Progress Toward Healthy People 2010 Targets

The following discussion highlights objectives that met or exceeded their 2010 targets; moved toward the targets, demonstrated no change, or moved away from the targets; and those that lacked data to assess progress. Progress is illustrated in the Progress Quotient bar chart (see Figure 18-1), which displays the percent of targeted change achieved for objectives and subobjectives with sufficient data to assess progress.

Progress was noted for primary care facilities providing mental health treatment (18-6), juvenile justice residential facilities that provide mental health screening (18-8), and State plans addressing mental health for elderly persons (18-14). Three objectives moved away from their targets: suicide (18-1), adolescent suicide attempts (18-2), and homeless persons with mental health problems who received services (18-3). Disordered eating behaviors among adolescents in grades 9 through 12 (18-5) and State tracking of consumer satisfaction (18-12) demonstrated no change toward or away from their targets.

Data became available to measure the employment of persons with SMI (18-4), treatment for children with mental health problems (18-7), treatment for co-occurring disorders (18-10), and the proportion of counties served by adult jail diversion programs or mental health courts (18-11). However, progress for these objectives could not be assessed at the midcourse due to lack of a second data point.

Objectives that met or exceeded their targets. One objective, primary care facilities providing treatment for mental disorders (18-6), exceeded its target, moving from a 2000 baseline of 62 percent of primary care facilities offering mental health services onsite or by referral to 74 percent having provided this service in 2003. The objective achieved 200 percent of the targeted change.

Mental disorders frequently co-exist with, and have a negative impact on, physical health.⁸ For example, depression impairs self-care and adherence to treatments for chronic illnesses. Depression may also be a factor in the onset of certain chronic diseases such as high blood pressure, heart disease, and stroke.^{9, 10, 11, 12, 13}

For these reasons, primary health care settings have long been identified as the initial point of contact for many adults with mental disorders.¹⁴ For some adults, these providers are their only source of mental health care services. Increased screening and assessment in primary care can promote early detection and intervention for mental health problems.¹⁴ However, large numbers of mental illnesses go undiagnosed in primary care settings.⁶ The Mental Health/Substance Abuse Service Expansion Grant, offered through HRSA's Bureau of Primary Health Care, Division of Health Center Development, is increasing the capacity of community health centers to establish new or expand existing mental health/substance abuse services.¹⁵

Objectives that moved toward their targets. Juvenile justice residential facility screenings (18-8) moved from a baseline of 50 percent in 2000 to 53 percent in 2002 of such facilities offering admission mental health screening exams. Objective 18-8 achieved 60 percent of the targeted change. The Juvenile Residential Facility Census, which measures objective 18-8, is one component of a multitiered effort to monitor youth placed in residential facilities, as well as the environments within those facilities, to maximize mental health.

In 2004, the National Center for Mental Health and Juvenile Justice published a resource guide for practitioners on screening and assessing mental health disorders among youth in the juvenile justice system.¹⁶ The guide provides clinicians and other professionals working with youth¹⁷ in the juvenile justice system with a range of best practice information. It reviews and synthesizes information about the most effective instruments for screening and assessing youth for mental health at various points in the juvenile justice system. A closer linkage between mental health agencies and juvenile justice agencies is needed to ensure further progress for this objective.

The number of States, Territories, and the District of Columbia with plans addressing mental health care needs of elderly persons (18-14) increased from 18 to 22 jurisdictions between 2000–01 and 2001–02, achieving 12 percent of the targeted change.⁸ The target is 50 States and the District of Columbia. This objective anticipates that the baby boom population will present society with unprecedented challenges in organizing, financing, and delivering effective prevention and treatment services for mental disorders in elderly persons in the near future. An operational plan at the State level represents a first step in developing a comprehensive strategy for addressing the special mental health issues society faces as the population ages.¹⁸

Objective 18-14 also addresses the significant advances in research that have successfully challenged the underlying belief that mental health problems are an inevitable part of aging. The medical community increasingly recognizes that depression and certain cognitive losses are not inevitable with aging and are treatable disorders.¹⁸ Increased awareness will improve diagnostic precision for people in later life and enhance the provision of age-appropriate treatment. SAMHSA's Center for Mental Health Services has administered Mental Health Block Grants that require each State to include a plan for its mental health expenditures, a portion of which is often devoted to older persons.¹⁹

Objectives that demonstrated no change. The number of States tracking consumer satisfaction with the mental health care services they receive (18-12) remained unchanged at 40 in 2002 and 2003. The target is 50 States and the District of Columbia.⁸ Adolescents engaging in disordered eating behaviors (18-5) remained constant at 19 percent in 2001 and 2003. The target is 16 percent.

Objectives that moved away from their targets. Reduction in the suicide rate (18-1) moved away from the target of 4.8 deaths per 100,000 population. Between 1999 and 2002, the age-adjusted suicide rate increased from 10.5 deaths per 100,000 population to 10.9 deaths per 100,000 population. Suicide attempts among students in grades 9 through 12 (18-2) increased from 2.6 percent of students in 1999 to 2.9 percent in 2003, moving away from the target of 1 percent.

Multiple suicide prevention initiatives exist. The National Strategy for Suicide Prevention lays out a framework for action to prevent suicide and guides the development of an array of services and programs.²⁰ The Suicide Prevention Resource Center provides technical assistance to States and communities in their efforts to develop effective suicide prevention efforts.²¹ Progress in reducing the rates for attempted and completed suicide depends on additional research into risk assessment methods, tailored prevention programs for vulnerable populations, and strategies for program dissemination and implementation.

Objective 18-3 focuses on homeless persons aged 18 years and older who receive mental health care services. Twenty-seven percent of homeless adults with mental health problems received mental health care services in 2000, and 26 percent received services in 2003, which represented a movement away from the target of 30 percent. The Projects for Assistance in Transition from Homelessness (PATH) supports community-based outreach and case management services for homeless persons with mental health problems.²²

Objectives that could not be assessed. Progress toward several objectives and subobjectives could not be assessed because data beyond the baseline were not available for the midcourse review: employment of persons with SMI (18-4), treatment for adults with mental disorders (18-9a, b, and d), and treatment for co-occurring disorders (18-10). For these objectives, the National Comorbidity Survey—Replication was used for baseline data; followup data points are anticipated by the end of the decade. The subobjective measuring increases in the proportion of adults aged 18 years and older with schizophrenia who have received treatment (18-9c) requires further development of a data source. Treatment for children with mental health problems (18-7) is anticipated to have several data points from the annual National Health Interview Survey. Annual data are also anticipated for adult jail diversion programs and/or mental health courts (18-11).

State plans for addressing cultural competence (18-13) was the only objective without baseline data at the midcourse review. Data are anticipated for the objective by the end of the decade through the National Technical Assistance Center for State Mental Health Systems.

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