14928 Federal Register / Vol. 62, No. 60 / Friday, March 28, 1997 / Notices

Place: 6120 Executive Blvd., Bethesda, MD

20892 (telephone conference call).

Contact Person: Richard Fisher, Ph.D.,

Scientific Review Administrator, NIDCD/

DEA/SRB, EPS Room 400C, 6120 Executive

Boulevard, MSC 7180, Bethesda MD 20892–

7180, 301–496–8683.

Purpose/Agenda: To review and evaluate

grant applications.

The meetings will be closed in accordance

with the provisions set forth in sections

552b(c)(4) and 552(b)(6), Title 5, United

States Code. The applications and/or

proposals and the discussion could reveal

confidential trade secrets or commercial

property such as patentable material and

personal information concerning individuals

associated with the applications and/or

proposals, the disclosure of which would

constitute a clearly unwarranted invasion of

personal privacy.

This notice is being published less than

fifteen days prior to the meetings due to the

urgent need to meet timing limitations

imposed by the review and funding cycle.

(Catalog of Federal Domestic Assistance

Program No. 93.173 Biological Research

Related to Deafness and Communication

Disorders)

Dated: March 21, 1997.

LaVerne Y. Stringfield,

Committee Management Officer, NIH.

[FR Doc. 97–7830 Filed 3–27–97; 8:45 am]

BILLING CODE 4140–01–M

Substance Abuse and Mental Health

Services Administration

Estimation Methodology for Adults

with Serious Mental Illness (SMI)

AGENCY: Center for Mental Health

Services, Substance Abuse and Mental

Health Services Administration, HHS.

ACTION: Solicitation of comments.

SUMMARY: This notice describes the

proposed methodology for identifying

and estimating the number of adults

with serious mental illness (SMI) within

each State. This notice is being served

as part of the requirement of Public Law

102–321, the ADAMHA Reorganization

Act of 1992.

COMMENT PERIOD: The Administrator is

requesting written comments which

must be received on or before May 27,

1997.

ADDRESSES: Comments should be sent to

Ronald W. Manderscheid, Ph.D., Chief,

Survey and Analysis Branch, Center for

Mental Health Services, Parklawn

Building Room 15C–04, 5600 Fishers

Lane, Rockville, MD 20857. (301) 443–

7926 fax.

FOR FURTHER INFORMATION CONTACT: A

detailed paper outlining the estimation

methodology described here is available

from Ronald W. Manderscheid, Ph.D.,

Chief, Survey and Analysis Branch,

Center for Mental Health Services,

Parklawn Building Room 15C–04, 5600

Fishers Lane, Rockville, MD 20857.

(301) 443–3343 voice, (301) 443–7926

fax.

Background

Public Law 102–321, the ADAMHA

Reorganization Act of 1992, amended

the Public Health Service Act and

created the Substance Abuse and Mental

Health Services Administration

(SAMHSA). The Center for Mental

Health Services (CMHS) was established

within SAMHSA to coordinate Federal

efforts in the prevention, treatment, and

promotion of mental health. Title II of

Public Law 102–321 establishes a Block

Grant for Community Mental Health

Services administered by CMHS, which

permits the allocation of funds to States

for the provision of community mental

health services to children with a

serious emotional disturbance and

adults with a serious mental illness.

Public Law 102–321 stipulates that

States estimate the incidence (number of

new cases) and prevalence (total

number of cases in a year) in their

applications for Block Grant funds. As

part of the process of implementing this

new block grant, definitions of the terms

‘‘children with a serious emotional

disturbance’’ and ‘‘adults with a serious

mental illness’’ were announced on May

20, 1993, in Federal Register Volume

58, No. 96, p. 29422. Subsequently, a

group of technical experts was

convened by CMHS to develop an

estimation methodology to

‘‘operationalize the key concepts’’ in the

definition of adults with serious mental

illness. A similar group is preparing an

estimation methodology for children

and adolescents with a serious

emotional disturbance.

