to 17) and 73.0% (N = 4,749,485) were adults (age 18 and older). The rate per 100,000 population of

clients in 2021 by age group was 2,626 per 100,000 for children and 2,042 per 100,000 for adults.

• Among children receiving mental health treatment services in 2021, 53.5% (N = 936,379) were males and

46.5% (N = 815,090) were females. Among adults receiving mental health treatment services in 2021, 44.8%

(N = 2,126,432) were males and 55.2% (N = 2,615,391) were females. The rate per 100,000 population of

children by sex was 2,742 per 100,000 for males and 2,500 per 100,000 for females. The rate per 100,000

population of adults by sex was 1,863 per 100,000 for males and 2,208 per 100,000 for females.

• Among children receiving mental health treatment services in 2021, the top two race groups were White

(59.8%, N = 892,182) and Black or African American (18.2%, N = 271,702). The race groups with the two

highest rates per 100,000 population receiving mental health treatment services were American Indian or

Alaska Native (5,341 per 100,000; N = 35,844) and Native Hawaiian or Other Pacific Islander (4,648 per

100,000; N = 6,157).

• Among adults receiving mental health treatment services in 2021, the top two race groups were White

(66.1%, N = 2,825,902) and Black or African American (20.4%, N = 870,932). The race groups with the two

highest rates per 100,000 population receiving mental health treatment services were American Indian or

Alaska Native (4,124 per 100,000; N = 96,160) and Black or African American (3,144 per 100,000;

N = 870,932).

• Among children receiving mental health treatment services in 2021, 75.0% (N = 1,256,378) had a serious

emotional disturbance (SED). Among adults receiving mental health treatment services in 2021, 75.5%

(N = 3,393,217) had a serious mental illness (SMI).

• Among children receiving mental health treatment services in 2021, 75.2% (N = 527,426) were in Grade 8 or

lower. Among adults receiving mental health treatment services in 2021, 47.2% (N = 1,086,156) had

graduated from high school or had a general equivalency diploma (GED).

Mental Health Client-Level Data (MH-CLD) Annual Report 2021 | 5 
 

 

 

3.2 Clients Receiving Mental Health Treatment Services by Sex, 2021 MH-CLD 

Figure 3.2.1: Percentages and Rates of Clients Receiving Mental Health Treatment Services by Sex, 2021 

Percentages (%) Rates per 100,000 Population 

100 6,000 

80 4,800 

53.5% 55.2% 60 3,600 

46.5% 44.8% 2,742 2,500 2,208 40 2,400 1,863 

20 1,200 

0 0 

Children Adults Children Adults 

■ Male ■ Female 

 

 

Figure 3.1.1: Percentages and Rates of Clients Receiving Mental Health Treatment Services by Age Group, 

2021 

Percentages (%) Rates per 100,000 Population 

100 6,000 

73.0% 

80 4,800 

60 3,600 

2,626 

2,042 40 2,400 

27.0% 

20 1,200 

0 0 

■ Children (ages 0-17) ■ Adults (ages 18 and older) 

 

 

 

 

 

 

 

 

 

 

 

3.1 Clients Receiving Mental Health Treatment Services by Age Group, 2021 MH-CLD 

Among clients receiving mental health treatment 

services in 2021, 27.0% (N = 1,752,884) were children 

(age 0 to 17) and 73.0% (N = 4,749,485) were adults 

(age 18 and older). 

The rate per 100,000 population5,6,9 of clients receiving 

mental health treatment services in 2021 by age group 

was 2,626 for children (N = 1,752,884) and 2,042 for 

adults (N = 4,749,485). 

Among children receiving mental health treatment 

services in 2021, 53.5% (N = 936,379) were males 

and 46.5% (N = 815,090) were females. Among 

adults, 44.8% (N = 2,126,432) were males and 55.2% 

(N = 2,615,391) were females. 

The rate per 100,000 population5,6,9 of children 

receiving mental health treatment services in 2021 

by sex was 2,742 for males (N = 936,379) and 

2,500 for females (N = 815,090). The rate per 

100,000 population of adults in 2021 by sex was 

1,863 for males (N =2,126,432) and 2,208 for 

females (N = 2,615,391). 

Mental Health Client-Level Data (MH-CLD) Annual Report 2021 | 6 
 

 

 

Figure 3.3.2: Rates of Clients Receiving Mental Health Treatment Services by Race, 2021 

Rates per 100,000 Population 

Children Adults 

■ American Indian or Alaska Native ■ Native Hawaiian or Other Pacific Islander ■ Black or African American 

■ White ■ Other Race ■ Asian 

5,341 

4,124 

4,648 

2,939 

3,412 3,144 

2,212 

2,014 

1,950 

833 

496 526 

0 

1,200 

2,400 

3,600 

4,800 

6,000 

 

 

Figure 3.3.1: Percentages of Clients Receiving Mental Health Treatment Services by Race, 2021 

Percentages (%) 

100 

80 

66.1% 

59.8% 

60 

40 

20.4% 18.2% 17.8% 

20 

9.3% 

2.4% 1.4% 0.4% 2.2% 1.7% 0.3% 

0 

Children Adults 

■ White ■ Black or African American ■ Other Race 

■ American Indian or Alaska Native ■ Asian ■ Native Hawaiian or Other Pacific Islander 

 

 

 

 

 

 

 

 

 

 

 

 

 

3.3 Clients Receiving Mental Health Treatment Services by Race, 2021 MH-CLD 

Among children receiving mental health treatment services in 2021, 59.8% (N = 892,182) were White, 18.2% 

(N = 271,702) were Black or African American, 17.8% (N = 264,661) were Other race,10 2.4% (N = 35,844) were 

American Indian or Alaska Native, 1.4% (N = 20,234) were Asian, and 0.4% (N = 6,157) were Native Hawaiian 

or Other Pacific Islander. Among adults receiving mental health treatment services (N = 4,278,016), 66.1% 

(N = 2,825,902) were White, 20.4% (N = 870,932) were Black or African American, 9.3% (N = 397,005) were 

Other race,

10 2.2% (N = 96,160) were American Indian or Alaska Native, 1.7% (N = 74,499) were Asian, and 

0.3% (N = 13,518) were Native Hawaiian or Other Pacific Islander. 

The rate per 100,000 population5,6,7,9 of children receiving mental health treatment services by race in 2021 was 

5,341 (N = 35,844) for American Indian or Alaska Native, 4,648 (N = 6,157) for Native Hawaiian or Other 

Pacific Islander, 3,412 (N = 271,702) for Black or African American, 2,212 (N=892,182) for White, 1,950 

(N = 264,661) for Other race,

10 and 496 (N = 20,234) for Asian. The rate per 100,000 population of adults 

receiving mental health treatment services in 2021 by race was 4,124 (N = 96,160) for American Indian or Alaska 

Native, 2,939 (N = 13,518) for Native Hawaiian or Other Pacific Islander, 3,144 (N = 870,932) for Black/African 

American, 2,014 (N = 2,825,902) for White, 833 (N = 397,005) for Other race10, and 526 (N = 74,499) for Asian. 

Mental Health Client-Level Data (MH-CLD) Annual Report 2021 | 7 
 

 

Figure 3.5.1: Percentages of Clients Receiving Mental Health Treatment Services by SMI/SED, 2021 

Percentages (%) 

100 

75.0% 75.5% 

80 

0 

20 

40 

60 

■ Children with SED ■ Adults with SMI 

 

 

Figure 3.4.1: Percentages and Rates of Clients Receiving Mental Health Treatment Services by Ethnicity, 

2021 

Percentages (%) Rates per 100,000 Population 

100 6,000 

80.9% 69.9% 80 4,800 

60 

30.1% 40 

19.1% 

20 

0 

Children Adults 

3,385 3,600 

1,917 1,798 2,400 1,710 

1,200 

0 

Children Adults 

■ Hispanic or Latino ■ Not Hispanic or Latino 

 

 

 

3.4 Clients Receiving Mental Health Treatment Services by Ethnicity, 2021 MH-CLD 

Among children receiving mental health treatment 

services in 2021, 30.1% (N = 443,159) were Hispanic 

or Latino and 69.9% (N = 1,028,725) were Not 

Hispanic or Latino. Among adults, 19.1% (N= 791,552) 

were Hispanic or Latino and 80.9% (N = 3,349,697) 

were Not Hispanic or Latino. 

The rate per 100,000 population5,6,7,9 of children in 

2021 by ethnicity was 3,385 for Hispanic or Latino 

(N = 443,159) and 1,917 for Not Hispanic or Latino 

(N = 1,028,725). The rate per 100,000 population of 

adults in 2021 by ethnicity was 1,710 for Hispanic or 

Latino (N = 791,552) and 1,798 for Not Hispanic or 

Latino (N = 3,349,697). 

3.5 Clients Receiving Mental Health Treatment Services by SMI/SED, 2021 MH-CLD 

Among children receiving mental health treatment services in 2021, 75.0% (N = 1,256,378) had a serious 

emotional disturbance (SED). Among adults receiving mental health treatment services in 2021, 75.5% 

(N = 3,393,217) had a serious mental illness (SMI). 

Mental Health Client-Level Data (MH-CLD) Annual Report 2021 | 8 
 

 

 

Figure 3.6.1: Percentages of Clients Receiving Mental Health Treatment Services by Education, 2021 

Percentages (%) 

100 

75.2% 80 

Children Adults 

8.9% 

21.9% 17.5% 

2.2% 

47.2% 

0.1% 

25.1% 

0.5% 1.3% 

0 

20 

40 

60 

■ Grades 8 or less ■ Grades 9-11 ■ HS or GED ■ More than HS ■ Special Education 

 

 

 

 

 

 

 

3.6 Clients Receiving Mental Health Treatment Services by Education, 2021 MH-CLD 

Among children receiving mental health treatment services in 2021, 75.2% (N = 527,426) were in Grade 8 or less, 

21.9% (N = 153,319) were in Grades 9-11, 2.2% (N = 15,527) graduated High School (HS) or had a general 

equivalency diploma (GED), 0.1% (N = 1,007) had more than High School education, and 0.5% (N = 3,637) were 

in Special Education. Among adults receiving mental health treatment services in 2021, 8.9% (N = 205,229) 

completed Grade 8 or lower, 17.5% (N = 402,183) completed Grades 9-11, 47.2% (N = 1,086,156) graduated High 

School or had a GED, 25.1% (N = 577,786) had more than High School education, and 1.3% (N = 30,941) were in 

Special Education. 

Mental Health Client-Level Data (MH-CLD) Annual Report 2021 | 9 
 

 

Figure 4.1.1: Percentages of Clients Receiving Mental Health Treatment Services by Residential Status, 2021 

Percentages (%) Percentages (%) 

92.6% 100 100 

83.5% 

80 80 

60 60 

40 40 

20 20 

3.9% 1.3% 1.1% 

0 0 

Children Adults 

2.7% 4.0% 5.5% 1.8% 1.9%

■ Private Residence ■ Foster Home/Care ■ Other ■ Residential Care

■ Experiencing Homelessness ■ Jail/Correctional Facility ■ Institutional Setting

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Section 4. National Outcome Measures Among Clients Receiving Mental Health Treatment 

Services 

This section presents data on NOMs among clients receiving mental health treatment services through SMHAs 

during the 2021 reporting period. The NOMs presented include residential status (pertaining to stability in 

housing/residential status), employment status for adults 18 and over (pertaining to adult employment), and service 

settings (pertaining to access to services/capacity). The data are visualized as percentages, and narratives describing 

key findings from the graphs include client counts for reference. Consistent with the previous section, data presented 

in this section were calculated after excluding missing values (e.g., clients with unknown or not collected residential 

status were excluded from the denominator when calculating residential status percentages). For variable definitions, 

please refer to Appendix A. For detailed data on counts, percentages, and rates corresponding to this section, 

including missing value counts and percentages, please refer to Appendix B. 

Key Takeaways 

• Among children receiving mental health treatment services in 2021, 92.6% (N = 883,227) lived in a

private residence and 0.4% (N = 3,543) were experiencing homelessness. Among adults receiving

mental health treatment services in 2021, 83.5% (N = 2,431,299) lived in a private residence and 5.5%

(N = 160,945) were experiencing homelessness.

• Among adults receiving mental health treatment services in 2021, 44.3% (N = 1,014,269) were not

participating in the labor force, 29.7% (N = 679,974) were unemployed, and 25.9% (N = 593,677) were

employed.

• Among children receiving mental health treatment services in 2021, 99.4% (N = 1,741,638) received

treatment at community-based programs. Among adults receiving mental health treatment services in

2021, 97.1% (N = 4,610,662) received treatment at community-based programs.

4.1 Clients Receiving Mental Health Treatment Services by Residential Status, 

2021 MH-CLD 

Among children receiving mental health treatment 

services in 2021, 92.6% (N = 883,227) lived in a 

private residence, 3.9% (N = 37,309) were in foster 

care, 1.3% (N = 11,994) had other residential status, 

and 1.1% (N = 10,740) were in residential care. For 

data on other residential statuses not visualized in this 

graph, please refer to Appendix B-2. 

Among adults receiving mental health treatment 

services in 2021, 83.5% (N = 2,431,293) lived in a 

private residence, 2.7% (N = 78,105) had other 

residential status, 4.0% (N = 116,788) were in 

residential care, 5.5% (N = 160,945) were experiencing 

homelessness, 1.8% (N = 53,041) were in jail or 

correctional facilities, and 1.9% (N = 54,039) were in 

institutional settings. For data on other residential 

statuses not visualized in this graph, please refer to 

Appendix B-2. 

Mental Health Client-Level Data (MH-CLD) Annual Report 2021 | 10 
 

 

 

Figure 4.2.1: Percentages of Clients Receiving Mental Health Treatment Services by Employment Status, 

Age 18 and Older, 2021 

Percentages (%) 

100 

80 

44.3% 

29.7% 25.9% 

0 

20 

40 

60 

■ Not in Labor Force ■ Unemployed ■ Employed 

 

 

 

Figure 4.3.1: Percentages of Clients Receiving Mental Health Treatment Services by Service Setting, 2021 

Percentages (%) Percentages (%) 

99.4% 100 

80 

60 

40 

20 

0 

Children 

1.5% 

97.1% 100 

80 

60 

40 

20 

0 

Adults 

4.2% 1.2% 2.0% 1.1% 

■ Community-Based Program ■ Other Psychiatric Inpatient ■ Residential Treatment Center 

■ State Psychiatric Hospital ■ Institutions Under the Justice System 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

4.2 Clients Receiving Mental Health Treatment Services by Employment Status, 

2021 MH-CLD 

Among adults receiving mental health treatment services in 2021, 44.3% (N = 1,014,269) were not participating 

in the labor force,11 29.7% (N = 679,974) were unemployed, and 25.9% (N = 593,677) were employed. 

4.3 Clients Receiving Mental Health Treatment Services by Service Setting, 2021 MH-CLD 

Among children receiving mental health treatment 

services in 2021, 99.4% (N = 1,741,638) received 

treatment at community-based programs and 1.5% 

(N = 26,457) at other psychiatric inpatient settings. 

Please note that since some clients received services at 

more than one service setting in 2021, the percentages 

presented above exceed 100%. For data on service 

settings not visualized in this graph, please refer to 

Appendix B-2. 

Among adults receiving mental health treatment 

services in 2021, 97.1% (N = 4,610,662) received 

treatment at community-based programs, 4.2% 

(N = 197,885) at other psychiatric inpatient setting 

services, 1.2% (N = 55,712) at residential treatment 

centers, 2.0% (N = 96,562) at state psychiatric 

hospitals, and 1.1% (N = 52,190) at institutions under 

the justice system. Please note that since some clients 

received services at more than one service setting in 

2021, the percentages presented above exceed 100%. 

Mental Health Client-Level Data (MH-CLD) Annual Report 2021 | 11 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Section 5. Mental Health Diagnoses Among Clients Receiving Mental Health Treatment 

Services 

This section presents data on the top 5 mental health diagnoses among clients receiving mental health treatment 

services through SMHAs during the 2021 reporting period. Mental health diagnosis categories presented below were 

generated by grouping mental health diagnostic codes into 13 diagnostic categories based on a modified version of 

the Clinical Classification Software12,13,14 (CCS). The overall and by age distributions of the top 5 mental health 

diagnoses are visualized as percentages of MH-CLD clients and rates per 100,000 population. For calculating 

percentages, clients with missing or no/deferred mental health diagnosis, data were excluded from the denominator. 

