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A PROFILE OF KENTUCKY MEDICAID MENTAL HEALTH DIAGNOSES, 2000-2010

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A Profile of Kentucky Medicaid Mental Health Diagnoses,2000‐2010 BY Michael T. Childress RESEARCH SUPPORTED BY The Foundation for a Healthy Kentucky SEPTEMBER 2012 College of Communication and Information 308B Lucille Caudill Little Fine Arts Library University of Kentucky Lexington, KY 40506‐0224 Center for Business and Economic Research 335AV Gatton College of Business and Economics University of Kentucky Lexington, KY 40506‐0034 859.257.2912 office 859.257.7671 fax [email protected]

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PREFACE

ood policy is dependent upon good data. This is especially true in health policy. Here we provide data on the number of Kentucky Medicaid beneficiaries who have received a mental or behavioral health diagnosis from 2000 to 2010. A Profile of Kentucky Medicaid Mental Health Diagnoses, 2000‐2010 provides infor‐

mation on the total number of individuals who have been diagnosed with a mental health disorder as well as a year‐by‐year count of the 15 broad categories used to classify these diagnoses. Presented for children (age 18 and younger) and adults (19 and older), these data are organized at the state, regional, and county levels—which should enable leaders and citizens to compare mental health diagnoses between different communities. These comparisons should provoke important public policy and public health questions, such as what accounts for the different patterns across the state overall, between genders, and among races with respect to, for example, ADHD, developmental disorders, and substance‐related disorders. Moreover, used in conjunction with a companion re‐port on Medicaid pharmaceutical utilization, the Kentucky Medicaid Pharmaceutical Utilization Guide, 2000‐2010, the strategic allocation of resources dedicated to improving health literacy can be advanced—among patients, health care providers, and the community at large. This work is a collaborative effort between the Foundation for a Healthy Kentucky, the University of Kentucky College of Communication and Information, and the Center for Business and Economic Research (CBER) in the Gat‐ton College of Business and Economics. Foundation for a Healthy Kentucky This research is funded by a grant from the Foundation for a Healthy Kentucky. For more information about the Foundation, please visit http://www.healthy‐ky.org. Inquiries about the Foundation and its various initiatives should be directed to: Susan G. Zepeda, Ph.D., President/CEO Foundation for a Healthy Kentucky 9300 Shelbyville Road, Suite 1305 Louisville, KY 40222 Voice: (502) 326‐2583 Toll Free: (877) 326‐2583 E‐mail: info@healthy‐ky.org Web: www.healthy‐ky.org College of Communication and Information Research has connected poor health literacy—the ability of individuals to understand basic health information and make appropriate decisions—to poor health outcomes and increased costs for healthcare. There are many indica‐tors that point to poor health literacy in Kentucky: our citizens frequently make poor health choices, they suffer from high levels of chronic disease and disability, and they have low levels of prose literacy. The College of Com‐munication and Information has launched a Health Literacy Initiative to help improve the health literacy and health outcomes of our citizens. Information about the College’s Health Literacy Initiative is available at http://cis.uky.edu/hl/. Inquiries about the College and its various initiatives should be directed to: Dan O'Hair, Ph.D. Dean & Professor 308 Lucille Caudill Little Fine Arts Library College of Communications and Information Studies University of Kentucky Lexington, KY 40506‐0224 Voice: (859) 218‐0290 E‐mail: [email protected] Web: cis.uky.edu

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Center for Business and Economic Research The Center for Business and Economic Research (CBER) is the applied economic research branch of the Carol Mar‐tin Gatton College of Business and Economics at the University of Kentucky. Its purpose is to disseminate economic information and provide economic and policy analysis to assist decision makers in Kentucky’s public and private sectors. In addition, CBER performs research projects for federal, state, and local government agencies, as well as for private‐sector clients nationwide. The primary motivation behind CBER’s research agenda is the belief that sys‐tematic and scientific inquiries into economic phenomena yield knowledge that is indispensable to the formulation of informed public policy. Inquiries about the Center and its various initiatives should be directed to: Chris Bollinger, Ph.D. Professor of Economics and Director CBER Department of Economics 335A Gatton Business and Economics BLDG University of Kentucky Lexington, KY 40506‐0034 Voice: (859) 257‐7675 E‐mail: [email protected] Web: cber.uky.edu Institute for Pharmaceutical Outcomes and Policy (IPOP) The Institute employs over 40 professional staff, researchers and students engaged in pharmaceutical outcomes and policy projects either grant‐funded or contracted with Kentucky Medicaid, UK HealthCare, the Kentucky Cabi‐net for Health & Family Services, the Urban Institute, the Robert Wood Johnson Foundation, UK Human Resources and the UK Center for Clinical and Translational Science. The Institute's projects include the development of deci‐sion support technology, data warehousing, business analysis tools, policy analysis and program evaluations. In‐quiries about the Institute should be directed to: Jeffery Talbert, Ph.D. Director, Institute for Pharmaceutical Outcomes and Policy (IPOP) College of Pharmacy Pharmacy Practice and Science University of Kentucky Lexington, KY 40536‐0596 Voice: (859) 323‐7141 E‐mail: [email protected] Web: pharmacy.mc.uky.edu

Institutional Review Board Approvals The University of Kentucky, Office of Research Integrity, Institutional Review Board, authorized this research with Exemption Certification for Protocol No. 11‐0641‐X2B (September 2011), as did the Kentucky Cabinet for Health and Family Services Institutional Review Board (CHFS IRB) (November 2011).