Data Sources

Data from two major national studies,

the National Comorbidity Survey (NCS)

and the Epidemiologic Catchment Area

(ECA) Study, were used to estimate the

prevalence of adults with serious mental

illness. The NCS, a nationally

representative sample household survey

conducted in 1990–91 assessed the

prevalence of DSM–III–R disorders in

persons aged 15–54 years old. This

sample included over 1,000 census

tracts in 174 counties in 34 States. The

ECA, a general population survey of five

local areas in the U.S., was conducted

in 1980–85 to determine the prevalence

of DSM III disorders in persons age 18

and older. The ECA data utilized for the

present analysis was limited to the

Baltimore site because that was the only

site that had disability data needed to

operationalize the criteria for SMI.

Although the Baltimore sample is not

nationally representative, it is used in

this analysis because the ECA provides

a rough replication and check on the

NCS data. Also, the NCS does not have

data on persons age 55 and older, so the

ECA data are used to estimate the

prevalence of serious mental illness

among persons 55 years and older. The

group of technical experts determined

that it is not possible to develop

estimates of incidence using currently

available data. However, it is important

to note that incidence is always a subset

of prevalence. In future, incidence and

prevalence data will be collected.

Serious Mental Illness (SMI)

As previously defined by CMHS,

adults with a serious mental illness are

persons 18 years and older who, at any

time during a given year, had a

diagnosable mental, behavioral, or

emotional disorder that met the criteria

of DSM–III–R AND ‘‘* * * that has

resulted in functional impairment

which substantially interferes with or

limits one or more major life activities

* * *.’’ The definition states that

‘‘* * * adults who would have met

functional impairment criteria during

the referenced year without the benefit

of treatment or other support services

are considered to have serious mental

illnesses * * *.’’ DSM–III–R ‘‘V’’ codes,

substance use disorders, and

developmental disorders are excluded

from this definition.

The following criteria were used to

operationalize the definition of serious

mental illness in the NCS and ECA data:

(1) Persons who met criteria for

disorders defined as severe and

persistent mental illnesses (SPMI) by

the National Institute of Mental Health

(NIMH) National Advisory Mental

Health Council (National Advisory

Mental Health Council, 1993).

To this group were added:

(2) Persons who had another 12-

month DSM–III–R mental disorder (with

the exclusions noted above), AND

• Either planned or attempted suicide

at some time during the past 12 months,

OR

• Lacked any legitimate productive

role, OR

• Had a serious role impairment in

their main productive roles, for

example, consistently missing at least

one full day of work per month as a

direct result of their mental health, OR

• Had serious interpersonal

impairment as a result of being totally

socially isolated, lacking intimacy in

social relationships, showing inability

to confide in others, and lacking social

support.
Federal Register / Vol. 62, No. 60 / Friday, March 28, 1997 / Notices 14929

Estimation Procedures

Two logistic regression models were

developed to calculate prevalence

estimates for adults with SMI.

(a) A Census Tract Model for years in

which the decennial U.S. census is

conducted.

(b) A County-Level Model to be used

biannually in intercensal years.

In non-censal years, the county-level

model will be used to estimate SMI

prevalence, after adjusting for its known

relationship with the census tract

model.

Formula

Census-Tract Model

Using 1990 census data, a logistic

regression model was developed to

calculate predicted rates for each cell of

an age by sex by race table for each of

the 61,253 Census Tracts in the country.

Next, the rates were multiplied by cell

frequencies and subtotaled to derive

tract-level estimates. Finally, the tractlevel estimates were aggregated to arrive

at county-level and state-level

prevalence estimates of adults with SMI.