The data are presented by age groups: all ages, children (ages 0-17), and adults (ages 18 and older). Since the MHCLD captures up to three diagnoses, clients with multiple diagnoses can be counted multiple times within the 

respective diagnostic groupings. Therefore, the percentage distributions presented in the figures below may exceed 

100% and caution should be exercised when adding or comparing data across subgroups and reports from previous 

years. 

This section is divided into further subsections as follows: 

• 5.1 – Percentage and rates distribution of the top 5 mental health diagnoses of all clients, children, and 

adults receiving mental health treatment services in 2021. 

• 5.2 – Maps of counts and rates per 100,000 population of all clients receiving mental health treatment 

services in 2021 by state. 

• 5.3 – Maps of counts and rates per 100,000 of the top 5 mental health diagnoses for children receiving 

mental health treatment services in 2021 by state. 

• 5.4 – Maps of counts and rates per 100,000 of the top 5 mental health diagnoses for adults receiving mental 

health treatment services in 2021 by state. 

The maps presented in Sections 5.2, 5.3, and 5.4 present data by two class intervals that were selected manually by 

sorting states from high to low on counts and rates, and selecting a cut-off value that corresponds to the 10th highest 

count and rate respectively. The counts and rates were rounded for better readability. In other words, Sections 5.2, 

5.3, and 5.4 highlight the top 10 states by their descending counts and rates. For data tables corresponding to figures 

and maps presented in this section, please refer to Appendix B. For more information on mental health diagnoses 

groupings used by this report, please refer to Appendix C (Table C-2). 

Key Takeaways 

• Among all clients receiving mental health treatment services in 2021 with at least one mental health 

diagnosis, the most common diagnosis was depressive disorders (31.6%, N = 1,790,346) followed by anxiety 

disorders (26.6%, N = 1,507,425). The rates per 100,000 population were 598 per 100,000 for depressive 

disorders and 504 per 100,000 for anxiety disorders. 

• Among children receiving mental health treatment services in 2021 with at least one mental health diagnosis, 

the most common diagnosis was trauma and stressor-related disorders (31.4%, N = 479,622) followed by 

attention-deficit hyperactivity disorders (29.1%, N = 444,432). The rates per 100,000 population by mental 

health diagnosis for children were 719 per 100,000 for trauma and stress-related disorders and 666 per 

100,000 for attention-deficit/hyperactivity disorders. 

• Among adults receiving mental health treatment services in 2021 with at least one mental health diagnosis, 

the most common diagnosis was depressive disorders (36.1%, N = 1,490,752) followed by anxiety disorders 

(28.3%, N = 1,169,209). The rates per 100,000 population by mental health diagnosis for adults were 641 per 

100,000 for depressive disorders and 503 per 100,000 for anxiety disorders. 

• In 2021, 10 states (California, Pennsylvania, Arizona, New Jersey, Texas, Minnesota, Michigan, 

Washington, Maryland, and Iowa) accounted for 58.2% (N = 3,290,165) of clients with mental health 

diagnoses receiving mental health treatment services in the United States. 

• The states of Vermont, New Mexico, Iowa, Minnesota, Montana, Oregon, Arizona, New Hampshire, 

Pennsylvania, and Maryland had higher rates per 100,000 population (between 1,450 and 3,950) of children 

with trauma and stressor-related disorders receiving mental health treatment services. 

• The District of Columbia, and the states of Iowa, Minnesota, Montana, New Mexico, Arizona, Rhode Island, 

Washington, Pennsylvania, and Maryland had higher rates per 100,000 population (between 1,100 and 

2,800) of adults with depressive disorders receiving mental health treatment services. 

Mental Health Client-Level Data (MH-CLD) Annual Report 2021 | 12 
 

 

 

 

Figure 5.1.1: Percentages Distribution of Top 5 Mental Health Diagnoses Among All Clients, 2021 

Percentages (%) Rates per 100,000 Population 

100 1,000 

80 800 

598 

60 

40 

20 

31.6% 

26.6% 22.8% 15.0% 12.7% 

600 

400 

200 

504 

431 

284 

240 

0 0 

■ Depressive Disorders ■ Anxiety Disorders ■ Trauma and Stressor-Related 

■ Other Mental Health Disorders ■ Schizophrenia Other Psychotic Disorders Disorders 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

5.1 Distribution of Top 5 Mental Health Diagnoses, 2021 MH-CLD 

Among all clients receiving mental health treatment 

services in 2021 with at least one mental health 

diagnosis (N = 5,659,646), 31.6% (N = 1,790,346) 

were diagnosed with depressive disorders, 26.6% 

(N = 1,507,425) with anxiety disorders, 22.8% 

(N = 1,289,534) with trauma and stressor-related 

disorders, 15.0% (N = 851,036) with other mental 

health disorders,15 and 12.7% (N = 719,002) with 

schizophrenia and other psychotic disorders. 

Among all clients receiving mental health treatment 

services in 2021 with at least one mental health 

diagnosis (N = 5,659,646), the rate per 100,000 

population by mental health diagnosis was 598 per 

100,000 (N = 1,790,346) for depressive disorders, 504 

per 100,000 (N = 1,507,425) for anxiety disorders, 431 

per 100,000 (N = 1,289,534) for trauma and stressorrelated disorders, 284 per 100,000 (N = 851,036) for 

other mental health disorders,15 and 240 per 100,000 

(N = 719,002) for schizophrenia and other psychotic 

disorders. 

Mental Health Client-Level Data (MH-CLD) Annual Report 2021 | 13 
 

 

Figure 5.1.3: Percentages Distribution of Top 5 Mental Health Diagnoses Among Adults, 2021 

Percentages (%) Rates per 100,000 Population 

100 1,000 

80 800 

641 

60 600 

503 

36.1% 348

40 400 

28.3% 305 277 

19.6% 17.2% 15.6% 20 200 

0 

Adults 

0 

■ Depressive Disorders ■ Anxiety Disorders ■ Trauma and Stressor-Related 

■ Schizophrenia and Other Psychotic Disorders ■ Bipolar Disorders Disorders 

 

 

 

Figure 5.1.2: Percentages Distribution of Top 5 Mental Health Diagnoses Among Children, 2021 

Percentages (%) Rates per 100,000 Population 

100 1,000 

80 800 719 

666 

60 600 

505 447 31.4% 417 40 29.1% 400 

22.1% 19.5% 18.3% 20 200 

0 

Children 0

■ Trauma and Stressor-Related Disorders ■ Attention-Deficit/Hyperactivity Disorders ■ Anxiety Disorders 

■ Depressive Disorders ■ Other Mental Health Disorders 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Among children receiving mental health treatment Among children receiving mental health treatment 

services in 2021 with at least one mental health services in 2021 with at least one mental health 

diagnosis (N = 1,526,408), 31.4% (N = 479,622) were diagnosis (N = 1,526,408), the rate per 100,000 

diagnosed with trauma and stress-related disorders, population by mental health diagnosis was 719 per 

29.1% (N = 444,342) with attention- 100,000 (N = 479,622) for trauma and stress-related 

deficit/hyperactivity disorders, 22.1% (N = 337,124) disorders, 666 per 100,000 (N = 444,342) for attentionwith anxiety disorders, 19.5% (N = 298,355) with deficit/hyperactivity disorders, 505 per 100,000 

depressive disorders, and 18.3% (N = 278,597) with (N = 337,124) for anxiety disorders, 447 per 100,000 

other mental health disorders.

15 (N = 298,355) for depressive disorders, and 417 per 

100,000 (N = 278,597) for other mental health 

disorders.15 

Among adults receiving mental health treatment 

services in 2021 with at least one mental health 

diagnosis (N = 4,128,574), 36.1% (N = 1,490,752) 

were diagnosed with depressive disorders, 28.3% 

(N = 1,169,209) with anxiety disorders, 19.6% 

(N = 809,311) with trauma and stress-related disorders, 

17.2% (N = 708,403) with schizophrenia and other 

psychotic disorders, and 15.6% (N = 643,443) with 

bipolar disorders. 

Among adults receiving mental health treatment 

services in 2021 with at least one mental health 

diagnosis (N = 4,128,574), the rate per 100,000 

population by mental health diagnosis was 641 per 

100,000 (N = 1,490,752) for depressive disorders, 503 

per 100,000 (N = 1,169,209) for anxiety disorders, 348 

per 100,000 (N = 809,311) for trauma and stressorrelated disorders, 305 per 100,000 (N = 708,403) for 

schizophrenia and other psychotic disorders, and 277 

per 100,000 (N = 643,443) for bipolar disorders. 

Mental Health Client-Level Data (MH-CLD) Annual Report 2021 | 14 
Figure 5.2.1: Counts and Rates of Clients with Mental Health Diagnoses Receiving Mental Health Treatment 

Services by State, 2021 

Counts Rates per 100,000 Population 

 

 

 

 

 

 

 

 

 

 

 

5.2 Geographic Distribution of Top 5 Mental Health Diagnoses Among Clients by State, 2021 

MH-CLD 

In 2021, 10 states (California, Pennsylvania, Arizona, New In 2021, 10 states (New Mexico, Iowa, Montana, the District 

Jersey, Texas, Minnesota, Michigan, Washington, Maryland, of Columbia, Arizona, Minnesota, Vermont, Pennsylvania, 

and Iowa) accounted for 58.2% (N = 3,290,165) of clients Oregon, and Maryland) had the highest rates per 100,000 

with mental health diagnoses receiving mental health population (between 3,550 and 9,500) of clients with mental 

treatment services in the United States. health diagnoses receiving mental health treatment services. 

*Other SAMHSA Region 9 jurisdictions reporting data in 2021 include the Commonwealth of Northern Mariana Islands and the 

Republic of Palau. 

Mental Health Client-Level Data (MH-CLD) Annual Report 2021 | 15 
 

 

 

Figure 5.3.2: Counts and Rates of Children with Attention-Deficit/Hyperactivity Disorders Diagnoses 

Receiving Mental Health Treatment Services by State, 2021 

Counts Rates per 100,000 Population 

 

 

Figure 5.3.1: Counts and Rates of Children with Trauma and Stressor-Related Disorders Diagnoses 

Receiving Mental Health Treatment Services by State, 2021 

Counts Rates per 100,000 Population 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

5.3 Geographic Distribution of Top 5 Mental Health Diagnoses Among Children by State, 2021 

MH-CLD 

In 2021, 10 states (California, Pennsylvania, Arizona, In 2021, 10 states (Vermont, New Mexico, Iowa, Minnesota, 

Minnesota, Washington, Iowa, Oregon, Maryland, Michigan, Montana, Oregon, Arizona, New Hampshire, Pennsylvania, 

and Colorado) accounted for 61.8% (N = 296,403) of children and Maryland) had the highest rates per 100,000 population 

with trauma and stressor-related disorder diagnoses receiving (between 1,450 and 3,950) of children with trauma and 

mental health treatment services in the United States. stressor-related disorders receiving mental health treatment 

services. 

In 2021, 10 states (Pennsylvania, California, Texas, Iowa, In 2021, 10 states (Iowa, Mississippi, Montana, Minnesota, 

Minnesota, Arizona, Michigan, Maryland, Indiana, and Pennsylvania, New Mexico, Vermont, Arizona, Maryland, and 

Washington) accounted for 63.2% (N = 280,748) of children Kentucky) had the highest rates per 100,000 population 

with ADHD receiving mental health treatment services in the (between 1,320 and 3,700) of children with ADHD receiving 

United States. mental health treatment services. 

Mental Health Client-Level Data (MH-CLD) Annual Report 2021 | 16 
 

 

Figure 5.3.4: Counts and Rates of Children with Depressive Disorders Diagnoses Receiving Mental Health 

Treatment Services by State, 2021 

Counts Rates per 100,000 Population 

 

 

Figure 5.3.3: Counts and Rates of Children with Anxiety Disorders Diagnoses Receiving Mental Health 

Treatment Services by State, 2021 

Counts Rates per 100,000 Population 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

In 2021, 10 states (California, Minnesota, Iowa, Washington, In 2021, 10 states ( Montana, Iowa, Minnesota, Vermont, New 

Pennsylvania, Arizona, Indiana, Texas, Oregon, and Mexico, Oregon, New Hampshire, Washington, Arizona, and 

Maryland) accounted for 62.9% (N = 212,159) of children Indiana) had the highest rates per 100,000 population 

with anxiety disorder diagnoses receiving mental health (between 1,050 and 4,150) of children with anxiety disorders 

treatment services in the United States. receiving mental health treatment services. 

In 2021, 10 states (California, Texas, Minnesota, 

Pennsylvania, Washington, Indiana, Iowa, Arizona, Michigan, 

and Maryland) accounted for 61.2% (N = 182,651) of children 

with depressive disorder diagnoses receiving mental health 

treatment services in the United States. 

In 2021, 10 states (Montana, Iowa, New Mexico, Minnesota, 

Vermont, New Hampshire, Indiana, Washington, Oregon, and 

Kentucky) had the highest rates per 100,000 population 

(between 780 and 2,150) of children with depressive disorders 

receiving mental health treatment services. 

Mental Health Client-Level Data (MH-CLD) Annual Report 2021 | 17 
 

 

 

Figure 5.3.5: Counts and Rates of Children with Other Mental Health Disorder Diagnoses Receiving Mental 

Health Treatment Services by State, 2021 

Counts Rates per 100,000 Population 

 

 

 

 

 

 

 

 

 

 

 

 

In 2021, 10 states (California, New Mexico, Arizona, In 2021, 10 states (New Mexico, Arizona, Montana, Iowa, 

Michigan, Pennsylvania, Texas, Washington, Minnesota, Vermont, Minnesota, Michigan, Kentucky, Washington, and 

Iowa, and Kentucky) accounted for 68.7% (N = 191,368) of New Hampshire) had the highest rates per 100,000 population 

children with other mental health disorders diagnoses15 (between 700 and 6,200) of children with other mental health 

receiving mental health treatment services in the United diagnoses15 receiving mental health treatment services. 

States. 

*Other SAMHSA Region 9 jurisdictions reporting data in 2021 include the Commonwealth of Northern Mariana Islands and the 

Republic of Palau. 

Mental Health Client-Level Data (MH-CLD) Annual Report 2021 | 18 
 

 

Figure 5.4.2: Counts and Rates of Adults with Anxiety Disorder Diagnoses Receiving Mental Health 

Treatment Services by State, 2021 

Counts Rates per 100,000 Population 

 

 

Figure 5.4.1: Counts and Rates of Adults with Depressive Disorder Diagnoses Receiving Mental Health 

Treatment Services by State, 2021 

Counts Rates per 100,000 Population 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

5.4 Geographic Distribution of Top 5 Mental Health Diagnoses Among Adults by State, 2021 

MH-CLD 

In 2021, 10 states (Pennsylvania, California, Minnesota, In 2021, the District of Columbia and 9 states (Iowa, 

Texas, Arizona, New Jersey, Washington, Michigan, Iowa, Minnesota, Montana, New Mexico, Arizona, Rhode Island, 

and Maryland) accounted for 57.4% (N = 855,879) of adults Washington, Pennsylvania, and Maryland) had the highest 

with depressive disorder diagnoses receiving mental health rates per 100,000 population (between 1,100 and 2,800) of 

treatment services in the United States. adults with depressive disorders receiving mental health 

treatment services. 

In 2021, 10 states (Minnesota, Arizona, Iowa, Washington, In 2021, 10 states (Iowa, Minnesota, New Mexico, Montana, 

Texas, Pennsylvania, California, Michigan, New Mexico, and Arizona, Washington, Oregon, Rhode Island, Wyoming, and 

Oregon) accounted for 60.4% (N = 706,500) of adults with Kentucky) had the highest rates per 100,000 population 

anxiety disorder diagnoses receiving mental health treatment (between 800 and 3,200) of adults with anxiety disorders 

services in the United States. receiving mental health treatment services. 

Mental Health Client-Level Data (MH-CLD) Annual Report 2021 | 19 
 

 

Figure 5.4.4: Counts and Rates of Adults with Schizophrenia and Other Psychotic Disorders Diagnoses 

Receiving Mental Health Treatment Services by State, 2021 

Counts Rates per 100,000 Population 

 

 

Figure 5.4.3: Counts and Rates of Adults with Trauma and Stressor-Related Disorders Diagnoses Receiving 

Mental Health Treatment Services by State, 2021 

Counts Rates per 100,000 Population 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

In 2021, 10 states (Minnesota, Washington, California, In 2021, 10 states (New Mexico, Minnesota, Oregon, 

Arizona, New Jersey, Texas, Pennsylvania, Oregon, Michigan, Montana, Vermont, Iowa, Washington, Arizona, New 

and New Mexico) accounted for 58.3% (N = 471,821) of Hampshire, and New Jersey) had the highest rates per 100,000 

adults with trauma and stressor-related disorder diagnoses population (between 670 and 1,930) of adults with trauma and 

receiving mental health treatment services in the United stressor-related disorders receiving mental health treatment 

States. services. 

