Lita Jans, Ph.D.
The establishment of the President's New Freedom Commission on Mental Health marks an important step in improving the lives of people with disabilities due to mental disorders. The wide prevalence of mental disorders, and the need for improved services and resources, is addressed in the Commission’s report "Achieving the Promise: Transforming Mental Health Care in America" (New Freedom Commission, 2003). Together with the 1999 Surgeon General’s Report, the Commission’s report makes a compelling case for increased research to enhance our understanding of mental disorders. The National Institute on Disability and Rehabilitation Research, U.S. Department of Education, is concerned with the disabling effects of mental disorders, and supports research leading to improved choices, services and outcomes.
This InfoUse Chartbook is one in a series of NIDRR-supported statistical chartbooks intended for a broad public audience. Drawing from national surveys and statistical research, this Chartbook presents information on the prevalence of mental disorders, and the extent to which mental disorders contribute to reduced participation in major life activities such as school and work. While existing information can be used to describe the issues and to engage in planning for improved services, the available surveys have serious limitations. Surveys use different definitions and terminology, and some key information is available only in older surveys or data sources. As we move toward the transformation of mental health care, it is important to continue to build our data sources, knowledge, and understanding.
Steven Tingus, Director
The Chartbook on Mental Health and Disability in the United States relies on published data from many federal agencies and organizations. We appreciate all of the people and agencies responsible for collecting, maintaining, and analyzing these data.
The following people graciously assisted us by providing information and/or commenting on preliminary drafts.
We especially thank the following people who provided extensive input on the development of the Chartbook.
We are also grateful to David Keer, NIDRR project officer, who has provided statistical materials, expert advice, review, and ongoing encouragement.
The Chartbook on Mental Health and Disability in the United States is a reference on disability and mental health in the United States, created for both non-technical and technical audiences. The book is a resource for agencies, employers, organizations, policymakers, researchers and others concerned with the relationship between mental health and disability.
Each section addresses an aspect of mental health and disability. Each page within the section contains a topic question, explanatory text on the topic and an explanatory graphic or table that provides data in an easy to read form. The figure title gives the name of the graphic. The source of the information and the survey used to collect the data appear at the bottom of the page. The key surveys, shown in boldface and color when mentioned in the text, have a technical summary that is located in the Appendix. In the text, key terms are also shown in boldface and color and are defined in the Glossary.
Mental disorders affect about one fifth of the United States population in a given year. If people with mental disorders are to participate actively and productively in our communities, workplaces and schools, resources must be expanded and services improved. Many researchers and professionals have contributed to our understanding of mental disorders and to improved treatment, medication, services and benefits. Much, however, remains to be accomplished.
This Chartbook on Mental Health and Disability provides easy-to-understand statistics about people who have mental disorders and people who have disabilities caused by mental disorders. Designed for use by policymakers, the press, and the public, the Chartbook summarizes important information from national surveys and from available research. This is a resource useful to people in the mental health field and people in the disability community, presenting research findings to create a bridge between those two perspectives.
In the area of mental health and disability, it is particularly difficult to find accurate and consistent language that is understood and accepted by both mental health and disability audiences. Following the lead of the Surgeon General’s 1999 report, we have chosen to use the general term mental disorder to describe "health conditions that are characterized by alterations in thinking, mood, or behavior (or some combination thereof) associated with distress and/or impaired functioning" (U.S. Department of Health and Human Services, 1999, p. vii). The studies and surveys on which this Chartbook is based have used other terms that are roughly synonymous with mental disorder, including mental condition, mental illness, and psychiatric disorder. These terms are defined in the text and in the glossary.
Not all people who have a mental disorder have a disability. This Chartbook is primarily about people who experience limitation in important life activities as a result of having a mental disorder -- a disability due to a mental disorder. Researchers have used the related terms mental health disability, severe mental illness, serious mental illness, and mental disability that are roughly equivalent to the term disability due to a mental disorder. On the pages that present information from particular studies and surveys, we use the terminology established by that study or survey finding.
In general we have not included people with mental retardation or learning disabilities in the categories of mental disorders and disabilities due to mental disorders. Occasionally, data sources do include those groups in the statistics. On those particular pages, we have noted when those groups are included.
Section One includes information on how many people have mental disorders and disabilities due to mental disorders. The concept of disability includes not only the diagnosis of a mental disorder but also limitations in basic activities due to the disorder.
Section Two provides additional information on disability due to mental disorders among adults. Adults with mental disorders may face limitations in their day-to-day activities, including work. The employment rate for people with mental disorders is much lower than the national employment rate, and is especially low for people with disabilities due to mental disorders.
Section Three includes estimates of how many children have disabilities due to mental disorders. Almost ten percent of the children in the special education system are identified as having emotional disturbance. Students with emotional disturbance have higher dropout rates than other students, and are less likely to successfully complete high school.
Section Four provides information on resources, benefits, and services designed to address the needs of people with disabilities due to mental disorders, and to reduce or eliminate barriers to their full participation. The need for services and resources is apparent in increased demand for Social Security support, as well as the use of services provided by Vocational Rehabilitation and Independent Living Centers. The service gap is also reflected in the numbers of people who are homeless, the numbers without access to needed care and treatment, and the extent to which both juveniles and adults receive mental health services through prisons and jails. The shortfall in appropriate treatment and services results in lost productivity, lost lifetime earnings, and cost of care for people with disabilities due to mental disorders.
Section Five addresses gaps in available information and services, and the need for better survey information.