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TABLE OF CONTENTS

PREFACE ....................................................................................................................................................... iii

ACKNOWLEDGEMENTS ............................................................................................................................... vii

INTRODUCTION ............................................................................................................................................. 1

Data and Method ...................................................................................................................................... 2

How to Use This Report ............................................................................................................................ 5

Organization and Presentation ................................................................................................................. 5

Limitations................................................................................................................................................. 5

A Profile of Kentucky Medicaid Mental Health Diagnoses, 2000‐2010: Tables ............................................ 7

Regions .................................................................................................................................................... 10

Area Development Districts .................................................................................................................... 18

BRFSS Groups .......................................................................................................................................... 48

Counties ................................................................................................................................................ 126

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ACKNOWLEDGEMENTS

his project would not have been possible without the support of the Foundation for a Healthy Kentucky. Sa‐rah Walsh, the project program officer at the Foundation, provided important feedback and review. Darren Henderson, with the University of Kentucky’s College of Pharmacy, performed an invaluable function in mak‐

ing this project possible—he organized and provided the data. Jeff Talbert, the director of the Institute for Phar‐maceutical Policy and Outcomes in the College of Pharmacy deserves credit for providing the initial idea for this project. While many others provided input, review, and inspiration, the author accepts sole responsibility for any errors.

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INTRODUCTION

his report provides data on mental health diagnoses for individuals on Medicaid in Kentucky. Medicaid is a state‐federal partnership to provide health care coverage for people with lower incomes, older people, peo‐ple with disabilities, and some families and children. The Medicaid program is jointly funded by states and

the federal government, but the states administer Medicaid within broad federal rules and have a lot of flexibility to design their programs. The eligibility rules for Medicaid are different for each state, but most states offer cover‐age for adults with children at some income level. In Kentucky, the Department for Medicaid Services, within the Cabinet for Health and Family Services, administers the Medicaid program—which in FY2010 was a $5.6 billion program. There are many types of services provided—from inpatient hospitalization to long‐term care to prescrip‐tion drugs for acute care. In the wider context of Kentucky’s state budget, Medicaid constitutes a significant portion of total state gov‐ernment spending. According to the National Association of State Budget Officers, State Expenditure Report: Fiscal Year 2010,1 21.9 percent of Kentucky state government expenditures where for Medicaid, which was second only to higher education (22.4 percent) and slightly higher than elementary and secondary education (19.4 percent). Within the Medicaid budget, mental health—also known as behavioral health—is an important category. Accord‐ing to a recent study in Health Affairs, behavioral health spending accounts for 11.5 percent of overall Medicaid spending.2 Beyond the percentages and dollars, there are other, perhaps more compelling reasons, why under‐standing the trajectory of various mental health disorders is important. Individuals diagnosed with mental health disorders are at a higher risk for physical illness and the cost of their medical care is much higher compared to those without a mental health disorder. A 2011 study by the United Hos‐pital Fund found that Medicaid beneficiaries evidence rates of hypertension, heart disease, asthma, and chronic obstructive pulmonary disease (COPD) 30 to 60 percent higher than individuals on Medicaid without a mental health condition or diagnosis.3 Moreover, those who have been diagnosed with substance abuse disorders demon‐strate conditions like heart disease, asthma/COPD, and HIV/AIDS at rates from 50 to 300 percent higher than indi‐viduals on Medicaid who do not have a substance abuse disorder.4 Finally, average Medicaid spending for mental health beneficiaries ($28,451) was nearly double the amount for those without a mental health diagnosis ($15,964), and only 25 percent of the spending for the mental health beneficiaries was actually for mental health treatment, including inpatient hospital care, prescription drugs, and outpatient psychiatric services.5 The Centers for Disease Control and Prevention (CDC) states that while mental health and mental illness are related, “they represent different psychological states.”6 The CDC notes that:

Mental health is “a state of well‐being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community.” It is estimated that only about 17% of U.S adults are considered to be in a state of optimal mental health.

Mental illness is defined as “collectively all diagnosable mental disorders” or “health conditions that are characterized by alterations in thinking, mood, or behavior (or some combination thereof) associated with distress and/or impaired functioning.” Depression is the most common type of mental illness, affecting more than 26% of the U.S. adult population.

The CDC states that “evidence has shown that mental disorders, especially depressive disorders, are strongly related to the occurrence, successful treatment, and course of many chronic diseases including diabetes, cancer,

1 State Expenditure Report: 2010, National Association of State Budget Officers, 2011, available at . 2 This is for 2005 spending. See Mark TL, Levit KR, Vandivort‐Warren R, Buck JA, Coffey RM. Changes in U.S .Spending on Mental Health and Substance Abuse Treatment, 1986 2005, And Implications for Policy. Health Affairs 30, No 2. (2011) (abstract available at : http://content.healthaffairs.org/content/30/2/284). 3 Elizabeth M. Patchias and Michael Birnbaum, Providing Care to Medicaid Beneficiaries with Behavioral Health Conditions, Medicaid Institute at United Hospital Fund, Feb. 2011. Available online at http://www.uhfnyc.org/assets/880. 4 Ibid. 5 Ibid. 6 Mental Health Basics, CDC Web site, available online at http://www.cdc.gov/mentalhealth/basics.htm.