In 2021, 10 states (California, Texas, Michigan, Pennsylvania, 

New Jersey, Arizona, Georgia, Virginia, Minnesota, and 

Washington) accounted for 57.9% (N = 410,430) of adults 

with schizophrenia and other psychotic disorder diagnoses 

receiving mental health treatment services in the United 

States. 

In 2021, the District of Columbia and 9 states (Mississippi, 

Minnesota, Iowa, Arizona, Michigan, New Mexico, New 

Jersey, Rhode Island, and Alabama) had the highest rates per 

100,000 population (between 450 and 1,250) of adults with 

schizophrenia and other psychotic disorders receiving mental 

health treatment services. 

Mental Health Client-Level Data (MH-CLD) Annual Report 2021 | 20 
 

 

Figure 5.4.5: Counts and Rates of Adults with Bipolar Disorders Diagnoses Receiving Mental Health 

Treatment Services by State, 2021 

Counts Rates per 100,000 Population 

 

 

 

 

 

 

 

 

 

 

 

 

 

In 2021, 10 states (Texas, Pennsylvania, California, Michigan, In 2021, the District of Columbia and 9 states (Iowa, New 

Arizona, New Jersey, Maryland, Georgia, Minnesota, and Mexico, Montana, Arizona, Maryland, Minnesota, Michigan, 

Virginia) accounted for 57.9% (N = 372,371) of adults with Pennsylvania, and Rhode Island) had the highest rates per 

bipolar disorder diagnoses receiving mental health treatment 100,000 population (between 450 and 1,150) of adults with 

services in the United States. bipolar disorders receiving mental health treatment services. 

*Other SAMHSA Region 9 jurisdictions reporting data in 2021 include the Commonwealth of Northern Mariana Islands and the 

Republic of Palau. 

Mental Health Client-Level Data (MH-CLD) Annual Report 2021 | 21 
 

 

 

 

 

 

 

 

 

 

 

 

 

Section 6. Limitations 

Calculations of rates per 100,000 population depend on the availability of suitably and comparably detailed 

denominator data for the U.S. and Puerto Rico population as a whole, less the populations of states not supplying 

MH-CLD data in the 2021 reporting period (Florida, Maine, Ohio, and South Dakota). When such denominator data 

are unavailable (e.g., for service settings, many residential status classifications, SMI/SED status, and others), rates 

per 100,000 population could not be calculated and therefore are not presented. 

Mental health diagnosis data presented in this document report up to three reported mental health diagnoses per 

client; data are presented as percentages of clients who have at least one mental health diagnosis. Since MH-CLD 

captures up to three diagnoses, clients with multiple diagnoses can be counted in more than one diagnostic grouping. 

Similarly, clients receiving treatment may report more than one service setting (state psychiatric hospital, 

community-based treatment, residential treatment, other psychiatric inpatient, and/or institutions under the justice 

system) during the course of the reporting year. As with mental health diagnosis counts and percentages, the sum of 

all specific service setting counts or percentages will be greater than the total or 100%, respectively. 

For more details on the MH-CLD overview, background, data notes, and limitations, please see Appendix C. 

Mental Health Client-Level Data (MH-CLD) Annual Report 2021 | 22 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Endnotes 

1. Different states have different reporting year definitions; most use the July-June fiscal year. See Section 2.2 

and Table B-1. 

2. Territories reporting MH-CLD data include Puerto Rico, the Commonwealth of the Northern Mariana 

Islands, and the Republic of Palau. 

3. Substance Abuse and Mental Health Services Administration (SAMHSA). (2022, December 8). 

Community Mental Health Services Block Grant. https://www.samhsa.gov/grants/block-grants/mhbg 

4. Territories receiving MHBG funding include American Samoa, Federated States of Micronesia, Guam, 

Marshall Islands, the Commonwealth of the Northern Mariana Islands, the Republic of Palau, Puerto Rico, 

and the U.S. Virgin Islands. 

5. U.S. Census Bureau. (2022). Population Estimates Program, Annual State Resident Population Estimates 

for 6 Race Groups (5 Race Alone Groups and Two or More Races) by Age, Sex, and Hispanic Origin: 

April 1, 2020 to July 1, 2021 (SC-EST2021-ALLDATA6) [Data set]. https://www2.census.gov/programssurveys/popest/datasets/2020-2021/state/asrh/sc-est2021-alldata6.csv 

6. U.S. Census Bureau. (2022). Population Estimates Program, Annual Estimates of the Resident Population 

by Single Year of Age and Sex for Puerto Rico Commonwealth: April 1, 2020 to July 1, 2021 (PRCEST2021-SYASEX) [Data set]. https://www2.census.gov/programs-surveys/popest/tables/2020-

2021/puerto-rico/asrh/prc-est2021-syasex.xlsx 

7. U.S. Census Bureau. (2021). American Community Survey (ACS) 1-Year Estimates Data Profiles: 

Selected Social Characteristics in the United States (ACSDP1Y2021) [Data set]. 

https://data.census.gov/table?q=DP02&g =0100000US,$0400000&tid =ACSDP1Y2021.DP02 

U.S. Census Bureau. (2021). ACS 1-Year Estimates Data Profiles: Selected Economic Characteristics 

(ACSDP1Y2021) [Data set]. https://data.census.gov/table?q=DP03&g =0100000US,$0400000&tid 

=ACSDP1Y2021.DP03 

U.S. Census Bureau. (2021). ACS 1-Year Estimates Data Profiles: ACS Demographic and Housing 

Estimates (ACSDP1Y2021) [Data set]. https://data.census.gov/table?tid=ACSDP1Y2021.DP05 

8. U.S. Department of Housing and Urban Development (HUD). (2023, February). PIT and HIC Data Since 

2007. HUD Exchange. https://www.hudexchange.info/resource/3031/pit-and-hic-data-since-2007/ 

9. Commonwealth of the Northern Mariana Islands and the Republic of Palau contribute marginally to 

numerators (counts) but not denominators of calculating rates per 100,000 population. 

10. “Other” races combine clients coded as “Some other race alone,” “Two or more races,” or “Hispanic.” For 

these and other details about race data, see Appendix A. 

11. The employment status “Not in Labor Force” races combine clients coded as homemakers, students, 

retirees, disabled, other reported classifications such as volunteers, sheltered/non-competitive employees, 

or otherwise unspecified Not in the Labor Force, i.e., not employed and not seeking employment. For these 

and other details about employment data, see Appendix A. 

12. Numbers may not sum to total, because clients could receive services in more than one service setting 

during the reporting period. 

13. Agency for Healthcare Quality and Research (AHRQ). (2017, March 6). Clinical Classifications Software 

(CCS) for ICD-9 CM. Healthcare Cost & Utilization Project. https://hcup-us.ahrq.gov/ 

toolssoftware/ccs/ccs.jsp 

AHRQ. (2016). CCS Category Names (Full Labels): Single-Level CCS and Multi-Level CCS. https://hcupus.ahrq.gov/toolssoftware/ccs/CCSCategoryNames_FullLabels.pdf 

14. AHRQ. (2016). CCS Category Names (Full Labels): Single-Level CCS and Multi-Level CCS. https://hcupus.ahrq.gov/toolssoftware/ccs/CCSCategoryNames_FullLabels.pdf 

15. “Other” mental health diagnoses include those not classified as any of twelve other diagnostic classes: 

Alcohol/Substance Use Disorders, Anxiety Disorders, Attention-Deficit/Hyperactivity Disorders (ADHD), 

Bipolar Disorders, Conduct Disorders, Delirium Disorders, Depressive Disorders, Oppositional Defiant 

Disorders, Personality Disorders, Pervasive Developmental Disorders, Schizophrenia and Other Psychotic 

Disorders, or Trauma and Stressor-Related Disorders. For these and other details about mental health 

diagnosis data, see Appendix A and Appendix C. 

Mental Health Client-Level Data (MH-CLD) Annual Report 2021 | 23 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Appendix A. Definitions 

Most data definitions presented below are based on definitions found in the Mental Health Client-Level Data 

(MH-CLD) State Instruction Manual Version 2.9 which is provided directly to states for reporting. Detailed mental 

health diagnosis definitions are available in Table C-2 of Appendix C. 

Clients -- Defined as all enrolled individuals who received mental health and support services, including screening, 

assessment, crisis services, and telemedicine, from programs operated or funded by the SMHA during the reporting 

period. 

Age -- Calculated from the client’s date of birth at midpoint of the state’s elected reporting period. Non-missing 

categories in this report include any number between 0 and 85; clients older than 85 are coded as age 85. Children 

are defined as clients of age 0 to 17, adults are defined as clients of age 18 and older. Missing categories include 

Unknown and Not Collected (if the state never collects the data or the client belongs to a population exempt from 

data collection for this). 

Sex -- Identifies the client’s most recent reported sex at the end of the reporting period. Non-missing categories in 

this report include male and female. Missing categories include Unknown and Not Collected (if the state never 

collects the data or the client belongs to a population exempt from data collection for this). Per Office of 

Management and Budget (OMB) guidance, sex is defined as biologic sex. Transgender clients are coded by their 

birth designations. 

Race -- Specifies the client’s most recent reported race at the end of the reporting period. Non-missing categories in 

this report include American Indian or Alaska Native, Asian (combining persons reported as “Asian or Pacific 

Islander” or “Asian”), Black or African American, Native Hawaiian or Other Pacific Islander, White, and 

Other (combining persons reported as “Some other race alone,” “Two or more races,” or “Hispanic” as a race 

category). Missing categories include Unknown and Not Collected (if the state never collects the data or the client 

belongs to a population exempt from data collection for this). Reporting clients as “Hispanic” or “Asian or Pacific 

Islander” is deprecated but is still done by some states; as noted, these are recoded to "Other race" and "Asian," 

respectively. 

Ethnicity -- Identifies whether or not the client is of Hispanic or Latino origin, based on the most recent reported 

ethnicity at the end of the reporting period. Non-missing categories in this report include Hispanic origin regardless 

of race (combining clients reported as Hispanic, Puerto Rican, Mexican, Cuban, or other specific Hispanic) and 

Non-Hispanic origin. Missing categories include Unknown and Not Collected (if the state never collects the data or 

the client belongs to a population exempt from data collection for this). 

SMI/SED Status -- Indicates whether the client has serious mental illness (SMI) or serious emotional disturbance 

(SED) using the state definition, based on the most recent available status at the end of the reporting period. Nonmissing categories in this report include SMI, SED, At risk for SED, and Not SMI or SED. Missing categories 

include Unknown (including clients still undergoing evaluation) and Not Collected (if the state does not collect the 

data or the client belongs to a population exempt from data collection for this). By definition, children should not be 

classified with SMI, and adults should not be classified with SED or being at risk for SED. “At risk” for SED is an 

optional recording value used by some states. 

Mental Health Diagnosis -- Specifies whether any of up to three detailed diagnoses for the client qualify as one of 

thirteen broad categories of mental health diagnosis for that client. Non-missing categories include 

Alcohol/Substance Use Disorders, Anxiety Disorders, Attention-Deficit/Hyperactivity Disorders (ADHD), 

Bipolar Disorders, Conduct Disorders, Delirium Disorders, Depressive Disorders, Oppositional Defiant 

Disorders, Personality Disorders, Pervasive Developmental Disorders, Schizophrenia and Other Psychotic 

Disorders, Trauma and Stressor-Related Disorders, and Other Diagnoses. (Note that “Other Diagnoses” always 

refer to diagnoses other than those in the prior twelve categories listed here.) The missing category, No/Deferred 

Diagnosis, applies to clients whose three diagnoses are all either Unknown or Not Collected at the time the client’s 

data is added to the data set. For details about the ICD-9 or ICD-10 codes associated with each diagnosis, see 

Appendix C and Table C-2. Again, mental health diagnosis data presented in this derive from up to three reported 

mental health diagnoses per client; data are presented as percentages of clients who have at least one mental health 

diagnosis. Since MH-CLD captures up to three diagnoses, clients with multiple diagnoses can be counted in more 

than one diagnostic grouping. 

Mental Health Client-Level Data (MH-CLD) Annual Report 2021 | Appendix-A.1 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Employment Status -- Specifies the client’s employment status at discharge (for new clients) or the most recent 

available employment status at the end of the reporting period (for continuing clients). Non-missing categories in 

this report include employed (combining clients reported as employed full-time, employed part time, or employed 

but full time/part time status is unknown), unemployed, and Not in the Labor Force (combining clients reported as 

homemakers, students, retirees, disabled, and other reported classifications such as volunteers, sheltered/noncompetitive employees, or otherwise unspecified Not In the Labor Force). Missing categories include Unknown, Not 

Collected (if the state never collects the data or the client belongs to a population exempt from data collection for 

this) and Not Applicable (if the client’s age is 15 or less, or received services in institutional settings). It is reported 

for all clients (16 years old and older) who are receiving services in non-institutional settings. Institutional settings 

include correctional facilities like prison, jail, detention centers, and mental health care facilities like state hospitals, 

other psychiatric inpatient facilities, nursing homes, or other institutions that keep a person, otherwise able, from 

entering the labor force. A second variable reports the same statuses at time of admission or beginning of the 

reporting period, allowing calculations of change in employment status within the reporting period; for purposes of 

this report, employment status at the time of discharge or end of the reporting period is preferred. 

Residential Status -- Specifies client’s residential status at time of discharge or end of reporting period (continuing 

clients). Non-missing categories in this report include experiencing homelessness, foster home/foster care, 

residential care, crisis residence, institutional setting, jail/correctional facility, private residence (combining 

clients reported as independent, dependent, or unknown adult living arrangement), and other residential status. 

Missing categories include Unknown and Not Collected (if the state never collects the data or the client belongs to a 

population exempt from data collection for this). Institutional settings include correctional facilities like prison, jail, 

detention centers, and mental health care facilities like state hospitals, other psychiatric inpatient facilities, nursing 

homes, or other institutions that keep a person, otherwise able, from entering the labor force. A second variable 

reports the same statuses at time of admission or beginning of the reporting period, allowing calculations of change 

in residential status within the reporting period; however, for purposes of this report, this version (time of discharge 

or end of the reporting period) is preferred. 

Educational Attainment -- Specifies the school grade level of three subpopulations of clients, as follows: current 

grade level for school age children who have attended school in the last 3 months, highest completed grade level for 

school age children who have not attended school in the last 3 months, and highest educational attainment for all 

adult clients, whether in school or not. Non-missing categories in this report are Special Education (formally SelfContained Special Education), 0-8 (combining clients reported as having no schooling or first through 8th grade 

schooling, as well as those in kindergarten or pre-school), 9-11 (combining clients reported as having 9th to 11th 

grade schooling, High School or GED (combining clients reported completing high school or a General 

Equivalency Diploma), and More than High School (combining college freshman through senior and 

graduate/professional school clients). Missing categories include Unknown and Not Collected (if the state never 

collects the data or the client belongs to a population exempt from data collection for this). 

Service Setting -- Indicates the types of up to 5 mental health treatment setting(s) in which the client received 

services throughout the reporting period. Service settings include state psychiatric hospital, SMHAfunded/operated community-based programs, residential treatment centers, other psychiatric inpatient, and 

institutions under the justice system. The setting refers to the place where services were provided, not the 

residence of the person. Since a person may have received services in more than one setting during the reporting 

year (e.g., state psychiatric hospitals and community-based settings, or institutions under the justice system and 

community-based settings), the settings are not mutually exclusive. This means that the sums of service setting 

counts or percentages can exceed the sums of the numbers of clients involved or 100%, respectively. 

Mental Health Client-Level Data (MH-CLD) Annual Report 2021 | Appendix-A.2 
Mental Health Client-Level Data (MH-CLD) Annual Report 2021 | Appendix-B.1 

Appendix B. Data Tables Corresponding to Figures Included in the Report

This section provides the data corresponding to the figures included in Sections 3, 4, and 5 of this report. Tables B-1 

through B-10 include data on counts, including the counts and percentages of clients with missing/unknown/not 

collected/not applicable data for each characteristic. The overall missing values for each major subgroup are 

included in Table B-11. For a comprehensive set of national, subgroup, and state-level data on key characteristics of 

clients receiving treatment in the 2021 reporting year along with their mental health diagnoses and co-occurring 

disorders, please go to 2021 MH-CLD Annual Detailed Tables. 