This regression methodology is often

used in small area estimation (Ericksen,

1974; Purcell & Kish, 1979). The actual

census tract model equation is specified

immediately below:

PARAMETER ESTIMATES FOR CENSUS-TRACT MODEL

Predictor Odds ratio

95% confidence interval

Intercept ................................................................................................................................................................... *0.02 (0.01–0.04)

Individual-Level Variables

Age:

18–24 ................................................................................................................................................................ *1.94 (1.18–3.17)

25–34 ................................................................................................................................................................ 1.32 (0.86–2.03)

35–44 ................................................................................................................................................................ 1.46 (0.96–2.21)

45–54 ................................................................................................................................................................ 1.00 (—)

Sex:

Female .............................................................................................................................................................. *2.23 (1.57–3.19)

Male .................................................................................................................................................................. 1.00 (—)

Race:

Nonhispanic white ............................................................................................................................................. 1.00 (—)

Black/Hispanic/other ......................................................................................................................................... *0.49 (0.28–0.87)

Marital Status:

Married/Cohabiting ............................................................................................................................................ 1.00 (—)

Never Married ................................................................................................................................................... *3.90 (1.15–3.08)

Separated/Divorced/Widowed ........................................................................................................................... *1.88 (2.41–6.31)

Census-Tract Level Variables

F2 (High socio-economic status) ............................................................................................................................. 1.16 (0.90–1.49)

F4 (Immigrants) ........................................................................................................................................................ 0.99 (0.85–1.14)

County-Level Variables

County Urbanicity:

Metropolitan ...................................................................................................................................................... 1.12 (0.85–1.49)

Other ................................................................................................................................................................. 1.00 (—)

Interactions Among Variables

FemaleXSeparated/Divorced/Widowed ................................................................................................................... *0.47 (0.24–0.91)

FemaleXNever Married ............................................................................................................................................ *0.47 (0.28–0.78)

Non WhiteXSeparated/Divorced/Widowed .............................................................................................................. *2.62 (1.29–5.33)

Non WhiteXNever Married ....................................................................................................................................... 1.81 (0.95–3.44)

FemaleXF2 ............................................................................................................................................................... *0.70 (0.51–0.96)

UrbanicityXF2 ........................................................................................................................................................... *0.75 (0.52–0.95)

F2XF4 ....................................................................................................................................................................... 0.78 (0.64–0.94)

*Significant at the .05 level, two tailed test; F2=Census Tract factor score for high socioeconomic status (SES); F4=Census Tract factor score

for immigrants.

The estimate for persons 55 years and

older is derived from analysis of ECA

data in conjunction with NCS data. The

prevalence ratio among ECA

respondents ages 55–64 and 65 years

and above, were found to be 84 and 31

percent as large, respectively, as the

prevalence estimate for NCS

respondents 18–54 years old, after

controlling for differences in gender and

race. NCS State-level estimates were

extrapolated using these ratios. These

ratios did not differ significantly by sex

or race. A factor of .81 was applied to

State-level SMI estimates for the age

range 18–54 to derive the rate for the age

range 55–64, and .31 was used to arrive

at the estimate for person 65 and older.

A weighted sum (by age distribution of

each State) was calculated to determine

the final State-level SMI prevalence

estimate.

County Model

U.S. Census Bureau tract-level data

are available only for years in which the

decennial U.S. Census is conducted. To

obtain prevalence estimates for adults

with a SMI during intercensal years, the

group of technical experts used biennial

individual- and county-level data from

the Census Bureau’s small area

estimation program. Predicted values
14930 Federal Register / Vol. 62, No. 60 / Friday, March 28, 1997 / Notices

from the logistic regression equation

were used to calculate county-level

estimates. In contrast to the census tract

model, the initial estimates using this

approach were generated at the county

level. These county-level estimates are

then summed to provide State-level

prevalence estimates. The actual

county-level model equation is specified

immediately below:

PARAMETER ESTIMATES FOR COUNTY-LEVEL MODEL

Predictor Odds ratio

95% confidence interval

Intercept ................................................................................................................................................................... *0.04 (0.02–0.07)

INDIVIDUAL-LEVEL VARIABLES

Age:

18–24 ................................................................................................................................................................ 1.69 (1.00–2.85)

25–34 ................................................................................................................................................................ 1.10 (0.65–1.88)

35–44 ................................................................................................................................................................ 1.24 (0.71–2.15)

45–54 ................................................................................................................................................................ 1.00 ( – )

Sex:

Female .............................................................................................................................................................. 1.58 (1.17–2.13)

Male .................................................................................................................................................................. 1.00 ( – )

COUNTY-LEVEL VARIABLES

Urbanicity:

Metropolitan ...................................................................................................................................................... 1.35 (0.99–1.85)

Other ................................................................................................................................................................. 1.00 ( – )

*Significant at the 0.05 level, two-tailed test.

Adjustment for persons age 55 years

and older is carried out as in the censustract model. An adjustment factor

(Census Bureau, Fay, 1987; Fay &

Herriot, 1979) based on the ratio of

county-level model estimates for 1990

and census-tract model estimates for

1990 can be used to adjust biannual

estimates for subsequent years from the

county-level model. This procedure

assumes that the census-tract model is

more accurate than the county-level

model.

County and State Estimates

As stated earlier, census tract model

prevalence estimates were summed to

derive county estimates, and county

estimates were summed to arrive at

State estimates. The 12-month

prevalence is estimated nationally to be

5.4 percent or 10.0 million people in the

adult household population, of which

2.6 percent or 4.8 million adults have a

serious and persistent mental illness

(figure 1).

The above estimates are based on

noninstitutionalized persons residing in

the community. Limited information

currently exists on SMI estimates for

persons institutionalized (i.e., persons

in correctional institutions, nursing

homes, the homeless, persons in

military barracks, hospitals/schools/

homes for persons who are mentally ill

or mentally retarded). Fischer and

Breakey (1991), indicate that on average,

the SMI prevalence rate for these groups

(including about 5 million people or 2.7

percent of the U.S. adult population) is

about 50 percent. The following

assumptions were made in deriving

rough estimates of SMI prevalence for

persons who are institutionalized:

(a) For 1.1 million residents of

correctional institutions, 100 percent of

whom are adults, prevalence of SMI is

estimated to be 57 percent.

(b) For 1.8 million residents of

nursing homes, 100 percent of whom

are adults, prevalence of SMI is

estimated to be 46 percent.

(c) For 0.5 million persons who are

homeless, 80 percent of whom are

adults, prevalence of SMI is estimated to

be 50 percent.

(d) For 0.6 million persons in military

barracks, all of whom are adults, the

SMI prevalence rate is equivalent to that

of the adult household population.

(e) For 0.4 million persons in

hospitals, homes, and schools for

persons who are mentally ill, 80 percent

of whom are adults, prevalence of SMI

is estimated to be 100 percent.

(f) For 0.6 million persons in other

institutional settings such as chronic

disease hospitals, homes and schools for

persons with physical disability, and

rooming houses, 50 percent of whom are

adults, prevalence of SMI is estimated to

be 50 percent.

State estimates of each of these

populations can be added to the State

SMI populations identified below.

Only a portion of adults with SMI

seek treatment in any given year. Due to

the episodic nature of SMI, some

persons may not require mental health

service at any particular time.

Provision of Estimates to States

CMHS will provide each State mental

health agency with estimates in order to

initiate the first cycle of use.

Subsequently, CMHS will provide

technical assistance to States to

implement the methodology using State

demographic information.