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cardiovascular disease, asthma, and obesity and many risk behaviors for chronic disease; such as, physical inactivi‐ty, smoking, excessive drinking, and insufficient sleep.”7 Survey results from the CDC Behavioral Risk Factor Surveillance System (BRFSS) provide some insight about the mental health status of Kentucky adults. The BRFSS is an annual state‐based telephone survey of the U.S. civil‐ian, non‐institutionalized adult population. While the sample is drawn from the general population—not just the Medicaid population—the numbers provide some context for understanding the state of mental health in Ken‐tucky and the United States. Figure 1 illustrates the survey results from the question, “Now thinking about your mental health, which includes stress, depression, and problems with emotions, for how many days during the past 30 days was your mental health not good?” At nearly 15 percent (14.8), a higher percentage of Kentucky adults are potentially at risk for frequent mental distress compared to the U.S. average (11.1).8

Data and Method We present data on the overall number of individuals—both children (18 and younger) and adults (19 and older)—with at least one mental health diagnosis.9 There are 15 categories within the Medicaid billing data used to indicate if a beneficiary has been diagnosed with a mental health disorder. It is possible for someone to have more than one of these 15 disorders (e.g., anxiety disorders and substance‐related disorders). While a patient is de‐signed with a primary diagnosis, we do not limit inclusion to the primary diagnosis; if a Medicaid recipient has ever had one of the diagnoses in a given category, in any of their billing data, then they are included in these data. The categories as well as their subcategories, if applicable, are listed below:

1. Adjustment disorders 2. Anxiety disorders

7 Ibid. 8 The CDC uses this question and 3 others to calculate frequent mental distress (FMD=14 to 30 mentally unhealthy days in the past 30 days) which has been used as a proxy for poor mental health. Refer to the CDC Web site for more information: . 9 A patient is included in the data set if they are coded with one of the 15 mental health disorder codes and they have at least two encounters within a year. An encounter is defined as the patient interacting with a health provider that generates a billing for Medicaid. These encounters do not have to be for mental health services. The encounters are both inpatient and outpatient and represent, for instance, dental visits, hospi‐tal stays, or regular doctor visits which are not necessarily related to a mental health disorder. Also, we do not present data if the cell size is less than 30 individuals. Typically this is an issue when reporting numbers for minorities at the county level. When this is the case, we also suppress the data for Whites when it might be possible to “back out” the number for minorities using the total number and the White number.

65.3

23.6

11.1

63.3

21.9

14.8

0

10

20

30

40

50

60

70

Zero 1 to 13 14 to 30

Perc

ent

Days

FIGURE 1Number of "bad mental health days" in the last 30 days

(pooled 2009‐2011 data)

US

KY

Source: Author's calculations using BRFSS data, various years

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3. Attention deficit, conduct, and disruptive behavior disorders a. Conduct disorder b. Oppositional defiant disorder c. Attention deficit disorder and Attention deficit hyperactivity disorder

4. Delirium, dementia, and amnestic and other cognitive disorders 5. Developmental disorders

a. Communication disorders b. Developmental disabilities c. Intellectual disabilities d. Learning disorders e. Motor skill disorders

6. Disorders usually diagnosed in infancy, childhood, or adolescence a. Elimination disorders b. Other disorders of infancy childhood or adolescence c. Pervasive developmental disorders d. Tic disorders

7. Impulse control disorders not elsewhere classified 8. Mood disorders

a. Bipolar disorders b. Depressive disorders

9. Personality disorders 10. Schizophrenia and other psychotic disorders 11. Alcohol‐related disorders 12. Substance‐related disorders 13. Suicide and intentional self‐inflicted injury 14. Screening and history of mental health and substance abuse codes

a. Codes related to mental health disorders b. Codes related to substance‐related disorders

15. Miscellaneous mental disorders a. Dissociative disorders b. Eating disorders c. Factitious disorders d. Psychogenic disorders e. Sexual and gender identity disorders f. Sleep disorders g. Somatoform disorders h. Mental disorders due to general medical conditions not elsewhere classified i. Other miscellaneous mental conditions

We present these data at the state, region,10 Area Development District (Figure 2), Behavioral Risk Factor Sur‐veillance System Region11 (Figure 3), and county levels. Most individuals will be counted only one time, but if a beneficiary moves from one county to another and uses Medicaid to pay for services in each county then they will be counted in each county.

10 The West region is comprised of the counties in the three most western Area Development Districts (ADDs). The East region is comprised of the six most eastern ADDs. The Urban Triangle is comprised of the Bluegrass, KIPDA, and N. KY ADDs, and the South Central region is Barren River, Lincoln Trail, and Lake Cumberland ADDs. 11 These county groups were developed by researchers at the University of Kentucky Markey Cancer Control Program and College of Public Health under the direction of the Kentucky Department for Public Health. The thirty‐nine county groups were developed using a methodology which considered socioeconomic, demographic, and health‐related statistics at the county level, together with geographical proximity and number of BRFSS respondents, to cluster counties based on similar characteristics. Aggregating counties in this manner provides more reliable estimates for areas with small populations. Figure 2 shows counties belonging to the same groups. Note that 14 counties had enough respond‐ents from the BRFSS to produce stable estimates on their own: Boyd, Daviess, Fayette, Greenup, Hardin, Jefferson, Kenton, Mason, McCracken, Montgomery, Pike, Pulaski, Rowan, Warren.

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To facilitate comparisons between regions as well as changes over time within a region we show the number of individuals with a mental health diagnosis as a percentage of the total number of Medicaid‐eligible individuals (children or adults). For example, in 2010 there were 244,089 Medicaid eligible children in the billing data with at least one of the mental health disorders. This represents a number that is 46% of the total number of Medicaid‐eligible children for that year and is a decrease from 53% in 2000. The Urban Triangle, by comparison, was lower than the state average in both 2000 (51%) and 2010 (42%).