Table B-1. Characteristics of Clients Receiving Mental Health Treatment Services, by Age Group, 2021

(Section 3)

Counts1 Percentages of 

All Records

Percentages Without 

Missing Records

Rates per 100,0002

Age Children Adults Total Children Adults Total Children Adults Total Children Adults Total

0-17 1,752,884 -- 1,752,884 100.0 -- 26.9 100.0 -- 27.0 2,626 -- 2,626

18 and above -- 4,749,485 4,749,485 -- 100.0 73.0 -- 100.0 73.0 -- 2,042 2,042

Unknown -- -- 6,655 -- -- 0.1 -- -- --

Not Collected -- -- 1 -- -- 0.0 -- -- --

Total 1,752,884 4,749,485 6,509,025 100.0 100.0 100.0 100.0 100.0 100.0 2,626 2,042 2,175

Age (detail) Children Adults Total Children Adults Total Children Adults Total Children Adults Total

0-11 810,055 -- 810,055 46.2 -- 12.4 46.2 -- 12.5 1,885 -- 1,885

12-17 942,829 -- 942,829 53.8 -- 14.5 53.8 -- 14.5 3,967 -- 3,967

18-24 -- 701,469 701,469 -- 14.8 10.8 -- 14.8 10.8 -- 2,558 2,558

25-39 -- 1,689,215 1,689,215 -- 35.6 26.0 -- 35.6 26.0 -- 2,745 2,745

40-54 -- 1,240,614 1,240,614 -- 26.1 19.1 -- 26.1 19.1 -- 2,222 2,222

55-64 -- 740,606 740,606 -- 15.6 11.4 -- 15.6 11.4 -- 1,931 1,931

65 and above -- 377,581 377,581 -- 7.9 5.8 -- 7.9 5.8 -- 764 764

Unknown -- -- 6,655 -- -- 0.1 -- -- -- -- -- --

Not Collected -- -- 1 -- -- 0.0 -- -- -- -- -- --

Total 1,752,884 4,749,485 6,509,025 100.0 100.0 100.0 100.0 100.0 100.0 2,626 2,042 2,175

Sex Children Adults Total Children Adults Total Children Adults Total Children Adults Total

Male 936,379 2,126,432 3,063,783 53.4 44.8 47.1 53.5 44.8 47.2 2,742 1,863 2,066

Female 815,090 2,615,391 3,432,674 46.5 55.1 52.7 46.5 55.2 52.8 2,500 2,208 2,272

Unknown 1,415 7,655 12,561 0.1 0.2 0.2 -- -- -- -- -- --

Not Collected -- 7 7 -- 0.0 0.0 -- -- -- -- -- --

Total 1,752,884 4,749,485 6,509,025 100.0 100.0 100.0 100.0 100.0 100.0 2,626 2,042 2,175

Race Children Adults Total Children Adults Total Children Adults Total Children Adults Total

American Indian or 

Alaska Native 35,844 96,160 132,017 2.0 2.0 2.0 2.4 2.2 2.3 5,341 4,124 4,396

Asian 20,234 74,499 94,765 1.2 1.6 1.5 1.4 1.7 1.6 496 526 520

Black or African 

American 271,702 870,932 1,142,776 15.5 18.3 17.6 18.2 20.4 19.8 3,412 3,144 3,204

Native Hawaiian or 

Other Pacific Islander 6,157 13,518 19,688 0.4 0.3 0.3 0.4 0.3 0.3 4,648 2,939 3,323

White 892,182 2,825,902 3,718,899 50.9 59.5 57.1 59.8 66.1 64.5 2,212 2,014 2,059

Other Race 264,661 397,005 661,883 15.1 8.4 10.2 17.8 9.3 11.5 1,950 833 1,081

Unknown 260,546 468,087 734,057 14.9 9.9 11.3 -- -- -- -- -- --

Not Collected 1,558 3,382 4,940 0.1 0.1 0.1 -- -- -- -- -- --

Total 1,752,884 4,749,485 6,509,025 100.0 100.0 100.0 100.0 100.0 100.0 2,626 2,042 2,175

Ethnicity Children Adults Total Children Adults Total Children Adults Total Children Adults Total

Hispanic or Latino 443,159 791,552 1,234,955 25.3 16.7 19.0 30.1 19.1 22.0 3,385 1,710 2,080

Not Hispanic or 

Latino 1,028,725 3,349,697 4,379,226 58.7 70.5 67.3 69.9 80.9 78.0 1,917 1,798 1,825

Unknown 261,778 552,079 817,018 14.9 11.6 12.6 -- -- -- -- -- --

Not Collected 19,222 56,157 77,826 1.1 1.2 1.2 -- -- -- -- -- --

Total 1,752,884 4,749,485 6,509,025 100.0 100.0 100.0 100.0 100.0 100.0 2,626 2,042 2,175
Mental Health Client-Level Data (MH-CLD) Annual Report 2021 | Appendix-B.2 

Counts1 Percentages of 

All Records

Percentages Without 

Missing Records

Rates per 100,0002

SMI/SED3 Children Adults Total Children Adults Total Children Adults Total Children Adults Total

SMI -- 3,393,217 3,396,583 -- 71.4 52.2 -- 75.5 55.0 -- -- --

SED 1,256,378 -- 1,256,390 71.7 -- 19.3 75.0 -- 20.4 -- -- --

At risk for SED 3,937 -- 3,937 0.2 -- 0.1 0.2 -- 0.1 -- -- --

Not SMI or SED 415,521 1,098,552 1,514,192 23.7 23.1 23.3 24.8 24.5 24.5 -- -- --

Unknown 61,355 196,946 261,459 3.5 4.1 4.0 -- -- -- -- -- --

Not Collected 15,693 60,770 76,464 0.9 1.3 1.2 -- -- -- -- -- --

Total 1,752,884 4,749,485 6,509,025 100.0 100.0 100.0 100.0 100.0 100.0 2,626 2,042 2,175

Education Children Adults Total Children Adults Total Children Adults Total Children Adults Total

Grades 8 or less 527,426 205,229 732,884 30.1 4.3 11.3 75.2 8.9 24.4 -- -- --

Grades 9-11 153,319 402,183 555,521 8.7 8.5 8.5 21.9 17.5 18.5 -- -- --

High School or 

General Educational 

Development (GED) 15,527 1,086,156 1,101,770 0.9 22.9 16.9 2.2 47.2 36.7 -- -- --

More than High 

School 1,007 577,786 578,817 0.1 12.2 8.9 0.1 25.1 19.3 -- -- --

Special Education 3,637 30,941 34,578 0.2 0.7 0.5 0.5 1.3 1.2 -- -- --

Unknown 170,479 455,887 630,296 9.7 9.6 9.7 -- -- -- -- -- --

Not Collected 881,489 1,991,303 2,875,159 50.3 41.9 44.2 -- -- -- -- -- --

Total 1,752,884 4,749,485 6,509,025 100.0 100.0 100.0 100.0 100.0 100.0 2,626 2,042 2,175

1

Since the ages of some clients were unknown or not collected, total counts can be greater than the sum of children and adult counts. 

2

Rates per 100,000 for subgroups were calculated using appropriate denominators from a combination of the 2021 Census/ACS and PIT-HUD 

population estimates. Total rates were calculated using overall children, adults, and total MH-CLD client counts as numerators, and the respective 

2021 Census/ACS populations as denominators. The Commonwealth of the Northern Mariana Islands and the Republic of Palau contribute 

marginally to numerators (counts) but not denominators for calculating rates per 100,000 population. For more details, please see the “Data Notes 

and Limitations” section of Appendix C.

3

 Clients who have serious mental illness (SMI) or serious emotional disturbance (SED). For notes on data definitions, please see 

Appendix A.

“--” – missing/unknown/not collected/not applicable. For notes on data definitions, please see Appendix A.
Mental Health Client-Level Data (MH-CLD) Annual Report 2021 | Appendix-B.3 

Table B-2. National Outcome Measures Among Clients Receiving Mental Health Treatment Services, by 

Age Group, 2021 (Section 4) 

Counts1 Percentages of 

All Records

Percentages Without 

Missing Records

Rates per 100,0002

Residential Status Children Adults Total Children Adults Total Children Adults Total Children Adults Total

Homeless 3,543 160,945 164,501 0.2 3.4 2.5 0.4 5.5 4.3 4,524 59,522 47,174

Foster Home/Care 37,309 16,526 53,923 2.1 0.3 0.8 3.9 0.6 1.4 -- -- --

Residential Care 10,740 116,788 127,543 0.6 2.5 2.0 1.1 4.0 3.3 -- -- --

Institutional 2,845 54,039 56,892 0.2 1.1 0.9 0.3 1.9 1.5 -- -- --

Jail/Correctional 

Facility 3,861 53,041 56,915 0.2 1.1 0.9 0.4 1.8 1.5 -- -- --

Private Residence 883,227 2,431,293 3,314,898 50.4 51.2 50.9 92.6 83.5 85.8 -- -- --

Other 11,994 78,105 90,154 0.7 1.6 1.4 1.3 2.7 2.3 -- -- --

Unknown 470,060 1,014,862 1,489,287 26.8 21.4 22.9 -- -- -- -- -- --

Not Collected 329,305 823,886 1,154,912 18.8 17.3 17.7 -- -- -- -- -- --

Total 1,752,884 4,749,485 6,509,025 100.0 100.0 100.0 100.0 100.0 100.0 2,626 2,042 2,175

Employment Children Adults Total Children Adults Total Children Adults Total Children Adults Total

Employed 8,124 593,677 601,887 0.5 12.5 9.2 6.0 25.9 24.8 177 436 428

Unemployed 8,678 679,974 688,664 0.5 14.3 10.6 6.4 29.7 28.4 2,734 7,231 7,084

Not in Labor Force 119,587 1,014,269 1,133,938 6.8 21.4 17.4 87.7 44.3 46.8 4,126 1,181 1,277

Not applicable 1,431,103 106,473 1,537,846 81.6 2.2 23.6 -- -- -- -- -- --

Unknown 125,218 1,856,901 1,986,676 7.1 39.1 30.5 -- -- -- -- -- --

Not Collected 60,174 498,191 560,014 3.4 10.5 8.6 -- -- -- -- -- --

Total 1,752,884 4,749,485 6,509,025 100.0 100.0 100.0 100.0 100.0 100.0 2,626 2,042 2,175

Service Settings3 Children Adults Total Children Adults Total Children Adults Total Children Adults Total

State Psychiatric 

Hospital 6,463 96,562 103,026 0.4 2.0 1.6 0.4 2.0 1.6 -- -- --

Community-Based 

Program 1,741,638 4,610,662 6,358,059 99.4 97.1 97.7 99.4 97.1 97.7 -- -- --

Residential 

Treatment Center 16,579 55,712 73,344 0.9 1.2 1.1 0.9 1.2 1.1 -- -- --

Other Psychiatric 

Inpatient 26,457 197,885 224,444 1.5 4.2 3.4 1.5 4.2 3.4 -- -- --

Institutions Under 

the Justice System 4,010 52,190 56,218 0.2 1.1 0.9 0.2 1.1 0.9 -- -- --

Total 1,752,884 4,749,485 6,509,025 100.0 100.0 100.0 100.0 100.0 100.0 2,626 2,042 2,175

1

Since the ages of some clients were unknown or not collected, total counts can be greater than the sum of children and adult counts. 

2

Rates per 100,000 for subgroups were calculated using appropriate denominators from a combination of the 2021 Census/ACS and PIT-HUD 

population estimates. Total rates were calculated using overall children, adults, and total MH-CLD client counts as numerators, and the respective 

2021 Census/ACS populations as denominators. The Commonwealth of the Northern Mariana Islands and the Republic of Palau contribute 

marginally to numerators (counts) but not denominators for calculating rates per 100,000 population. For more details, please see the “Data Notes 

and Limitations” section of Appendix C.

3

Service Setting indicates up to 5 types of mental health treatment settings in which the individual received services throughout the reporting 

period, and not the type of service received.

“--” – missing/unknown/not collected/not applicable. For notes on data definitions, please see Appendix A.
Mental Health Client-Level Data (MH-CLD) Annual Report 2021 | Appendix-B.4 

Table B-3. Mental Health Diagnoses Among Clients Receiving Mental Health Treatment Services, by Age 

Group, 2021 (Section 5)

Counts1 Percentages of 

All Records

Percentages Without 

Missing Records

Rates per 100,0002

Mental Health 

Diagnoses Children Adults Total Children Adults Total Children Adults Total Children Adults Total

Alcohol/Substance Use 

Disorders 12,295 367,873 380,511 0.7 7.7 5.8 0.8 8.9 6.7 18 158 127

Anxiety Disorders 337,124 1,169,209 1,507,425 19.2 24.6 23.2 22.1 28.3 26.6 505 503 504

Attention-Deficit/ 

Hyperactivity Disorders 444,342 192,328 636,759 25.3 4.0 9.8 29.1 4.7 11.3 666 83 213

Bipolar Disorders 22,478 643,443 666,114 1.3 13.5 10.2 1.5 15.6 11.8 34 277 223

Conduct Disorders 76,294 21,887 98,205 4.4 0.5 1.5 5.0 0.5 1.7 114 9 33

Delirium Disorders 1,310 27,750 29,589 0.1 0.6 0.5 0.1 0.7 0.5 2 12 10

Depressive Disorders 298,355 1,490,752 1,790,346 17.0 31.4 27.5 19.5 36.1 31.6 447 641 598

Oppositional Defiant 

Disorders 137,073 18,013 155,101 7.8 0.4 2.4 9.0 0.4 2.7 205 8 52

Personality Disorders 2,503 156,798 159,354 0.1 3.3 2.4 0.2 3.8 2.8 4 67 53

Pervasive Developmental 

Disorders 65,996 41,659 107,665 3.8 0.9 1.7 4.3 1.0 1.9 99 18 36

Schizophrenia and Other 

Psychotic Disorders 10,188 708,403 719,002 0.6 14.9 11.0 0.7 17.2 12.7 15 305 240

Trauma and StressorRelated Disorders 479,622 809,311 1,289,534 27.4 17.0 19.8 31.4 19.6 22.8 719 348 431

Other Mental Health 

Disorders3 278,597 570,550 851,036 15.9 12.0 13.1 18.3 13.8 15.0 417 245 284

No/Deferred Diagnosis 226,476 620,911 849,379 12.9 13.1 13.0 14.8 15.0 15.0 -- -- --

Any Specific Diagnosis 1,526,408 4,128,574 5,659,646 87.1 86.9 87.0 100.0 100.0 100.0 2,287 1,775 1,891

MH-CLD Clients 1,752,884 4,749,485 6,509,025 100.0 100.0 100.0 100.0 100.0 100.0 2,626 2,042 2,175

1

Since the ages of some clients were unknown or not collected, total counts can be greater than the sum of children and adult counts. 

2

Rates per 100,000 for diagnosis subgroups were calculated using the appropriate denominators from the 2021 Census/ACS population for 

children, adults, and total MH-CLD clients. Rates for any specific diagnosis were calculated using children, adults, and total MH-CLD client with 

any listed mental health diagnosis (i.e., excluding no/deferred diagnosis clients) as numerators, and respective 2021 Census/ACS population as 

denominators. Total MH-CLD client rates were calculated using overall children, adults, and total MH-CLD client counts as numerators, and 

respective 2021 Census/ACS population as denominators. The Commonwealth of the Northern Mariana Islands and the Republic of Palau 

contribute marginally to numerators (counts) but not denominators for calculating rates per 100,000 population. For more details, please see the 

“Data Notes and Limitations” section of Appendix C.

3

Other mental health diagnoses include those not classified as any of twelve other diagnostic classes: Alcohol/Substance Use Disorders, Anxiety 

Disorders, Attention-Deficit/Hyperactivity Disorders (ADHD), Bipolar Disorders, Conduct Disorders, Delirium Disorders, Depressive Disorders, 

Oppositional Defiant Disorders, Personality Disorders, Pervasive Developmental Disorders, Schizophrenia and Other Psychotic Disorders, or 

Trauma and Stressor-Related Disorders. 