TABLE 1.—ESTIMATED 12-MONTH PREVALENCE OF SERIOUS MENTAL ILLNESS (SMI) AMONG PERSONS AGES 18 AND

OLDER, BY STATE, 1990∗∂

State Number of people

with SMI

Total adult population 18 yrs+ Prevalence of SMI

Alabama ............................................................................................................... 172,944 2,981,799 5.8

Alaska ................................................................................................................... 23,795 377,699 6.3

Arizona ................................................................................................................. 179,835 2,684,109 6.7
Federal Register / Vol. 62, No. 60 / Friday, March 28, 1997 / Notices 14931

TABLE 1.—ESTIMATED 12-MONTH PREVALENCE OF SERIOUS MENTAL ILLNESS (SMI) AMONG PERSONS AGES 18 AND

OLDER, BY STATE, 1990∗∂—Continued

State Number of people

with SMI

Total adult population 18 yrs+ Prevalence of SMI

Arkansas ............................................................................................................... 95,128 1,729,594 5.5

California .............................................................................................................. 1,386,586 22,009,296 6.3

Colorado ............................................................................................................... 160,586 2,433,128 6.6

Connecticut ........................................................................................................... 129,414 2,537,535 5.1

Delaware .............................................................................................................. 28,661 502,827 5.7

District of Columbia .............................................................................................. 28,409 489,808 5.8

Florida ................................................................................................................... 624,445 10,071,689 6.2

Georgia ................................................................................................................. 299,308 4,750,913 6.3

Hawaii ................................................................................................................... 31,468 828,103 3.8

Idaho ..................................................................................................................... 38,409 698,344 5.5

Illinois .................................................................................................................... 500,570 8,484,236 5.9

Indiana .................................................................................................................. 237,115 4,088,195 5.8

Iowa ...................................................................................................................... 109,067 2,057,875 5.3

Kansas .................................................................................................................. 103,510 1,815,960 5.7

Kentucky ............................................................................................................... 161,141 2,731,202 5.9

Louisiana .............................................................................................................. 176,570 2,992,704 5.9

Maine .................................................................................................................... 48,703 918,926 5.3

Maryland ............................................................................................................... 220,773 3,619,227 6.1

Massachusetts ...................................................................................................... 265,811 4,663,350 5.7

Michigan ............................................................................................................... 410,192 6,836,532 6.0

Minnesota ............................................................................................................. 179,666 3,208,316 5.6

Mississippi ............................................................................................................ 100,455 1,826,455 5.5

Missouri ................................................................................................................ 216,728 3,802,247 5.7

Montana ................................................................................................................ 30,002 576,961 5.2

Nebraska .............................................................................................................. 62,066 1,149,373 5.4

Nevada ................................................................................................................. 65,152 904,885 7.2

New Hampshire .................................................................................................... 49,830 830,497 6.0

New Jersey ........................................................................................................... 314,328 5,930,726 5.3

New Mexico .......................................................................................................... 69,441 1,068,328 6.5

New York .............................................................................................................. 768,930 13,730,906 5.6

North Carolina ...................................................................................................... 296,326 5,022,488 5.9

North Dakota ........................................................................................................ 23,634 463,415 5.1

Ohio ...................................................................................................................... 474,795 8,047,371 5.9

Oklahoma ............................................................................................................. 133,898 2,308,578 5.8

Oregon .................................................................................................................. 124,973 2,118,191 5.9

Pennsylvania ........................................................................................................ 508,863 9,086,833 5.6

Rhode Island ........................................................................................................ 48,222 777,774 6.2

South Carolina ...................................................................................................... 156,556 2,566,496 6.1

South Dakota ........................................................................................................ 24,877 497,542 5.0

Tennessee ............................................................................................................ 230,617 3,660,581 6.3

Texas .................................................................................................................... 850,547 12,150,671 7.0

Utah ...................................................................................................................... 71,201 1,095,406 6.5

Vermont ................................................................................................................ 24,341 419,675 5.8

Virginia .................................................................................................................. 280,957 4,682,620 6.0

Washington ........................................................................................................... 216,318 3,605,305 6.0

West Virginia ........................................................................................................ 70,195 1,349,900 5.2

Wisconsin ............................................................................................................. 205,359 3,602,787 5.7

Wyoming ............................................................................................................... 17,812 318,063 5.6

*Total ......................................................................................................... 9,995,579 185,103,320 5.4

Does not include persons who are homeless or are institutionalized.