FIGURE 2 Kentucky Area Development Districts

Source: Kentucky State Data Center (http://ksdc.louisville.edu/1maps.htm)

FIGURE 3 Behaviorial Risk Factor Surveillence System (BRFSS) Regions

Source: University of Kentucky Markey Cancer Control Program and College of Public Health under the direction of the Kentucky Department for Public Health.

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How to Use This Report Comparing Medicaid mental health disorders between different geographic regions, such as county‐to‐county

or county‐to‐state, or between gender and racial/ethnic groups within a region, provides a view into community‐level health indicators that might not otherwise be readily available. It should generate discussion within a com‐munity about size differences between respective populations and whether they are changing over time. This in‐formation that can be used for the strategic allocation of health literacy resources. We provide examples below on how the data in this report might be used by state and local leaders:

In the companion report on pharmaceutical utilization, Kentucky Medicaid Pharmaceutical Utilization

Guide, 2000‐2010, we show that important differences between counties across Kentucky in the use of medication for Attention Deficit Hyperactivity Disorder (ADHD) (Therapeutic Class H2V). Some of the drugs included in this class are Focalin, Metadate, and Concerta. Overall, 244.4 grams per 1,000 member‐years were dispensed to Medicaid‐eligible children in Kentucky. However, there is considerable variation from one county to the next—evidenced by 57.5 grams in Leslie County and 553.3 grams in Henderson County. Likewise, in 2010 about 45 percent of Medicaid‐eligible children with a mental health disorder were classified as having ADHD, while Henderson County children evidenced a much higher rate at nearly 63 percent and Leslie County children showed a much lower rate at just under 32 percent.

Medicaid‐eligible adults categorized with mood disorders, which includes bipolar disorder and depressive disorders, as a percentage of all individuals with a mental health disorder increased in Kentucky from 58.8 percent in 2000 to 63.5 percent in 2010—representing an increase of 4.7 percentage points. Adults in Muhlenberg County increased by 10.4 percentage points—from 55.4 to 65.8 percent—but during the same time period Magoffin County adults remained at 56.2 percent, showing no change.

The examples above are illustrative of how the data in A Profile of Kentucky Medicaid Mental Health Diagno‐ses, 2000‐2010 can be used—and there are many other examples of large differences between regions and demo‐graphic groups across the state. Health, community, and education leaders in these counties might want to know why their county numbers are so different from the state average, or why they are changing over time.

Organization and Presentation This report should be of interest to public health officials, health care providers, and community leaders. In the tables that follow we show the year‐by‐year numbers for the individuals with a mental health diagnosis. There are two pages for each geographic region—one for children and another for adults. We present total numbers as well as by gender and race. We then use the total number of individuals in the region who are eligible for Medicaid in that year as the denominator to calculate percentages. This facilitates comparisons between regions and through time within a region. Finally, we show the total number of individuals categorized as having any of the 15 mental health disorders. At the bottom of each page we show a chart that compares the percentage point differ‐ence between that region and the state average for the percentage of individuals with at least one mental health diagnosis as a percent of the total number of Medicaid‐eligible individuals.

Limitations First, all of the data are derived from fully adjudicated paid claims, not all claims submitted. Second, it is possi‐ble, indeed likely, that not all claims for 2010 are included in the data presented here—as they continue to be submitted and adjudicated at the time of this report. Consequently, the drop in numbers we see for 2010 could be a function of unprocessed claims instead of a real decrease in the number of individuals with a particular disorder.

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A Profile of Kentucky Medicaid Mental Health Diagnoses, 2000‐2010: Tables

A PROFILE OF KENTUCKY MEDICAID MENTAL HEALTH DIAGNOSES, 2000 TO 2010

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CHILDREN: Number 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010Al l 206,705 226,735 239,191 250,790 256,732 260,172 261,566 248,589 257,974 258,714 244,089 Female 102,037 110,517 115,151 119,408 121,064 121,500 121,454 114,260 118,159 117,448 109,932 Male 104,668 116,218 124,040 131,382 135,668 138,672 140,112 134,329 139,815 141,266 134,157 White 166,108 181,893 190,758 199,586 203,727 206,158 206,461 195,738 202,843 203,247 191,828 Minori ty 29,628 32,164 34,070 35,254 35,536 35,439 35,231 32,982 34,224 34,148 32,155

CHILDREN: Percent 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010Al l 53% 55% 57% 57% 57% 57% 56% 52% 53% 50% 46%Female 54% 55% 56% 56% 55% 54% 54% 50% 50% 47% 42%Male 53% 55% 58% 59% 59% 59% 58% 55% 56% 53% 49%White 53% 55% 57% 57% 57% 56% 55% 52% 52% 50% 45%Minori ty 39% 39% 40% 40% 39% 38% 37% 34% 34% 32% 29%