“--” – missing/unknown/not collected/not applicable. For notes on data definitions, please see Appendix A.
Mental Health Client-Level Data (MH-CLD) Annual Report 2021 | Appendix-B.5 

Table B-4. Characteristics of Clients Receiving Mental Health Treatment Services by State and Age 

Group, 2021 (Section 5) 

Counts1 Percentages of all records Rates per 100,000

States Children Adults Total Children Adults Total Children Adults Total

Alabama 30,143 64,754 94,898 1.7 1.4 1.5 2,686 1,653 1,883

Alaska 3,276 6,360 9,636 0.2 0.1 0.1 1,827 1,149 1,315

Arizona 124,105 281,603 405,709 7.1 5.9 6.2 7,689 4,973 5,576

Arkansas 22,540 53,943 76,483 1.3 1.1 1.2 3,204 2,323 2,528

California 236,815 414,004 651,426 13.5 8.7 10.0 2,699 1,359 1,660

Colorado 36,183 106,500 142,685 2.1 2.2 2.2 2,910 2,331 2,455

Connecticut 33,066 54,916 87,983 1.9 1.2 1.4 4,531 1,910 2,440

Delaware 3,456 12,020 15,479 0.2 0.3 0.2 1,659 1,512 1,543

District of Columbia 7,598 62,399 70,002 0.4 1.3 1.1 6,038 11,466 10,447

Georgia 10,044 120,366 130,414 0.6 2.5 2.0 398 1,455 1,208

Hawaii 1,591 7,784 9,496 0.1 0.2 0.1 523 685 659

Idaho 3,016 11,009 14,039 0.2 0.2 0.2 643 769 739

Illinois 5,641 24,047 29,688 0.3 0.5 0.5 201 244 234

Indiana 55,005 87,230 142,235 3.1 1.8 2.2 3,466 1,671 2,090

Iowa 85,910 218,402 306,017 4.9 4.6 4.7 11,667 8,890 9,584

Kansas 21,274 40,331 61,605 1.2 0.8 0.9 3,026 1,807 2,099

Kentucky 44,245 102,136 146,394 2.5 2.2 2.2 4,355 2,924 3,246

Louisiana 6,840 34,408 41,249 0.4 0.7 0.6 632 972 892

Maryland 68,393 152,848 221,241 3.9 3.2 3.4 5,017 3,183 3,589

Massachusetts 2,150 22,231 24,382 0.1 0.5 0.4 158 395 349

Michigan 71,252 216,869 288,128 4.1 4.6 4.4 3,309 2,746 2,867

Minnesota 85,344 227,478 312,825 4.9 4.8 4.8 6,477 5,182 5,481

Mississippi 31,639 64,144 95,785 1.8 1.4 1.5 4,567 2,842 3,247

Missouri 20,494 61,913 82,407 1.2 1.3 1.3 1,480 1,294 1,336

Montana 23,013 48,740 71,754 1.3 1.0 1.1 9,790 5,607 6,498

Nebraska 3,148 21,628 24,778 0.2 0.5 0.4 652 1,461 1,262

Nevada 3,911 10,723 15,937 0.2 0.2 0.2 560 439 507

New Hampshire 12,897 36,194 49,091 0.7 0.8 0.8 5,031 3,196 3,534

New Jersey 59,855 358,362 418,437 3.4 7.5 6.4 2,959 4,947 4,515

New Mexico 59,514 140,345 199,859 3.4 3.0 3.1 12,576 8,544 9,446

New York 5,820 41,448 47,269 0.3 0.9 0.7 141 264 238

North Carolina 8,465 92,689 101,155 0.5 2.0 1.6 368 1,124 959

North Dakota 1,683 9,296 10,979 0.1 0.2 0.2 906 1,578 1,417

Oklahoma 29,980 79,167 109,149 1.7 1.7 1.7 3,118 2,617 2,738

Oregon 45,956 112,925 158,881 2.6 2.4 2.4 5,335 3,336 3,742

Pennsylvania 178,722 392,537 571,346 10.2 8.3 8.8 6,684 3,815 4,407

Puerto Rico 798 7,375 8,174 0.0 0.2 0.1 146 271 250

Rhode Island 6,834 25,480 32,314 0.4 0.5 0.5 3,273 2,873 2,949

South Carolina 32,507 64,237 96,744 1.9 1.4 1.5 2,910 1,577 1,864
Mental Health Client-Level Data (MH-CLD) Annual Report 2021 | Appendix-B.6 

Counts1 Percentages of all records Rates per 100,000

States Children Adults Total Children Adults Total Children Adults Total

Tennessee 16,201 85,028 101,229 0.9 1.8 1.6 1,052 1,565 1,451

Texas 92,152 333,393 425,546 5.3 7.0 6.5 1,233 1,512 1,441

Utah 20,358 37,119 57,477 1.2 0.8 0.9 2,149 1,553 1,722

Vermont 10,167 17,374 27,541 0.6 0.4 0.4 8,692 3,287 4,266

Virginia 32,967 93,629 126,598 1.9 2.0 1.9 1,749 1,386 1,465

Washington 79,463 209,243 291,139 4.5 4.4 4.5 4,741 3,451 3,762

West Virginia 2,703 15,778 18,589 0.2 0.3 0.3 753 1,108 1,043

Wisconsin 12,439 57,405 69,845 0.7 1.2 1.1 976 1,242 1,185

Wyoming 3,246 10,987 14,233 0.2 0.2 0.2 2,451 2,461 2,459

Other Jurisdictions2 65 688 755 0.0 0.0 0.0 -- -- --

TOTAL 1,752,884 4,749,485 6,509,025 100.0 100.0 100.0 2,626 2,042 2,175

1

Since the ages of some clients were unknown or not collected, total counts can be greater than the sum of children and adult counts. 

2

Other jurisdictions include the Commonwealth of Northern Mariana Islands and the Republic of Palau. Data are presented together to minimize 

disclosure risk.

“--” – missing/unknown/not collected/not applicable. For notes on data definitions, please see Appendix A.
Mental Health Client-Level Data (MH-CLD) Annual Report 2021 | Appendix-B.7 

Table B-5. Top 5 Mental Health Diagnoses Counts Among Children by State, 2021 (Section 5)

States Counts

Overall1

Trauma and 

Stressor-Related 

Disorders

Attention Deficit/

Hyperactivity 

Disorders

Anxiety 

Disorders

Depressive 

Disorders

Other Mental 

Health Disorders

Alabama 30,098 6,947 13,947 5,503 5,578 4,616

Alaska 3,232 1,433 362 429 633 326

Arizona 109,623 36,979 25,075 17,574 12,133 27,607

Arkansas 21,871 6,697 2,660 3,340 3,265 2,104

California 217,533 57,112 35,665 42,976 52,415 37,997

Colorado 35,781 15,923 6,075 7,012 8,893 3,113

Connecticut 1,301 416 354 146 274 416

Delaware 1,722 542 524 127 386 302

District of 

Columbia 3,289 852 972 195 668 279

Georgia 10,044 2,178 5,664 1,454 1,728 2,789

Hawaii 1,454 565 445 243 297 256

Idaho 1,166 199 424 347 426 304

Illinois 5,623 2,008 1,311 1,115 1,332 861

Indiana 54,967 12,876 20,787 17,279 15,042 7,553

Iowa 65,412 22,466 27,190 21,788 12,790 11,051

Kansas 20,963 6,349 4,649 4,826 4,934 2,248

Kentucky 43,930 13,264 13,462 9,937 7,924 8,612

Louisiana 3,731 694 1,632 871 1,018 367

Maryland 68,355 19,931 21,159 10,232 9,205 6,147

Massachusetts 1,445 409 447 554 455 421

Michigan 66,340 19,331 22,232 8,785 10,583 20,747

Minnesota 72,054 34,756 26,173 33,883 18,037 12,872

Mississippi 31,513 6,965 16,019 2,762 3,695 4,565

Missouri 20,353 4,996 8,634 6,935 6,655 4,731

Montana 22,642 5,909 5,285 9,710 5,017 3,634

Nebraska 2,184 539 430 275 303 495

Nevada 3,336 909 431 569 961 778

New 

Hampshire 11,286 4,591 2,747 3,518 2,538 1,988

New Jersey 36,238 14,741 10,349 5,855 4,966 6,698

New Mexico 59,506 15,486 8,370 8,478 7,163 29,261

New York 5,625 1,596 2,275 1,707 2,010 1,912

North 

Carolina 8,398 2,565 2,240 1,022 1,777 1,925

North Dakota 1,370 407 591 476 397 408

Oklahoma 27,138 11,191 3,926 4,905 5,859 2,236

Oregon 45,946 21,353 7,968 12,673 7,931 5,557

Pennsylvania 160,098 44,870 50,209 19,507 17,173 15,843

Puerto Rico 541 80 288 32 60 108

Rhode Island 6,278 2,585 2,250 2,012 1,434 1,210

South 

Carolina 30,970 11,044 12,895 7,359 7,318 4,280

Tennessee 8,679 3,253 2,911 2,141 2,278 1,164
Mental Health Client-Level Data (MH-CLD) Annual Report 2021 | Appendix-B.8 

States Counts

Overall1

Trauma and 

Stressor-Related 

Disorders

Attention Deficit/

Hyperactivity 

Disorders

Anxiety 

Disorders

Depressive 

Disorders

Other Mental 

Health Disorders

Texas 66,011 14,799 34,881 14,875 19,700 14,304

Utah 19,350 5,891 3,550 7,716 5,390 3,335

Vermont 9,123 4,596 2,000 2,220 1,256 1,409

Virginia 30,758 11,736 14,446 8,556 8,281 5,066

Washington 63,135 23,682 17,377 21,372 15,573 13,074

West Virginia 1,421 282 272 394 264 189

Wisconsin 11,391 2,596 2,206 2,713 1,440 3,084

Wyoming 3,140 1,025 572 723 897 344

Other 

jurisdictions2 44 8 11 3 3 11

Total 1,525,467 479,622 444,342 337,124 298,355 278,597

1

Diagnostic category counts are not mutually exclusive since MH-CLD clients can have up to 3 reported diagnoses, and clients with multiple 

diagnoses are counted in more than one diagnostic grouping. Therefore, sum of diagnostic category counts may exceed the overall total.

2

Other jurisdictions include the Commonwealth of Northern Mariana Islands and the Republic of Palau. Data are presented together to minimize 

disclosure risk.
Mental Health Client-Level Data (MH-CLD) Annual Report 2021 | Appendix-B.9 

Table B-6. Top 5 Mental Health Diagnoses Percentages Among Children by State, 2021 (Section 5)

States Percentages

Overall1

Trauma and 

Stressor-Related 

Disorders

Attention Deficit/ 

Hyperactivity 

Disorders

Anxiety 

Disorders

Depressive 

Disorders

Other Mental 

Health Disorders

Alabama 2.0 1.4 3.1 1.6 1.9 1.7

Alaska 0.2 0.3 0.1 0.1 0.2 0.1

Arizona 7.2 7.7 5.6 5.2 4.1 9.9

Arkansas 1.4 1.4 0.6 1.0 1.1 0.8

California 14.3 11.9 8.0 12.7 17.6 13.6

Colorado 2.3 3.3 1.4 2.1 3.0 1.1

Connecticut 0.1 0.1 0.1 0.0 0.1 0.1

Delaware 0.1 0.1 0.1 0.0 0.1 0.1

District of 

Columbia 0.2 0.2 0.2 0.1 0.2 0.1

Georgia 0.7 0.5 1.3 0.4 0.6 1.0

Hawaii 0.1 0.1 0.1 0.1 0.1 0.1

Idaho 0.1 0.0 0.1 0.1 0.1 0.1

Illinois 0.4 0.4 0.3 0.3 0.4 0.3

Indiana 3.6 2.7 4.7 5.1 5.0 2.7

Iowa 4.3 4.7 6.1 6.5 4.3 4.0

Kansas 1.4 1.3 1.0 1.4 1.7 0.8

Kentucky 2.9 2.8 3.0 2.9 2.7 3.1

Louisiana 0.2 0.1 0.4 0.3 0.3 0.1

Maryland 4.5 4.2 4.8 3.0 3.1 2.2

Massachusetts 0.1 0.1 0.1 0.2 0.2 0.2

Michigan 4.3 4.0 5.0 2.6 3.5 7.4

Minnesota 4.7 7.2 5.9 10.1 6.0 4.6

Mississippi 2.1 1.5 3.6 0.8 1.2 1.6

Missouri 1.3 1.0 1.9 2.1 2.2 1.7

Montana 1.5 1.2 1.2 2.9 1.7 1.3

Nebraska 0.1 0.1 0.1 0.1 0.1 0.2

Nevada 0.2 0.2 0.1 0.2 0.3 0.3

New 

Hampshire 0.7 1.0 0.6 1.0 0.9 0.7

New Jersey 2.4 3.1 2.3 1.7 1.7 2.4

New Mexico 3.9 3.2 1.9 2.5 2.4 10.5

New York 0.4 0.3 0.5 0.5 0.7 0.7

North 

Carolina 0.6 0.5 0.5 0.3 0.6 0.7

North Dakota 0.1 0.1 0.1 0.1 0.1 0.1

Oklahoma 1.8 2.3 0.9 1.5 2.0 0.8

Oregon 3.0 4.5 1.8 3.8 2.7 2.0

Pennsylvania 10.5 9.4 11.3 5.8 5.8 5.7

Puerto Rico 0.0 0.0 0.1 0.0 0.0 0.0

Rhode Island 0.4 0.5 0.5 0.6 0.5 0.4

South 

Carolina 2.0 2.3 2.9 2.2 2.5 1.5
Mental Health Client-Level Data (MH-CLD) Annual Report 2021 | Appendix-B.10 

States Percentages

Overall11

Trauma and 

Stressor-Related 

Disorders

Attention Deficit/ 

Hyperactivity 

Disorders

Anxiety 

Disorders

Depressive 

Disorders

Other Mental 

Health Disorders

Tennessee 0.6 0.7 0.7 0.6 0.8 0.4

Texas 4.3 3.1 7.9 4.4 6.6 5.1

Utah 1.3 1.2 0.8 2.3 1.8 1.2

Vermont 0.6 1.0 0.5 0.7 0.4 0.5

Virginia 2.0 2.4 3.3 2.5 2.8 1.8

Washington 4.1 4.9 3.9 6.3 5.2 4.7

West Virginia 0.1 0.1 0.1 0.1 0.1 0.1

Wisconsin 0.7 0.5 0.5 0.8 0.5 1.1

Wyoming 0.2 0.2 0.1 0.2 0.3 0.1

Other 

jurisdictions2 0.0 0.0 0.0 0.0 0.0 0.0

Total 100.0 100.0 100.0 100.0 100.0 100.0

1

Diagnostic category percentages are not mutually exclusive since MH-CLD clients can have up to 3 reported diagnoses, and clients with multiple 

diagnoses are counted in more than one diagnostic grouping. Therefore, sum of diagnostic category percentages may exceed the overall total.

2

Other jurisdictions include the Commonwealth of Northern Mariana Islands and the Republic of Palau. Data are presented together to minimize 

disclosure risk.
Mental Health Client-Level Data (MH-CLD) Annual Report 2021 | Appendix-B.11 

Table B-7. Top 5 Mental Health Diagnoses Rates per 100,000 Population Among Children by State, 2021 

(Section 5)

States Rates per 100,000

Overall

Trauma and 

Stressor-Related 

Disorders

Attention 

Deficit/Hyperactivity 

Disorders

Anxiety 

Disorders

Depressive 

Disorders

Other Mental 

Health Disorders

Alabama 2,682 619 1,243 490 497 411

Alaska 1,802 799 202 239 353 182

Arizona 6,792 2,291 1,554 1,089 752 1,710

Arkansas 3,109 952 378 475 464 299

California 2,480 651 407 490 597 433

Colorado 2,878 1,281 489 564 715 250

Connecticut 178 57 49 20 38 57

Delaware 827 260 252 61 185 145

District of 

Columbia 2,614 677 772 155 531 222

Georgia 398 86 224 58 68 110

Hawaii 478 186 146 80 98 84

Idaho 249 42 90 74 91 65

Illinois 201 72 47 40 48 31

Indiana 3,464 811 1,310 1,089 948 476

Iowa 8,883 3,051 3,692 2,959 1,737 1,501

Kansas 2,982 903 661 686 702 320

Kentucky 4,324 1,306 1,325 978 780 848

Louisiana 345 64 151 80 94 34

Maryland 5,014 1,462 1,552 751 675 451

Massachusetts 106 30 33 41 33 31

Michigan 3,081 898 1,032 408 491 963

Minnesota 5,469 2,638 1,986 2,572 1,369 977

Mississippi 4,548 1,005 2,312 399 533 659

Missouri 1,470 361 624 501 481 342

Montana 9,632 2,514 2,248 4,131 2,134 1,546

Nebraska 452 112 89 57 63 103

Nevada 477 130 62 81 138 111

New 

Hampshire 4,402 1,791 1,071 1,372 990 775

New Jersey 1,791 729 512 289 245 331

New Mexico 12,575 3,272 1,769 1,792 1,514 6,183

New York 137 39 55 41 49 46

North 

Carolina 365 111 97 44 77 84

North Dakota 738 219 318 256 214 220

Oklahoma 2,822 1,164 408 510 609 233

Oregon 5,334 2,479 925 1,471 921 645

Pennsylvania 5,987 1,678 1,878 730 642 592

Puerto Rico 99 15 53 6 11 20

Rhode Island 3,006 1,238 1,077 963 687 579

South 

Carolina 2,772 989 1,154 659 655 383
Mental Health Client-Level Data (MH-CLD) Annual Report 2021 | Appendix-B.12 

States Rates per 100,000

Overall

Trauma and 

Stressor-Related 

Disorders

Attention 

Deficit/Hyperactivity 

Disorders

Anxiety 

Disorders

Depressive 

Disorders

Other Mental 

Health Disorders

Tennessee 563 211 189 139 148 76

Texas 883 198 467 199 264 191

Utah 2,043 622 375 815 569 352

Vermont 7,799 3,929 1,710 1,898 1,074 1,205

Virginia 1,632 623 766 454 439 269

Washington 3,767 1,413 1,037 1,275 929 780

West Virginia 396 79 76 110 74 53

Wisconsin 894 204 173 213 113 242

Wyoming 2,371 774 432 546 677 260

Other 

jurisdictions1 -- -- -- -- -- --

Total 2,286 719 666 505 447 417

1

Other jurisdictions include the Commonwealth of Northern Mariana Islands and the Republic of Palau. Data are presented together to minimize 

disclosure risk.

