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Substance Abuse and Mental Health Services Administration
Community-Based Care Increases for People With Serious Mental Illness
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Mental disorders take an enormous toll on the nation’s families and finances. The indirect costs of mental illness, such as for lost productivity, were estimated at $78.6 billion in 1990. In 1997, $73 billion was spent on mental health services. The Surgeon General has estimated that about 20 percent of the U.S. population is affected by a mental disorder in a given year.1 About 5 percent of the population are considered to have a serious mental illness (SMI). SMI, which includes, among other diseases, schizophrenia, bipolar disorder, and major depression, is a chronic condition that can substantially limit a person’s ability to function in many areas of life such as employment, self-care, and interpersonal relationships. Effective treatment can reduce the severity of these problems for the majority of people with SMI. Much of this treatment can now be provided in the community rather than in institutions.

Because of your long-standing concern with the availability and financing of mental health services, you asked us to review mental health services for people with SMI. Specifically, you asked us to (1) provide information on mental health spending and how it has changed since the 1980s; (2) identify the types of community-based services that are provided to adults with SMI, including people who are homeless, and difficulties in providing these services; and (3) determine how the Health Care Financing Administration (HCFA), which administers the Medicaid program, supports the provision of community-based services for adults with SMI who are eligible for Medicaid. (GAO)
Washington, D.C.