CHILDREN: Number with Disorder 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010Adjustment disorders 45,222 49,817 52,895 55,204 55,920 55,946 55,168 50,950 51,033 49,287 45,149 Alcohol ‐related disorders 9,656 9,802 9,622 9,334 8,897 8,268 7,551 6,411 5,880 5,150 4,166 Anxiety disorders 71,601 77,189 80,717 84,226 86,000 86,464 86,163 81,373 82,010 79,802 73,970 Attention‐defici t, conduct, and dis ruptive behavior disorders 93,708 104,180 111,876 118,886 123,117 125,126 125,184 117,669 119,125 117,026 109,718 Del i rium, dementia , and amnestic and other cognitive disorders 3,265 3,407 3,517 3,560 3,580 3,560 3,527 3,315 3,341 3,168 2,879 Developmental disorders 46,535 53,923 60,782 67,372 72,851 77,021 80,481 80,117 85,320 87,473 84,734 Disorders usua l ly diagnosed in infancy, chi ldhood, adolescence 16,116 18,479 20,565 22,513 24,124 25,239 26,050 25,206 26,020 25,871 24,822 Impulse control disorders , NEC 12,519 13,343 13,822 13,977 13,782 13,244 12,612 11,232 10,571 9,664 8,326 Miscel laneous disorders 31,506 33,268 34,053 34,590 34,642 34,204 33,463 31,028 31,081 29,977 27,582 Mood disorders 74,296 77,497 78,123 77,769 75,710 72,339 68,426 60,993 58,620 54,585 47,865 Persona l i ty disorders 7,758 7,925 7,910 7,776 7,586 7,093 6,548 5,768 5,331 4,768 4,026 Schizophrenia and other psychotic disorders 8,659 8,818 8,923 8,989 8,858 8,562 8,211 7,476 7,257 6,679 5,825 Screening and his tory of mental health and substance abuse 126,878 135,736 139,524 140,731 137,991 133,672 129,282 118,037 117,855 113,552 103,154 Substance‐related disorders 24,462 24,659 23,991 23,144 21,815 20,163 18,450 15,984 15,143 13,641 11,375 Suicide and intentional sel f‐infl i cted injury 6,575 6,727 6,752 6,694 6,531 6,287 6,083 5,574 5,462 5,143 4,439

Kentucky


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ADULTS: Number 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010Al l 225,450 243,303 256,716 267,776 276,437 282,089 287,249 272,093 293,459 298,589 288,956 Female 158,620 170,679 179,831 187,427 193,374 196,993 200,332 188,061 203,085 205,347 196,888 Male 66,830 72,624 76,885 80,349 83,063 85,096 86,917 84,032 90,374 93,242 92,068 White 190,390 205,588 217,053 226,574 234,081 239,134 243,872 230,392 248,919 252,625 242,958 Minori ty 23,803 25,661 26,840 27,691 28,150 28,040 27,470 25,675 28,197 29,318 28,518

ADULTS: Percent 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010Al l 63% 66% 67% 69% 69% 69% 69% 65% 69% 68% 64%Female 66% 68% 70% 71% 71% 71% 71% 66% 71% 70% 66%Male 59% 61% 63% 64% 64% 64% 65% 62% 65% 64% 61%White 64% 67% 68% 69% 70% 70% 70% 65% 69% 69% 65%Minori ty 40% 42% 43% 43% 43% 42% 42% 39% 41% 41% 38%

ADULTS: Number with Disorder 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010Adjustment disorders 22,771 25,143 27,260 29,165 30,746 32,209 33,577 32,722 35,594 36,924 36,266 Alcohol ‐related disorders 23,476 25,829 27,576 29,309 30,694 31,261 32,094 30,692 32,424 32,609 31,342 Anxiety disorders 129,110 140,625 150,323 158,878 165,425 170,157 175,095 169,572 180,105 182,533 177,450 Attention‐defici t, conduct, and dis ruptive behavior disorders 11,888 13,527 15,238 17,337 19,499 21,542 23,979 24,723 28,588 31,350 32,177 Del i rium, dementia , and amnestic and other cognitive disorders 52,230 53,717 53,780 52,575 51,249 50,245 49,039 46,002 45,488 42,947 39,316 Developmenta l disorders 21,490 22,712 23,806 24,785 25,542 26,212 26,999 26,818 28,068 28,898 29,184 Disorders usual ly diagnosed in infancy, chi ldhood, adolescence 2,586 2,876 3,083 3,342 3,611 3,904 4,248 4,471 5,040 5,597 5,990 Impulse control disorders , NEC 4,135 4,599 5,039 5,502 5,994 6,418 6,955 7,040 7,803 8,364 8,574 Miscel laneous disorders 52,695 58,183 62,915 67,781 71,705 74,416 76,191 72,017 76,226 76,745 73,311 Mood disorders 132,572 144,884 155,086 164,218 171,210 176,045 181,025 174,152 185,850 188,637 183,432 Personal i ty disorders 18,094 19,716 21,148 22,382 23,398 23,815 24,225 23,352 24,245 24,247 23,465 Schizophrenia and other psychotic disorders 49,939 52,829 54,402 55,092 55,335 55,466 55,564 53,359 53,781 52,443 49,549 Screening and his tory of menta l health and substance abuse 126,386 140,398 152,691 163,182 171,696 176,718 181,553 172,642 187,822 191,672 185,627 Substance‐related disorders 40,783 45,404 49,211 53,458 56,939 59,588 62,327 60,217 65,607 67,614 65,810 Suicide and intentional sel f‐infl i cted injury 8,506 9,435 10,333 11,210 12,114 12,983 14,204 14,259 15,757 16,285 16,154