“--” – missing/unknown/not collected/not applicable. For notes on data definitions, please see Appendix A.
Mental Health Client-Level Data (MH-CLD) Annual Report 2021 | Appendix-B.13 

Table B-8. Top 5 Mental Health Diagnoses Counts Among Adults by State, 2021 (Section 5)

States Counts

Overall1

Depressive 

Disorders

Anxiety 

Disorders

Trauma and 

Stressor-Related 

Disorders

Schizophrenia/

Other Psychotic 

Disorders Bipolar Disorders

Alabama 64,551 26,088 13,849 6,918 17,765 11,841

Alaska 6,307 1,790 1,118 1,626 550 421

Arizona 271,630 78,971 94,776 49,076 31,012 33,198

Arkansas 50,942 15,526 6,017 5,977 8,591 6,587

California 355,514 111,819 61,083 49,856 105,577 45,463

Colorado 104,992 35,076 24,368 29,234 14,242 16,696

Connecticut 40,037 14,172 10,094 9,242 9,527 6,998

Delaware 10,638 3,316 1,511 1,279 2,232 2,097

District of 

Columbia 35,748 14,997 1,597 3,616 6,626 6,234

Georgia 120,354 39,703 30,052 21,974 28,633 24,112

Hawaii 7,385 1,742 351 2,631 3,212 1,128

Idaho 4,098 1,200 553 347 1,633 868

Illinois 23,827 7,047 5,215 3,846 6,856 4,970

Indiana 86,508 39,771 37,943 19,789 13,738 13,986

Iowa 139,469 65,316 78,427 21,988 13,655 17,679

Kansas 39,672 17,478 13,447 8,989 3,481 5,323

Kentucky 101,498 35,010 28,076 21,223 10,926 11,789

Louisiana 15,682 6,649 4,392 1,676 3,670 3,340

Maryland 152,669 54,142 30,995 18,713 15,840 27,427

Massachusetts 9,692 2,567 2,148 1,593 4,463 2,431

Michigan 204,980 74,220 50,423 35,402 42,385 40,841

Minnesota 205,712 105,674 117,499 70,746 24,534 23,586

Mississippi 63,629 24,389 15,493 7,337 14,254 10,096

Missouri 59,942 31,150 21,682 11,464 16,348 13,673

Montana 48,517 18,355 21,675 9,162 3,480 5,613

Nebraska 18,083 6,559 4,700 3,457 2,351 3,456

Nevada 8,601 1,414 1,302 790 2,469 986

New 

Hampshire 30,819 10,334 8,258 9,514 4,054 3,475

New Jersey 282,032 76,108 29,792 48,664 36,779 29,735

New Mexico 140,263 34,279 41,522 31,562 8,746 11,756

New York 41,071 7,606 4,973 9,690 18,285 5,230

North 

Carolina 85,317 35,790 20,334 20,358 16,278 17,836

North Dakota 7,156 2,930 3,233 2,061 1,789 1,081

Oklahoma 70,089 32,040 13,357 13,526 10,436 9,988

Oregon 112,891 33,910 39,356 38,060 12,348 10,856

Pennsylvania 335,218 116,882 69,770 47,433 39,103 51,031

Puerto Rico 2,851 448 129 65 1,557 207

Rhode Island 23,130 11,588 8,250 5,856 4,479 3,999

South 

Carolina 62,406 23,306 17,523 15,034 17,296 11,978
Mental Health Client-Level Data (MH-CLD) Annual Report 2021 | Appendix-B.14 

States Counts

Overall1

Depressive 

Disorders

Anxiety 

Disorders

Trauma and 

Stressor-Related 

Disorders

Schizophrenia/

Other Psychotic 

Disorders Bipolar Disorders

Tennessee 57,642 25,094 12,469 9,955 7,918 12,529

Texas 225,907 96,758 76,503 47,900 53,199 73,645

Utah 32,565 12,838 14,899 5,268 6,053 4,568

Vermont 15,919 3,942 3,343 4,801 1,859 1,329

Virginia 90,717 38,411 30,373 19,839 26,302 23,333

Washington 187,794 75,989 77,141 53,122 22,906 22,108

West Virginia 11,341 3,099 5,013 1,442 439 822

Wisconsin 51,623 10,906 10,440 4,687 9,366 5,548

Wyoming 10,645 4,282 3,696 2,443 1,011 1,522

Other 

jurisdictions2 501 71 49 80 150 28

Total 4,123,627 1,490,752 1,169,209 809,311 708,403 643,443

1

Diagnostic category counts are not mutually exclusive since MH-CLD clients can have up to 3 reported diagnoses, and clients with multiple 

diagnoses are counted in more than one diagnostic grouping. Therefore, sum of diagnostic category counts may exceed the overall total.

2

Other jurisdictions include the Commonwealth of Northern Mariana Islands and the Republic of Palau. Data are presented together to minimize 

disclosure risk.
Mental Health Client-Level Data (MH-CLD) Annual Report 2021 | Appendix-B.15 

Table B-9. Top 5 Mental Health Diagnoses Percentages Among Adults, by State, 2021 (Section 5)

States Percentages

Overall

Depressive 

Disorders

Anxiety 

Disorders

Trauma and 

Stressor-Related 

Disorders

Schizophrenia/

Other Psychotic 

Disorders Bipolar Disorders

Alabama 1.6 1.7 1.2 0.9 2.5 1.8

Alaska 0.2 0.1 0.1 0.2 0.1 0.1

Arizona 6.6 5.3 8.1 6.1 4.4 5.2

Arkansas 1.2 1.0 0.5 0.7 1.2 1.0

California 8.6 7.5 5.2 6.2 14.9 7.2

Colorado 2.5 2.4 2.1 3.6 2.0 2.6

Connecticut 1.0 1.0 0.9 1.1 1.3 1.1

Delaware 0.3 0.2 0.1 0.2 0.3 0.3

District of 

Columbia 0.9 1.0 0.1 0.4 0.9 0.9

Georgia 2.9 2.7 2.6 2.7 4.0 3.7

Hawaii 0.2 0.1 0.0 0.3 0.5 0.2

Idaho 0.1 0.1 0.0 0.0 0.2 0.1

Illinois 0.6 0.5 0.4 0.5 1.0 0.8

Indiana 2.1 2.7 3.2 2.4 1.9 2.2

Iowa 3.4 4.4 6.7 2.7 1.9 2.7

Kansas 1.0 1.2 1.2 1.1 0.5 0.8

Kentucky 2.5 2.3 2.4 2.6 1.5 1.8

Louisiana 0.4 0.4 0.4 0.2 0.5 0.5

Maryland 3.7 3.6 2.7 2.3 2.2 4.2

Massachusetts 0.2 0.2 0.2 0.2 0.6 0.4

Michigan 5.0 5.0 4.3 4.4 6.0 6.3

Minnesota 5.0 7.1 10.0 8.7 3.5 3.6

Mississippi 1.5 1.6 1.3 0.9 2.0 1.6

Missouri 1.5 2.1 1.9 1.4 2.3 2.2

Montana 1.2 1.2 1.9 1.1 0.5 0.9

Nebraska 0.4 0.4 0.4 0.4 0.3 0.5

Nevada 0.2 0.1 0.1 0.1 0.3 0.2

New 

Hampshire 0.7 0.7 0.7 1.2 0.6 0.5

New Jersey 6.8 5.1 2.5 6.0 5.2 4.6

New Mexico 3.4 2.3 3.6 3.9 1.2 1.9

New York 1.0 0.5 0.4 1.2 2.6 0.8

North 

Carolina 2.1 2.4 1.7 2.5 2.3 2.7

North Dakota 0.2 0.2 0.3 0.3 0.3 0.2

Oklahoma 1.7 2.1 1.1 1.7 1.5 1.5

Oregon 2.7 2.3 3.4 4.7 1.7 1.7

Pennsylvania 8.1 7.8 6.0 5.9 5.5 8.0

Puerto Rico 0.1 0.0 0.0 0.0 0.2 0.0

Rhode Island 0.6 0.8 0.7 0.7 0.6 0.6

South 

Carolina 1.5 1.6 1.5 1.9 2.4 1.9
Mental Health Client-Level Data (MH-CLD) Annual Report 2021 | Appendix-B.16 

States Percentages

Overall1

Depressive 

Disorders

Anxiety 

Disorders

Trauma and 

Stressor-Related 

Disorders

Schizophrenia/

Other Psychotic 

Disorders Bipolar Disorders

Tennessee 1.4 1.7 1.1 1.2 1.1 1.9

Texas 5.5 6.5 6.5 5.9 7.5 11.5

Utah 0.8 0.9 1.3 0.7 0.9 0.7

Vermont 0.4 0.3 0.3 0.6 0.3 0.2

Virginia 2.2 2.6 2.6 2.5 3.7 3.7

Washington 4.5 5.1 6.6 6.6 3.2 3.4

West Virginia 0.3 0.2 0.4 0.2 0.1 0.1

Wisconsin 1.3 0.7 0.9 0.6 1.3 0.9

Wyoming 0.3 0.3 0.3 0.3 0.1 0.2

Other 

jurisdictions2 0.0 0.0 0.0 0.0 0.0 0.0

Total 100.0 100.0 100.0 100.0 100.0 100.0

1

Diagnostic category counts are not mutually exclusive since MH-CLD clients can have up to 3 reported diagnoses, and clients with multiple 

diagnoses are counted in more than one diagnostic grouping. Therefore, sum of diagnostic category counts may exceed the overall total.

2

Other jurisdictions include the Commonwealth of Northern Mariana Islands and the Republic of Palau. Data are presented together to minimize 

disclosure risk.
Mental Health Client-Level Data (MH-CLD) Annual Report 2021 | Appendix-B.17 

Table B-10. Top 5 Mental Health Diagnoses Rates per 100,000 Population Among Adults by State, 2021 

(Section 5)

States Rates per 100,000

Overall

Depressive 

Disorders

Anxiety 

Disorders

Trauma and 

Stressor-Related 

Disorders

Schizophrenia/

Other Psychotic 

Disorders Bipolar Disorders

Alabama 1,648 666 354 177 453 302

Alaska 1,140 324 202 294 99 76

Arizona 4,797 1,395 1,674 867 548 586

Arkansas 2,193 669 259 257 370 284

California 1,167 367 201 164 347 149

Colorado 2,298 768 533 640 312 365

Connecticut 1,392 493 351 321 331 243

Delaware 1,338 417 190 161 281 264

District of 

Columbia 6,569 2,756 293 664 1,218 1,146

Georgia 1,454 480 363 266 346 291

Hawaii 649 153 31 231 282 99

Idaho 286 84 39 24 114 61

Illinois 241 71 53 39 69 50

Indiana 1,658 762 727 379 263 268

Iowa 5,677 2,659 3,192 895 556 720

Kansas 1,778 783 603 403 156 239

Kentucky 2,905 1,002 804 608 313 337

Louisiana 443 188 124 47 104 94

Maryland 3,179 1,128 645 390 330 571

Massachusetts 172 46 38 28 79 43

Michigan 2,596 940 638 448 537 517

Minnesota 4,686 2,407 2,677 1,612 559 537

Mississippi 2,819 1,081 686 325 632 447

Missouri 1,253 651 453 240 342 286

Montana 5,582 2,112 2,494 1,054 400 646

Nebraska 1,221 443 317 233 159 233

Nevada 352 58 53 32 101 40

New 

Hampshire 2,721 912 729 840 358 307

New Jersey 3,893 1,051 411 672 508 410

New Mexico 8,539 2,087 2,528 1,921 532 716

New York 261 48 32 62 116 33

North 

Carolina 1,034 434 246 247 197 216

North Dakota 1,214 497 549 350 304 183

Oklahoma 2,317 1,059 442 447 345 330

Oregon 3,335 1,002 1,163 1,124 365 321

Pennsylvania 3,258 1,136 678 461 380 496

Puerto Rico 105 16 5 2 57 8

Rhode Island 2,608 1,307 930 660 505 451

South 

Carolina 1,532 572 430 369 425 294
Mental Health Client-Level Data (MH-CLD) Annual Report 2021 | Appendix-B.18 

States Rates per 100,000

Overall1

Depressive 

Disorders

Anxiety 

Disorders

Trauma and 

Stressor-Related 

Disorders

Schizophrenia/

Other Psychotic 

Disorders Bipolar Disorders

Tennessee 1,061 462 229 183 146 231

Texas 1,024 439 347 217 241 334

Utah 1,362 537 623 220 253 191

Vermont 3,012 746 632 908 352 251

Virginia 1,342 568 449 294 389 345

Washington 3,098 1,253 1,272 876 378 365

West Virginia 796 218 352 101 31 58

Wisconsin 1,117 236 226 101 203 120

Wyoming 2,385 959 828 547 226 341

Other 

jurisdictions1 -- -- -- -- -- --

Total 1,773 641 503 348 305 277

1

Other jurisdictions include the Commonwealth of Northern Mariana Islands and the Republic of Palau. Data are presented together to minimize 

disclosure risk.

“--” – missing/unknown/not collected/not applicable. For notes on data definitions, please see Appendix A.
Mental Health Client-Level Data (MH-CLD) Annual Report 2021 | Appendix-B.19 

Table B-11. Overall Missing Counts and Percentages by Key Characteristics, 2021

Characteristics Number Reporting Number Missing1 Percent Reporting Percent Missing1

Age group 6,502,369 6,656 99.9 0.1

Sex 6,496,457 12,568 99.8 0.2

Race 5,770,028 738,997 88.6 11.4

Ethnicity 5,614,181 894,844 86.3 13.7

SMI/SED2 6,171,102 337,923 94.8 5.2

Employment 2,424,489 4,084,536 37.2 62.8

Residential 3,864,826 2,644,199 59.4 40.6

Education 3,003,570 3,505,455 46.1 53.9

Service Setting3 6,509,025 0 100.0 0.0

Mental Health Diagnoses 5,659,646 849,379 87.0 13.0

1

Includes missing, unknown, not collected and not applicable.

2.Clients who have serious mental illness (SMI) or serious emotional disturbance (SED). For notes on data definitions, please see 

Appendix A.