∂ The total for the U.S. is based upon direct, weighted counts from the survey results. The total for each State is based upon synthetic modeling at the county level and then summing across counties to derive a State total. These two approaches are subject to different types of sampling and nonsampling errors. Therefore, the sum of the state totals will not necessarily equal the U.S. total.

Limitations

The ECA and NCS were designed to

study lifetime prevalence of mental

disorders rather than 12-month

prevalence. As a result, the emphasis in

diagnostic assessment was on lifetime

disorders. In addition, functional

impairment was not a primary focus in

either the ECA or the NCS.

Current data cannot provide estimates

of incidence. Additional information

needs to be collected in the future.

Scope of Application

Inclusion in or exclusion from the

definition is not intended to confer or

deny eligibility for any service or benefit

at the Federal, State, or local levels.

Additionally, the definition is not

intended to restrict the flexibility or

responsibility of the State or local

government to tailor publicly funded

service systems to meet local needs and

priorities. However, all individuals

whose services are funded through

Federal Community Mental Health

Services Block Grant funds must fall

within the criteria set forth in these

definitions. Any ancillary use of these

definitions for purposes other than

those identified in the legislation is

outside the purview and control of

CMHS.
14932 Federal Register / Vol. 62, No. 60 / Friday, March 28, 1997 / Notices

It is anticipated that additional work

will be done in future years to refine

and update the estimation methodology.

CMHS will keep States apprised as this

work develops.

References

Ericksen, E. P. (1974). A regression method

for estimating population changes of

local areas. Journal of American

Statistical Association, 69, 867–875.

Fay, R. E. (1987). Application of multivariate

regression to small domain estimation. In

R. Platek, J.N.K. Rao, C.E. Sarndal & M.P.

Singh (Eds.), Small Area Statistics: An

International Symposium, Pp. 91–102.

New York: John Wiley and Sons.

Fay, R. E., & Herriot, R. A. (1979). Estimates

of income for small places: An

application of James-Stein procedures to

Census data. Journal of the American

Statistical Association, 74, 269–277.

Fischer, P.J., Breakey, W.R. (1991). The

Epidemiology of alcohol, drug, and

mental disorders among homeless

persons. American Psychologist. 46,

1115–1125.

Kessler, R.C., et al. Estimation of the 12-

month Prevalence of Serious Mental

Illness (SMI). (1996). Unpublished

document.

National Advisory Mental Health Council.

(1993). Health care reform for Americans

with severe mental illness. American

Journal of Psychiatry, 150, 1447–1465.

Purcell, N. J., & Kish, L. (1979). Estimation

for small domains. Biometrics, 35, 365–

384.

Regier, D. A., Narrow, W.E., Rae, D.S.,

Manderscheid, R.W., Locke, D.Z.,

Goodwin, F.K. (1993). The de Facto US

Mental and Addictive Disorders Service

System. Archives of General Psychiatry,

50, 85–94.

Dated: March 5, 1997.

Richard Kopanda,

Executive Officer, Substance Abuse and

Mental Health Services Administration.

BILLING CODE 4162–20–P

[FR Doc. 97–7734 Filed 3–27–97; 8:45 am]

BILLING CODE 4162–20–C

DEPARTMENT OF HOUSING AND

URBAN DEVELOPMENT

[Docket No. FR–4124–N–31]

Federal Property Suitable as Facilities

to Assist the Homeless

AGENCY: Office of the Assistant

Secretary for Community Planning and

Development, HUD.

ACTION: Notice.

SUMMARY: This Notice identifies

unutilized, underutilized, excess, and

surplus Federal property reviewed by

HUD for suitability for possible use to

assist the homeless.

FOR FURTHER INFORMATION CONTACT:

Mark Johnston, room 7256, Department

of Housing and Urban Development,

451 Seventh Street SW., Washington,