Kentucky


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CHILDREN: Number with Disorder 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010Adjustment disorders 5,222 5,711 6,005 6,172 6,166 6,158 6,086 5,542 5,480 5,274 4,876 Alcohol ‐related disorders 956 970 937 892 827 778 706 597 552 488 385 Anxiety disorders 7,812 8,301 8,627 8,950 8,963 8,950 8,770 7,992 7,869 7,472 6,783 Attention‐defici t, conduct, and disruptive behavior disorders 15,493 17,146 18,316 19,479 20,155 20,432 20,185 18,709 18,817 18,432 17,348 Del i rium, dementia , and amnestic and other cognitive disorders 442 468 473 488 503 501 488 458 469 446 404 Developmenta l disorders 5,927 6,995 8,042 9,030 9,842 10,561 11,159 11,064 11,772 12,143 11,776 Disorders usual ly diagnosed in infancy, chi ldhood, adolescence 1,832 2,091 2,331 2,582 2,780 2,967 3,061 2,946 3,051 3,081 2,962 Impulse control disorders , NEC 2,658 2,809 2,883 2,914 2,900 2,829 2,673 2,385 2,251 2,076 1,817 Miscel laneous disorders 5,047 5,346 5,450 5,507 5,504 5,428 5,214 4,705 4,658 4,439 4,058 Mood disorders 11,408 12,024 12,287 12,327 12,113 11,695 11,097 9,850 9,522 8,920 7,912 Personal i ty disorders 855 874 849 813 792 730 692 619 573 491 411 Schizophrenia and other psychotic disorders 1,134 1,134 1,157 1,160 1,132 1,087 1,032 931 887 804 710 Screening and his tory of mental health and substance abuse 17,921 19,329 20,098 20,209 19,732 19,322 18,670 16,930 16,922 16,405 14,966 Substance‐related disorders 2,602 2,667 2,579 2,531 2,365 2,186 2,000 1,714 1,636 1,448 1,207 Suicide and intentiona l sel f‐infl i cted injury 832 860 844 823 819 756 728 628 597 549 481

Note: N.D. indicates that the number is not disclosable because the sample size is too small while #N/A indicates the value is zero and therefore "not applicable."

Western Kentucky

‐0.5%

0.0%

0.5%

1.0%

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

Percentage Point Difference with Kentucky Overall (All Children, Percent)


Page 11



ADULTS: Number with Disorder 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010Adjustment disorders 2,721 3,057 3,371 3,558 3,691 3,856 4,003 3,799 4,107 4,246 4,077 Alcohol ‐related disorders 2,593 2,853 3,054 3,266 3,462 3,497 3,620 3,448 3,692 3,738 3,611 Anxiety disorders 15,254 16,765 17,975 19,234 20,144 20,873 21,540 20,636 22,183 22,422 21,719 Attention‐defici t, conduct, and dis ruptive behavior disorders 2,183 2,457 2,751 3,154 3,556 3,904 4,332 4,464 5,127 5,639 5,749 Del i rium, dementia , and amnestic and other cognitive disorders 8,010 8,199 8,236 7,980 7,689 7,484 7,308 6,866 6,949 6,496 5,971 Developmenta l disorders 3,255 3,415 3,538 3,594 3,665 3,714 3,813 3,791 3,891 3,931 3,947 Disorders usual ly diagnosed in infancy, chi ldhood, adolescence 261 289 323 355 390 425 455 486 543 594 646 Impulse control disorders , NEC 613 680 744 812 884 973 1,093 1,091 1,217 1,341 1,374 Miscel laneous disorders 6,216 6,967 7,519 8,048 8,574 8,906 9,142 8,466 9,128 9,269 8,875 Mood disorders 17,398 19,262 20,774 22,174 23,244 24,026 24,684 23,538 25,421 25,787 24,958 Personal i ty disorders 2,009 2,216 2,391 2,482 2,616 2,673 2,710 2,664 2,834 2,877 2,735 Schizophrenia and other psychotic disorders 7,124 7,549 7,776 7,891 7,898 7,917 7,967 7,696 7,836 7,682 7,316 Screening and his tory of menta l health and substance abuse 15,554 17,659 19,295 20,736 21,870 22,662 23,195 21,515 23,622 24,092 23,100 Substance‐related disorders 4,037 4,575 5,042 5,462 5,852 6,200 6,498 6,189 6,806 7,019 6,665 Suicide and intentional sel f‐infl i cted injury 1,162 1,306 1,435 1,567 1,737 1,871 2,045 2,094 2,403 2,530 2,446


Western Kentucky

‐2.0%

‐1.5%

‐1.0%

‐0.5%

0.0%2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

Percentage Point Difference with Kentucky Overall (All Adults, Percent)


Page 12



CHILDREN: Number with Disorder 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010Adjustment disorders 7,868 8,699 9,286 9,673 9,759 9,753 9,565 8,828 8,949 8,795 8,048 Alcohol ‐related disorders 1,540 1,559 1,536 1,495 1,378 1,252 1,152 953 850 718 539 Anxiety disorders 14,087 15,444 16,314 17,091 17,620 17,899 18,060 17,283 17,592 17,204 15,995 Attention‐defici t, conduct, and disruptive behavior disorders 17,896 19,845 21,242 22,382 23,085 23,348 23,254 21,792 22,054 21,722 20,229 Del i rium, dementia , and amnestic and other cognitive disorders 554 586 607 606 606 602 590 541 545 521 481 Developmenta l disorders 7,860 9,155 10,397 11,569 12,544 13,303 14,018 14,033 15,041 15,556 15,111 Disorders usual ly diagnosed in infancy, chi ldhood, adolescence 2,971 3,404 3,807 4,147 4,405 4,574 4,678 4,527 4,689 4,697 4,516 Impulse control disorders , NEC 2,842 3,040 3,150 3,178 3,093 2,948 2,794 2,436 2,314 2,133 1,822 Miscel laneous disorders 5,427 5,769 5,896 5,971 5,927 5,804 5,609 5,162 5,084 4,811 4,344 Mood disorders 14,427 15,150 15,285 15,170 14,660 13,856 13,079 11,682 11,168 10,393 9,055 Personal i ty disorders 1,377 1,397 1,386 1,370 1,344 1,237 1,152 1,023 946 861 709 Schizophrenia and other psychotic disorders 1,434 1,455 1,495 1,497 1,474 1,392 1,341 1,199 1,158 1,057 909 Screening and his tory of mental health and substance abuse 22,840 24,661 25,304 25,407 24,541 23,526 22,543 20,389 20,335 19,621 17,912 Substance‐related disorders 3,996 4,034 3,966 3,844 3,554 3,256 2,947 2,445 2,248 1,981 1,582 Suicide and intentiona l sel f‐infl i cted injury 1,060 1,077 1,087 1,037 996 942 911 815 785 746 628