3

Service Setting indicates up to 5 types of mental health treatment settings in which the individual received services throughout the reporting 

period, and not the type of service received.
Mental Health Client-Level Data (MH-CLD) Annual Report 2021 | Appendix-C.1 

Appendix C. Mental Health Client-Level Data (MH-CLD) Detailed Overview

Introduction and Background

Mental Health Client-Level Data (MH-CLD) is administered by the Substance Abuse and Mental Health Services 

Administration (SAMHSA). This data system collects and reports data on clients receiving mental health treatment 

services that are provided or funded, at least partially, through state mental health agencies (SMHAs). MH-CLD 

provides a mechanism for reporting demographic, clinical, and outcomes data from states and territories receiving 

MHBG funds from SAMHSA. The MH-CLD data are currently collected for and reported to SAMHSA’s Center for 

Behavioral Health Statistics and Quality (CBHSQ) by the SMHAs in accordance with the reporting terms and 

conditions of the Behavioral Health Services Information System (BHSIS) Agreements funded by SAMHSA.3

SAMHSA’s MHBG program funds a total of 59 SMHAs in all 50 states, the District of Columbia, and 8 territories.4

MH-CLD provides demographic, clinical, and National Outcome Measures (NOMs) data on clients receiving 

publicly funded mental health treatment services to behavioral health service providers; researchers; the public; and 

federal, state, and local governments. The NOMs presented in this report include stability in housing/residential 

status, adult employment, and access to services/capacity. MH-CLD provides data on the race, ethnicity, sex, and 

age of clients served, and can cross-tabulate these demographic categories with NOMs such as employment and 

living situation. The combination of demographic information with NOMs can provide information and insight into 

who is accessing services and how well they do once they are receiving services.

SAMHSA uses the MH-CLD data to enhance their understanding of publicly funded mental health treatment service

systems. The data are used to examine these service systems over time; to inform decisions about SAMHSA’s use of 

its mental health block grant funds; and to better understand the technical assistance and support needs of mental 

health providers and the communities they serve. 

In 2008, SAMHSA’s Center for Mental Health Services (CMHS) tested the feasibility of transitioning from 

aggregate reporting of SAMHSA’s mental health NOMs to client-level data reporting. This led to the development 

of the MH-CLD reporting method. The general framework for the MH-CLD involves a compilation of the 

demographic, clinical, and NOMs data of clients served by an SMHA within a state-defined 12-month reporting 

period. States may choose the calendar year or the state fiscal year as their reporting period. Clients served are 

defined as all enrolled clients who received mental health and support services, including screening, assessment, 

crisis services, and telemedicine, from programs operated or funded by the SMHA during the reporting period. Two 

data sets are submitted each reporting period: Basic Client Information is due December 1, and the State Hospital 

Readmission data set is due March 1 of the following year. These two data sets provide data that inform the 

following mental health NOMs: increased access to services/capacity, increased stability in family and living 

conditions, increased/retained employment (adults) and return to/stay in school (children), reduced use of psychiatric 

inpatient beds, and decreased criminal justice involvement. Data are reported in accordance with the Health 

Insurance Portability and Accountability Act of 1996 rules for non-protected health information.

In 2010, CBHSQ began a parallel effort of testing the feasibility of building a national behavioral health database 

that integrates both mental health and substance use data using a uniform platform for data reporting. This effort led 

to the integration of mental health data into the well-established system of reporting for substance use client-level 

data, known as the Treatment Episode Data Set (TEDS). To enable reporting of mental health data to TEDS, the 

system was modified to incorporate data elements that capture characteristics unique to the mental health services 

system and the clients receiving mental health treatment services. These characteristics include, among others, the 

extended period of time that a client may be engaged in treatment, the recovery process, and the simultaneous 

receipt of different types of services from different service providers. This method of reporting mental health data at 

the client level is referred to as the Mental Health Treatment Episode Data Set (MH-TEDS). MH-TEDS is a 

compilation of demographic, substance use, mental health, clinical, legal, and socioeconomic characteristics of 

clients who are primarily receiving publicly funded mental health and/or substance use services. MH-TEDS data 

also support program performance measurement and management goals. The same set of mental health NOMs 

enumerated under MH-CLD is also supported by MH-TEDS. National mental health client-level data reporting was 

launched in 2011, when MH-CLD was the only reporting method available. Beginning in the 2014 reporting period, 

states could choose either method—MH-CLD or MH-TEDS—to use for data reporting. The number of states 

reporting mental health data to SAMHSA using MH-CLD and/or MH-TEDS has increased from 19 in 2011 to 50 in 

2021. 

Unlike MH-CLD, MH-TEDS is structured around treatment events, that is, admissions and discharges from specific 

service settings. Admission and discharge records can be linked to track treatment episodes and the treatment 

services received by clients. Thus, with MH-TEDS, both the client and the treatment episode can serve as a unit of 

analysis, whereas with MH-CLD the client is the sole unit of analysis. MH-TEDS data can be made compatible for 
Mental Health Client-Level Data (MH-CLD) Annual Report 2021 | Appendix-C.2 

analysis with MH-CLD data by developing a file with a structure similar to the MH-CLD data set. After transposing 

admission and discharge records from MH-TEDS into a client-level file, the MH-TEDS variables are crosswalked to 

MH-CLD variables, which allows for using clients as the unit of analysis for mental health client-level data. This in 

turn allows the SMHAs to use either MH-CLD or MH-TEDS as their reporting method. The common TEDS 

platform in which both the substance use and mental health data are reported enhances the ability to report data for 

people with co-occurring mental and substance use disorders. It also offers optional data fields for clients with 

mental illness that are not captured in MH-CLD, such as referral source, details on criminal justice referral, income 

sources, and health insurance.

Data Reporting Exclusions, Methods, and Periods by State and Territory

Irrespective of the reporting method used (i.e., MH-TEDS and/or MH-CLD), the data presented in this report 

includes clients served through a 12-month reporting period as defined by each SMHA. This report excludes states 

and territories that did not submit their data for the 2021 reporting period. State and territory specific exclusions, 

reporting methods, and reporting periods are described below and are presented in Table C-1. 

• Exclusions: Four states (Florida, Maine, Ohio, and South Dakota) and five territories (American Samoa, 

Federated States of Micronesia, Guam, Marshall Islands, and the U.S. Virgin Islands) did not submit data 

for the 2021 reporting period and are therefore excluded from this report. 

• Reporting Periods: Thirty-seven states and Puerto Rico used the 2021 state fiscal year period (7/1/2020 to 

6/30/2021) as their reporting frame for MH-CLD in 2021. Other states and territories used different starting 

months (e.g., October) and/or lagged fiscal years. 

• Reporting Method: Thirty-two states and 2 territories used MH-CLD as their reporting method; 13 states, the 

District of Columbia, and Puerto Rico used MH-TEDS as their reporting method. Connecticut used both 

MH-CLD (for children and adolescents) and MH-TEDS (for adults) as its reporting method. 
Mental Health Client-Level Data (MH-CLD) Annual Report 2021 | Appendix-C.3 

Table C-1. State and Territory Reporting Methods and Periods, 2021

(C = MH-CLD, T = MH-TEDS)

State or Territory Method 2021 reporting period

Alabama C 10/1/2020 to 9/30/2021

Alaska T 7/1/2020 to 6/30/2021

American Samoa - -

Arizona C 7/1/2020 to 6/30/2021

Arkansas C 7/1/2020 to 6/30/2021

California C 7/1/2019 to 6/30/2020

Colorado C 7/1/2020 to 6/30/2021

Connecticut1 T, C 7/1/2020 to 6/30/2021

Delaware T 7/1/2020 to 6/30/2021

District of Columbia T 10/1/2020 to 9/30/2021

Federated States of 

Micronesia

- -

Florida - 7/1/2020 to 6/30/2021

Georgia T 7/1/2020 to 6/30/2021

Guam - -

Hawaii C 7/1/2020 to 6/30/2021

Idaho C 7/1/2020 to 6/30/2021

Illinois C 7/1/2020 to 6/30/2021

Indiana C 7/1/2020 to 6/30/2021

Iowa C 7/1/2020 to 6/30/2021

Kansas T 7/1/2020 to 6/30/2021

Kentucky C 7/1/2020 to 6/30/2021

Louisiana T 7/1/2020 to 6/30/2021

Maine ** 7/1/2020 to 6/30/2021

Marshall Islands - -

Maryland C 7/1/2020 to 6/30/2021

Massachusetts C 7/1/2020 to 6/30/2021

Michigan T 10/1/2019 to 9/30/2020

Minnesota C 1/1/2020 to 12/31/2020

Mississippi T 7/1/2020 to 6/30/2021

Missouri C 7/1/2020 to 6/30/2021

Montana C 7/1/2020 to 6/30/2021

Nebraska T 7/1/2020 to 6/30/2021

Nevada C 7/1/2020 to 6/30/2021

State or Territory Method 2021 reporting period

New Hampshire C 7/1/2020 to 6/30/2021

New Jersey C 7/1/2020 to 6/30/2021

New Mexico C 7/1/2020 to 6/30/2021

New York2 C 4/1/2020 to 3/31/2021

North Carolina T 7/1/2020 to 6/30/2021

North Dakota C 7/1/2020 to 6/30/2021

Commonwealth of the 

Northern Mariana 

Islands

C 10/1/2020 to 9/30/2021

Ohio * 7/1/2020 to 6/30/2021

Oklahoma T 7/1/2020 to 6/30/2021

Oregon C 1/1/2020 to 12/31/2020

Republic of Palau C 10/1/2019 to 9/30/2020

Pennsylvania T 7/1/2019 to 6/30/2020

Puerto Rico T 7/1/2020 to 6/30/2021

Rhode Island C 7/1/2020 to 6/30/2021

South Carolina C 7/1/2020 to 6/30/2021

South Dakota - 7/1/2020 to 6/30/2021

Tennessee2 C 7/1/2020 to 6/30/2021

Texas C 9/1/2020 to 8/31/2021

Utah C 7/1/2020 to 6/30/2021

Vermont T 7/1/2020 to 6/30/2021

Virginia C 7/1/2020 to 6/30/2021

U.S. Virgin Islands - -

Washington C 7/1/2020 to 6/30/2021

West Virginia T 7/1/2020 to 6/30/2021

Wisconsin C 1/1/2020 to 12/31/2020

Wyoming C 7/1/2020 to 6/30/2021

- State is building capacity for future reporting of client-level data; 

* State is building capacity to switch to MH-TEDS reporting; 

** State switched to building capacity (for MH-CLD reporting) 

due to staff turnover. 1

Connecticut: MH-TEDS for adults, MH-CLD for 

children/adolescents. 

2

New York and Tennessee report only a subset of the total clients 

served through their SMHAs.
Mental Health Client-Level Data (MH-CLD) Annual Report 2021 | Appendix C.4

Data Notes and Limitations

The data included in this report are presented as counts, percentages, and rates per 100,000 population, as 

applicable. The population data for calculating rates per 100,000 were drawn from: 

1.The 2021 Census for estimating total, by age, and by sex populations; 

2.The 2021 America Communities Survey (ACS) for estimating by race, by ethnicity, by employment, and by 

school attendance populations; and

3.The 2021 Point in Time (PIT) data from the Department of Housing and Urban Development (HUD) for 

estimating population by residential status (specifically, clients experiencing homelessness). 

Given the state exclusions and lack of subgroup-level data from a single/consistent source, the population estimates 

downloaded from above sources were adjusted to do the following:

1. Exclude populations for states not included in this report (i.e., Florida, Maine, Ohio, and South Dakota); 

2. Include Puerto Rico total and subgroup population estimates wherever necessary; 

3. Apply U.S. and Puerto Rico Census 2021 population distribution ratios to ACS estimates to generate 

population estimates for children (ages 0 to 17) and adults (ages 18 and older); and

4. Estimate population not experiencing homelessness by subtracting the population experiencing 

homelessness estimates provided by HUD PIT data from the Census/ACS totals. 

It should be noted that data from the Commonwealth of the Northern Mariana Islands and the Republic of Palau 

contribute marginally to the numerators but not to the denominators of all rates.

Mental health diagnosis category data presented in this report uses any reported mental health diagnosis to group 

clients and are presented as percentages of clients who have at least one specific known mental health diagnosis. 

MH-CLD can capture up to 3 diagnoses, and this report uses any mental health diagnosis (whether first, second, or 

third) to group clients. This means that clients with multiple diagnoses can be counted multiple times with their 

respective diagnostic groupings. For some clients, no mental health diagnosis was reported; where tabulated, these 

clients are counted as “No/deferred diagnosis.”

Similar to mental health diagnosis categories, clients may have been in multiple service settings during the reporting 

period; therefore, like mental health diagnosis categories, the sums of counts or percentages of specific service 

settings will exceed the overall count or 100%, respectively.

Records with partially complete data have been retained in this report. For example, an entire client record is not 

removed from the report because a single data item is missing. When records include missing or invalid data for a 

specific variable, those records are excluded from tabulations of that variable. 

States continually review and improve their data collection and processing. When systematic errors are identified, 

states may revise or replace historical MH-TEDS and MH-CLD data files. While this process represents an 

improvement in the data system, the data presented in this report may differ slightly from revised MH-TEDS and 

MH-CLD files. 

Lastly, since both MH-TEDS and MH-CLD reporting methods only capture data on clients served through SMHAs 

using state-defined 12-month reporting periods, these data do not represent the total national demand for mental 

health treatment nor describe the mental health status of the national population. 

Mental Health Diagnosis Group Definitions 

Mental health diagnoses are reported in the MH-TEDS and MH-CLD as codes from the International Classification 

of Diseases, Clinical Modification (ICD-9-CM/ICD-10-CM). Up to three mental health diagnostic codes may be 

reported for each client. For this report, diagnostic codes were grouped to 13 diagnostic groups, based on a modified 

version of the Clinical Classification Software (CCS)1

. Table C-2 below presents these diagnostic groups and their 

associated ICD-9/ICD-10 codes. 
Mental Health Client-Level Data (MH-CLD) Annual Report 2021 | Appendix C.5

Table C-2. Mental Health Diagnosis Groups and International Classification of Diseases (ICD) Codes 