South Central Kentucky

‐1.0%

‐0.5%

0.0%

0.5%

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010



Page 13



ADULTS: Number with Disorder 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010Adjustment disorders 4,132 4,578 4,923 5,261 5,468 5,735 5,947 5,794 6,316 6,507 6,384 Alcohol ‐related disorders 4,183 4,638 4,934 5,137 5,391 5,427 5,485 5,163 5,385 5,459 5,238 Anxiety disorders 25,835 28,000 29,972 31,487 32,815 33,702 34,590 33,539 35,459 36,105 34,994 Attention‐defici t, conduct, and dis ruptive behavior disorders 2,154 2,452 2,748 3,143 3,570 3,857 4,350 4,473 5,201 5,772 5,932 Del i rium, dementia , and amnestic and other cognitive disorders 11,032 11,282 11,196 10,846 10,484 10,207 9,890 9,302 9,037 8,458 7,741 Developmenta l disorders 4,491 4,669 4,858 5,020 5,148 5,234 5,373 5,338 5,531 5,685 5,694 Disorders usual ly diagnosed in infancy, chi ldhood, adolescence 583 633 675 725 778 823 898 912 1,018 1,131 1,179 Impulse control disorders , NEC 864 952 1,074 1,177 1,282 1,351 1,479 1,482 1,631 1,736 1,783 Miscel laneous disorders 9,561 10,531 11,325 12,135 12,673 13,159 13,551 12,931 13,603 13,777 13,170 Mood disorders 27,253 29,693 31,616 33,196 34,530 35,284 36,145 34,764 36,884 37,508 36,177 Personal i ty disorders 3,554 3,800 4,038 4,218 4,332 4,347 4,393 4,212 4,385 4,383 4,283 Schizophrenia and other psychotic disorders 10,266 10,797 11,125 11,177 11,138 11,057 11,001 10,615 10,637 10,245 9,602 Screening and his tory of menta l health and substance abuse 23,021 25,484 27,607 29,241 30,672 31,238 31,910 30,277 32,496 33,153 31,868 Substance‐related disorders 6,393 7,114 7,636 8,167 8,665 8,901 9,266 8,868 9,581 9,943 9,657 Suicide and intentional sel f‐infl i cted injury 1,541 1,682 1,860 1,988 2,144 2,253 2,448 2,429 2,657 2,738 2,752


South Central Kentucky

‐1.5%

‐1.0%

‐0.5%

0.0%

0.5%

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010



Page 14



CHILDREN: Number with Disorder 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010Adjustment disorders 19,981 22,474 24,098 25,370 25,939 25,999 25,778 23,843 23,964 23,104 21,266 Alcohol ‐related disorders 3,107 3,258 3,249 3,170 3,089 2,946 2,737 2,352 2,207 1,977 1,645 Anxiety disorders 22,754 25,060 26,602 27,976 28,721 28,907 28,891 27,254 27,639 27,089 25,135 Attention‐defici t, conduct, and disruptive behavior disorders 35,717 40,389 43,974 47,211 49,360 50,591 51,220 48,602 49,567 49,155 46,481 Del i rium, dementia , and amnestic and other cognitive disorders 1,353 1,447 1,532 1,569 1,608 1,619 1,633 1,568 1,603 1,520 1,393 Developmenta l disorders 15,542 18,531 21,283 23,912 26,087 27,924 29,697 30,039 32,521 33,925 33,256 Disorders usual ly diagnosed in infancy, chi ldhood, adolescence 6,906 8,055 9,065 9,963 10,743 11,313 11,814 11,536 11,987 11,961 11,550 Impulse control disorders , NEC 4,763 5,127 5,391 5,478 5,444 5,252 5,057 4,538 4,286 3,921 3,406 Miscel laneous disorders 10,559 11,468 12,032 12,439 12,679 12,702 12,659 11,869 12,121 11,895 11,079 Mood disorders 26,303 28,110 28,842 29,113 28,832 28,006 26,826 24,173 23,602 22,288 19,796 Personal i ty disorders 2,537 2,647 2,682 2,606 2,535 2,394 2,224 1,974 1,872 1,683 1,462 Schizophrenia and other psychotic disorders 3,649 3,823 3,880 3,984 3,990 3,924 3,828 3,567 3,553 3,303 2,921 Screening and his tory of mental health and substance abuse 44,054 47,723 49,629 50,367 49,790 48,436 47,150 43,172 43,213 41,680 37,825 Substance‐related disorders 8,220 8,541 8,522 8,269 7,992 7,603 7,102 6,244 6,100 5,552 4,673 Suicide and intentiona l sel f‐infl i cted injury 2,740 2,864 2,974 3,033 3,035 3,010 2,964 2,810 2,856 2,738 2,411