Crosswalk

Diagnosis 

group

ICD-10 codes ICD-9 codes

Attention 

Deficit / 

Hyperactivity 

Disorder 

F90.0, F90.1, F90.2, F90.8, F90.9, R46.0, R46.1, R46.2, R46.3, 

R46.4, R46.5, R46.6, R46.7, R46.81, R46.89

314.00, 314.01, 314.1, 314.2, 314.8, 314.9

(ADD/ADHD) (F90, R46)* (314, 314.0, 314.10, 314.80, 314.90)*

Alcohol-Related 

Disorders 

F10.10, F10.11, F10.120, F10.121, F10.129, F10.14, F10.150, 

F10.151, F10.159, F10.180, F10.181, F10.182, F10.188, F10.19, 

F10.20, F10.21, F10.220, F10.221, F10.229, F10.230, F10.231, 

F10.232, F10.239, F10.24, F10.250, F10.251, F10.259, F10.26, 

F10.27, F10.280, F10.281, F10.282, F10.288, F10.29, F10.920, 

F10.921, F10.929, F10.94, F10.950, F10.951, F10.959, F10.96, 

F10.97, F10.980, F10.981, F10.982, F10.988, F10.99, G62.1, 

I42.6, K29.20, K29.21, K70.0, K70.10, K70.11, K70.2, K70.30, 

K70.31, K70.40, K70.9, O99.310, O99.311, O99.312, O99.313, 

O99.314, O99.315, P04.3, Q86.0

291.0, 291.1, 291.2, 291.3, 291.4, 291.5, 291.8, 291.81, 291.82, 

291.89, 291.9, 303.00, 303.01, 303.02, 303.03, 303.90, 303.91, 

303.92, 303.93, 305.00, 305.01, 305.02, 305.03, 357.5, 425.5, 

535.3, 535.30, 535.31, 571.0, 571.1, 571.2, 571.3, 760.71, 980.0

(F10, F10.1, F10.12, F10.15, F10.18, F10.2, F10.22, F10.23, 

F10.25, F10.28, F10.9, F10.92, F10.95, F10.98, K70, K70.3, 

K70.4, O99.31, Q86)*

(291.00, 291, 291.10, 291.20, 291.30, 291.40, 291.50, 291.80, 

201.90, 303, 303.0, 303.9, 305, 305.0)*

Anxiety 

Disorders 

F06.4, F40.00, F40.01, F40.02, F40.10, F40.11, F40.210, 

F40.218, F40.220, F40.228, F40.230, F40.231, F40.232, 

F40.233, F40.240, F40.241, F40.242, F40.243, F40.248, 

F40.290, F40.291, F40.298, F40.8, F40.9, F41.0, F41.1, F41.3, 

F41.8, F41.9, F42., F42.2, F42.3, F42.4, F42.8, F42.9, F43.0, 

F43.11, F43.12, F48.8, F48.9, F93.0, R45.2, R45.3, R45.4, 

R45.5, R45.6, R45.7, R45.81, R45.82, R45.83, R45.84

293.84, 300.00, 300.01, 300.02, 300.09, 300.10, 300.20, 300.21, 

300.22, 300.23, 300.29, 300.3, 300.5, 300.89, 300.9, 308.0, 

308.1, 308.2, 308.4, 308.9, 309.21, 313.0, 313.1, 313.21, 313.22, 

313.3, 313.82, 313.83

(F40, F40.1, F40.21, F40.22, F40.23, F40.24, F40.29, F41, 

F93)*

(300.0, 300, 300.1, 300.2, 300.30, 300.50, 300.90, 308.00, 308, 

308.10, 308.20, 308.40, 308.90, 313, 313.00, 313.8, 313.80)*

Bipolar 

Disorders 

F31.0, F31.10, F31.11, F31.12, F31.13, F31.2, F31.30, F31.31, 

F31.32, F31.4, F31.5, F31.60, F31.61, F31.62, F31.63, F31.64, 

F31.70, F31.71, F31.72, F31.73, F31.74, F31.75, F31.76, 

F31.77, F31.78, F31.81, F31.89, F31.9

296.00, 296.01, 296.02, 296.03, 296.04, 296.05, 296.06, 296.10, 

296.11, 296.12, 296.13, 296.14, 296.15, 296.16, 296.40, 296.41, 

296.42, 296.43, 296.44, 296.45, 296.46, 296.50, 296.51, 296.52, 

296.53, 296.54, 296.55, 296.56, 296.60, 296.61, 296.62, 296.63, 

296.64, 296.65, 296.66, 296.7, 296.80, 296.81, 296.82, 296.89, 

296.90, 296.99

(F31, F31.1, F31.3, F31.6, F31.7, F31.8)* (296, 296.0, 296.1, 296.4, 296.5, 296.6, 296.70, 296.8, 296.9)*

Conduct 

Disorders 

F91.0, F91.1, F91.2, F91.8, F91.9 312.00, 312.01, 312.02, 312.03, 312.10, 312.11, 312.12, 312.13, 

312.20, 312.21, 312.22, 312.23, 312.4, 312.8, 312.81, 312.82, 

312.89, 312.9

(312, 312.0, 312.1, 312.2, 312.40, 312.80, 312.90)*

Delirium, 

Dementia, and 

Amnestic and 

other Cognitive 

Disorders

F01.50, F01.51, F02.80, F02.81, F03.90, F03.91, F04, F05, 

F07.0, F07.81, F07.89, F07.9, F09, F48.2, G30.0, G30.1, G30.8, 

G30.9, G31.01, G31.09, G31.1, G31.83, R41.81, R54

290.0, 290.10, 290.11, 290.12, 290.13, 290.20, 290.21, 290.3, 

290.40, 290.41, 290.42, 290.43, 290.8, 290.9, 293.0, 293.1, 

294.0, 294.1, 294.10, 294.11, 294.20, 294.21, 294.8, 294.9, 

310.0, 310.2, 310.8, 310.81, 310.89, 310.9, 331.0, 331.1, 331.11, 

331.19, 331.2, 331.82, 797

(F01, F07, G30)* (290.00, 290, 290.1, 290.2, 290.30, 290.4, 290.80, 290.90, 293, 

293.00, 294.00, 294, 294.2, 294.80, 294.90, 310, 310.00, 310.20, 

310.90, 331, 331.00, 331.10)*

Depressive 

Disorders 

F32.0, F32.1, F32.2, F32.3, F32.4, F32.5, F32.8, F32.81, 

F32.89, F32.9, F33.0, F33.1, F33.2, F33.3, F33.40, F33.41, 

F33.42, F33.8, F33.9

293.83, 296.20, 296.21, 296.22, 296.23, 296.24, 296.25, 296.26, 

296.30, 296.31, 296.32, 296.33, 296.34, 296.35, 296.36, 300.4, 

311

(F32, F33, F33.4)* (296.2, 296.3, 300.40, 311.00, 311.0)*

Oppositional 

Defiant Disorder 

(ODD)

F91.3 313.81

Personality 

Disorders 

F60.0, F60.1, F60.2, F60.3, F60.4, F60.5, F60.6, F60.7, F60.81, 

F60.89, F60.9, F69

301.0, 301.10, 301.11, 301.12, 301.13, 301.20, 301.21, 301.22, 

301.3, 301.4, 301.50, 301.51, 301.59, 301.6, 301.7, 301.81, 

301.82, 301.83, 301.84, 301.89, 301.9

(F60)* (301.00, 301, 301.1, 301.2, 301.30, 301.40, 301.5, 301.60, 

301.70, 301.90)*

Pervasive 

Developmental 

Disorders 

(PDD)

F84.0, F84.3, F84.5, F84.8, F84.9 299.00, 299.01, 299.10, 299.11, 299.80, 299.81, 299.90, 299.91

(F84)* (299, 299.1, 299.8, 299.9)*
Mental Health Client-Level Data (MH-CLD) Annual Report 2021 | Appendix C.6

Diagnosis 

group

ICD-10 codes ICD-9 codes

Schizophrenia 

and Other 

Psychotic 

Disorders 

F06.0, F06.2, F20.0, F20.1, F20.2, F20.3, F20.5, F20.81, 

F20.89, F20.9, F21, F22, F23, F24, F25.0, F25.1, F25.8, F25.9, 

F28, F29

293.81, 293.82, 295.00, 295.01, 2950.2, 295.03, 295.04, 295.05, 

295.10, 295.11, 295.12, 295.13, 295.14, 295.15, 295.20, 295.21, 

295.22, 295.23, 295.24, 295.25, 295.30, 295.31, 295.32, 295.33, 

295.34, 295.35, 295.40, 295.41, 295.42, 295.43, 295.44, 295.45, 

295.50, 295.51, 295.52, 295.53, 295.54, 295.55, 295.60, 295.61, 

295.62, 295.63, 295.64, 295.65, 295.70, 295.71, 295.72, 295.73, 

295.74, 295.75, 295.80, 295.81, 295.82, 295.83, 295.84, 295.85, 

295.90, 295.91, 295.92, 295.93, 295.94, 295.95, 297.0, 297.1, 

297.2, 297.3, 297.8, 297.9, 298.0, 298.1, 298.2, 298.3, 298.4, 

298.8, 298.9

(F06, F20, F25)* (295, 295.0, 295.1, 295.2, 295.3, 295.4, 295.5, 295.6, 295.7, 

295.8, 295.9, 297.00, 297, 297.10, 297.20, 207.30, 207.80, 

207.90, 298.00, 298, 298.10, 298.20, 298.30, 298.40, 298.80, 

298.90)*

SubstanceRelated 

Disorders 

F11.10, F11.11, F11.120, F11.121, F11.122, F11.129, F11.13, 

F11.14, F11.150, F11.151, F11.159, F11.181, F11.182, F11.188, 

F11.19, F11.20, F11.21, F11.220, F11.221, F11.222, F11.229, 

F11.23, F11.24, F11.250, F11.251, F11.259, F11.281, F11.282, 

F11.288, F11.29, F11.90, F11.920, F11.921, F11.922, F11.929, 

F11.93, F11.94, F11.950, F11.951, F11.959, F11.981, F11.982, 

F11.988, F11.99, F12.10, F12.120, F12.121, F12.122, F12.129, 

F12.13, F12.150, F12.151, F12.159, F12.180, F12.188, F12.19, 

F12.20, F12.21, F12.220, F12.221, F12.222, F12.229, F12.23, 

F12.250, F12.251, F12.259, F12.280, F12.288, F12.29, F12.90, 

F12.920, F12.921, F12.922, F12.929, F12.950, F12.951, 

F12.959, F12.980, F12.988, F12.99, F13.10, F13.11, F13.120, 

F13.121, F13.129, F13.14, F13.150, F13.151, F13.159, F13.180, 

F13.181, F13.182, F13.188, F13.19, F13.20, F13.21, F13.220, 

F13.221, F13.229, F13.230, F13.231, F13.232, F13.239, F13.24, 

F13.250, F13.251, F13.259, F13.26, F13.27, F13.280, F13.281, 

F13.282, F13.288, F13.29, F13.90, F13.920, F13.921, F13.929, 

F13.930, F13.931, F13.932, F13.939, F13.94, F13.950, F13.951, 

F13.959, F13.96, F13.97, F13.980, F13.981, F13.982, F13.988, 

F13.99, F14.10, F14.120, F14.121, F14.122, F14.129, F14.14, 

F14.150, F14.151, F14.159, F14.180, F14.181, F14.182, 

F14.188, F14.19, F14.20, F14.21, F14.220, F14.221, F14.222, 

F14.229, F14.23, F14.24, F14.250, F14.251, F14.259, F14.280, 

F14.281, F14.282, F14.288, F14.29, F14.90, F14.920, F14.921, 

F14.922, F14.929, F14.94, F14.950, F14.951, F14.959, F14.980, 

F14.981, F14.982, F14.988, F14.99, F15.10, F15.120, F15.121, 

F15.122, F15.129, F15.14, F15.150, F15.151, F15.159, F15.180, 

F15.181, F15.182, F15.188, F15.19, F15.20, F15.21, F15.220, 

F15.221, F15.222, F15.229, F15.23, F15.24, F15.250, F15.251, 

F15.259, F15.280, F15.281, F15.282, F15.288, F15.29, F15.90, 

F15.920, F15.921, F15.922, F15.929, F15.93, F15.94, F15.950, 

F15.951, F15.959, F15.980, F15.981, F15.982, F15.988, F15.99, 

F16.10, F16.11, F16.120, F16.121, F16.122, F16.129, F16.14, 

F16.150, F16.151, F16.159, F16.180, F16.183, F16.188, F16.19, 

F16.20, F16.21, F16.220, F16.221, F16.229, F16.24, F16.250, 

F16.251, F16.259, F16.280, F16.283, F16.288, F16.29, F16.90, 

F16.920, F16.921, F16.929, F16.94, F16.950, F16.951, F16.959, 

F16.980, F16.983, F16.988, F16.99, F17.200, F17.201, F17.203, 

F17.208, F17.209, F17.210, F17.211, F17.213, F17.218, 

F17.219, F17.220, F17.221, F17.223, F17.228, F17.229, 

F17.290, F17.291, F17.293, F17.298, F17.299, F18.10, F18.11, 

F18.120, F18.121, F18.129, F18.14, F18.150, F18.151, F18.159, 

F18.17, F18.180, F18.188, F18.19, F18.20, F18.21, F18.220, 

F18.221, F18.229, F18.24, F18.250, F18.251, F18.259, F18.27, 

F18.280, F18.288, F18.29, F18.90, F18.920, F18.921, F18.929, 

F18.94, F18.950, F18.951, F18.959, F18.97, F18.980, F18.988, 

F18.99, F19.10, F19.120, F19.121, F19.122, F19.129, F19.14, 

F19.150, F19.151, F19.159, F19.16, F19.17, F19.180, F19.181, 

F19.182, F19.188, F19.19, F19.20, F19.21, F19.220, F19.221, 

F19.222, F19.229, F19.230, F19.231, F19.232, F19.239, F19.24, 

F19.250, F19.251, F19.259, F19.26, F19.27, F19.280, F19.281, 

F19.282, F19.288, F19.29, F19.90, F19.920, F19.921, F19.922, 

F19.929, F19.930, F19.931, F19.932, F19.939, F19.94, F19.950, 

F19.951, F19.959, F19.96, F19.97, F19.980, F19.981, F19.982, 

F19.988, F19.99, F55.0, F55.1, F55.2, F55.3, F55.4, F55.8, 

O35.5XX0, O35.5XX1, O35.5XX2, O35.5XX3, O35.5XX4, 

O35.5XX5, O35.5XX9, O99.320, O99.321, O99.322, O99.323, 

O99.324, O99.325, P04.41, P04.49, P96.1, P96.2, T40.0X1A, 

292.0, 292.11, 292.12, 292.2, 292.81, 292.82, 292.83, 292.84, 

292.85, 292.89, 292.9, 304.00, 304.01, 304.02, 304.03, 304.10, 

304.11, 304.12, 304.13, 304.20, 304.21, 304.22, 304.23, 304.30, 

304.31, 304.32, 304.33, 304.40, 304.41, 304.42, 304.43, 304.50, 

304.51, 304.52, 304.53, 304.60, 304.61, 304.62, 304.63, 304.70, 

304.71, 304.72, 304.73, 304.80, 304.81, 304.82, 304.83, 304.90, 

304.91, 304.92, 304.93, 305.20, 305.21, 305.22, 305.23, 305.30, 

305.31, 305.32, 305.33, 305.40, 305.41, 305.42, 305.43, 305.50, 

305.51, 305.52, 305.53, 305.60, 305.61, 305.62, 305.63, 305.70, 

305.71, 305.72, 305.73, 305.80, 305.81, 305.82, 305.83, 305.90, 

305.91, 305.92, 305.93, 648.30, 648.31, 648.32, 648.33, 648.34, 

655.50, 655.51, 655.53, 760.72, 760.73, 760.75, 779.5, 965.00, 

965.01, 965.02, 965.09, V65.42
Mental Health Client-Level Data (MH-CLD) Annual Report 2021 | Appendix C.7

Diagnosis 

group

ICD-10 codes ICD-9 codes

T40.0X1D, T40.0X1S, T40.0X3A, T40.0X3D, T40.0X3S, 

T40.0X4A, T40.0X4D, T40.0X4S, T40.0X5A, T40.0X5D, 

T40.0X5S, T40.0X6A, T40.0X6D, T40.0X6S, T40.1X1A, 

T40.1X1D, T40.1X1S, T40.1X3A, T40.1X3D, T40.1X3S, 

T40.1X4A, T40.1X4D, T40.1X4S, T40.1X5A, T40.1X5D, 

T40.1X5S, T40.5X1A, T40.5X1D, T40.5X1S, T40.5X3A, 

T40.5X3D, T40.5X3S, T40.5X4A, T40.5X4D, T40.5X4S, 

T40.5X5A, T40.5X5D, T40.5X5S, T40.5X6A, T40.5X6D, 

T40.5X6S, T40.7X1A, T40.7X1D, T40.7X1S, T40.7X3A, 

T40.7X3D, T40.7X3S, T40.7X4A, T40.7X4D, T40.7X4S, 

T40.7X5A, T40.7X5D, T40.7X5S, T40.7X6A, T40.7X6D, 

T40.7X6S, T40.8X1A, T40.8X1D, T40.8X1S, T40.8X3A, 

T40.8X3D, T40.8X3S, T40.8X4A, T40.8X4D, T40.8X4S, 

T40.8X5A, T40.8X5D, T40.8X5S, T40.901A, T40.901D, 

T40.901S, T40.903A, T40.903D, T40.903S, T40.904A, 

T40.904D, T40.904S, T40.905A, T40.905D, T40.905S, 

T40.906A, T40.906D, T40.906S, T40.991A, T40.991D, 

T40.991S, T40.993A, T40.993D, T40.993S

(292, 292.00, 202.20, 202.90, 304, 304.0, 304.1, 304.2, 304.3, 

304.4, 304.5, 304.6, 304.7, 304.8, 304.9, 305., 305.2, 305.3, 

305.4, 305.5, 305.6, 305.7, 305.8, 305.9, 655.5, 965)*

Trauma and 

Stressor-Related 

Disorders

F43.10, F43.20, F43.21, F43.22, F43.23, F43.24, F43.25, 

F43.29, F43.8, F43.9

308.3, 309.0, 309.1, 309.22, 309.23, 309.24, 309.28, 309.29, 

309.3, 309.4, 309.81, 309.82, 309.83, 309.89, 309.9

(F43.1, F43.2)* (308.30, 309, 309.00, 309.10, 309.20, 309.30, 309.40, 309.80, 

30.98, 309.90)*

Other For additional specific ICD-10 codes classified as ‘other’ mental 

health diagnoses, see Appendix E of the 2020

MH-CLD Annual Report.1

For additional specific ICD-9 codes classified as ‘other’ mental 

health diagnoses, see Appendix E of the 2020 MH-CLD Annual 

Report.2

1

CCS Category Names/Labels can be accessed at https://hcup-us.ahrq.gov/toolssoftware/ccs/CCSCategoryNames_FullLabels.pdf 

2

Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. Mental Health Annual Report: 

2015–2020. Use of Mental Health Services: National Client-Level Data. Rockville, MD: Substance Abuse and Mental Health Services 

Administration, 2022. https://www.samhsa.gov/data/report/2020-mental-health-client-level-data-annual-report 

*Italicized codes are nonstandard ICD-9 or ICD-10 codes in the data belonging to the same mental health diagnostic group and included in the 

category. 
Mental Health Client-Level Data (MH-CLD) Annual Report 2021 | Appendix C.8