Urban Triangle

‐4.0%

‐3.0%

‐2.0%

‐1.0%

0.0%2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010



Page 15



ADULTS: Number with Disorder 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010Adjustment disorders 8,409 9,366 10,253 11,011 11,765 12,412 12,977 12,725 14,045 14,794 14,627 Alcohol ‐related disorders 7,449 8,314 9,033 9,656 10,150 10,568 10,978 10,544 11,348 11,503 11,041 Anxiety disorders 33,417 37,219 40,461 43,326 45,675 47,743 49,839 48,586 52,641 54,198 52,811 Attention‐defici t, conduct, and dis ruptive behavior disorders 4,466 5,164 5,884 6,683 7,452 8,379 9,347 9,789 11,390 12,481 12,732 Del i rium, dementia , and amnestic and other cognitive disorders 17,556 18,321 18,549 18,298 18,020 17,996 17,740 16,717 16,706 16,027 14,747 Developmenta l disorders 6,568 7,067 7,511 7,840 8,073 8,412 8,750 8,787 9,336 9,755 9,904 Disorders usual ly diagnosed in infancy, chi ldhood, adolescence 879 1,009 1,098 1,213 1,322 1,455 1,632 1,769 2,029 2,299 2,491 Impulse control disorders , NEC 1,253 1,420 1,569 1,723 1,899 2,076 2,312 2,422 2,726 2,975 3,095 Miscel laneous disorders 13,781 15,580 17,331 19,226 20,815 22,115 23,039 21,292 23,250 23,739 22,516 Mood disorders 38,692 42,900 46,532 49,838 52,464 54,675 56,873 54,943 59,608 61,362 59,977 Personal i ty disorders 5,570 6,165 6,708 7,101 7,405 7,711 8,103 7,814 8,170 8,196 7,843 Schizophrenia and other psychotic disorders 16,590 17,727 18,401 18,676 18,939 19,325 19,516 18,787 19,099 18,857 17,864 Screening and his tory of menta l health and substance abuse 37,558 42,476 46,986 51,077 54,639 56,996 59,002 56,104 62,415 64,656 62,622 Substance‐related disorders 11,891 13,518 14,848 16,421 17,633 18,704 19,815 19,156 21,373 22,427 21,799 Suicide and intentional sel f‐infl i cted injury 2,861 3,210 3,583 3,933 4,253 4,620 5,129 5,132 5,813 6,104 6,092


Urban Triangle

‐4.0%

‐3.0%

‐2.0%

‐1.0%

0.0%2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010



Page 16



CHILDREN: Number with Disorder 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010Adjustment disorders 12,151 12,933 13,506 13,989 14,056 14,036 13,739 12,737 12,640 12,114 10,959 Alcohol ‐related disorders 4,053 4,015 3,900 3,777 3,603 3,292 2,956 2,509 2,271 1,967 1,597 Anxiety disorders 26,948 28,384 29,174 30,209 30,696 30,708 30,442 28,844 28,910 28,037 26,057 Attention‐defici t, conduct, and disruptive behavior disorders 24,602 26,800 28,344 29,814 30,517 30,755 30,525 28,566 28,687 27,717 25,660 Del i rium, dementia , and amnestic and other cognitive disorders 916 906 905 897 863 838 816 748 724 681 601 Developmenta l disorders 17,206 19,242 21,060 22,861 24,378 25,233 25,607 24,981 25,986 25,849 24,591 Disorders usual ly diagnosed in infancy, chi ldhood, adolescence 4,407 4,929 5,362 5,821 6,196 6,385 6,497 6,197 6,293 6,132 5,794 Impulse control disorders , NEC 2,256 2,367 2,398 2,407 2,345 2,215 2,088 1,873 1,720 1,534 1,281 Miscel laneous disorders 10,473 10,685 10,675 10,673 10,532 10,270 9,981 9,292 9,218 8,832 8,101 Mood disorders 22,158 22,213 21,709 21,159 20,105 18,782 17,424 15,288 14,328 12,984 11,102 Personal i ty disorders 2,989 3,007 2,993 2,987 2,915 2,732 2,480 2,152 1,940 1,733 1,444 Schizophrenia and other psychotic disorders 2,442 2,406 2,391 2,348 2,262 2,159 2,010 1,779 1,659 1,515 1,285 Screening and his tory of mental health and substance abuse 42,063 44,023 44,493 44,748 43,928 42,388 40,919 37,546 37,385 35,846 32,451 Substance‐related disorders 9,644 9,417 8,924 8,500 7,904 7,118 6,401 5,581 5,159 4,660 3,913 Suicide and intentiona l sel f‐infl i cted injury 1,943 1,926 1,847 1,801 1,681 1,579 1,480 1,321 1,224 1,110 919


Eastern Kentucky

0.0%

2.0%

4.0%

6.0%

8.0%

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010



Page 17

ADULTS: Number 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010Al l 83,419 88,902 92,986 96,422 98,671 99,550 100,968 96,094 101,930 102,205 99,214 Female 55,431 58,854 61,416 63,410 64,818 65,478 66,427 62,850 66,672 66,603 64,220 Male 27,988 30,048 31,570 33,012 33,853 34,072 34,541 33,244 35,258 35,602 34,994 White 76,403 81,625 85,546

a profile of kentucky medicaid mental health … · a profile of kentucky medicaid mental health...

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