This study of Expenditures on Clients Receiving Treatment for Both Mental Illness and Substance-Use Disorders was funded by the Substance Abuse and Mental Health Administration to address the gap in information on the cost of treating clients with these co-occurring disorders in the public sector. Although the data are from 1997, they were a rare source for studying expenditures across multiple States and multiple State agencies involved in treatment of people with M/SU conditions. The study analyzed treatment expenditures per public client in three States—Delaware, Oklahoma, and Washington State—after linking client data in each State across three public programs—mental health, substance abuse, and Medicaid agencies. Client data linked across multiple agencies were essential to understand fully the treatment of clients with such co-occurring disorders.
The study estimated expenditures on clients with co-occurring M/SU conditions and compared those with expenditures on clients with a single type of disorder—mental illness (MI only) and substance-use disorders only (SUD only). "Clients with co-occurring disorders" were defined in this study to include patients who were either receiving both MI and SUD services or had both types of diagnosis recorded by a mental health or substance abuse treatment program during 1997.
The numbers reported are estimates of expenditures made for three States with mental health and substance abuse (MH/SA) treatment services through three types of State programs—mental health (MH), substance abuse (SA), and Medicaid agencies. The expenditure estimates did not capture the spending on treatment of MI and/or SUD that may have occurred outside these programs in other State government departments (e.g., corrections, education, or child welfare) or other public or private systems or entities.
The authors highlight the following key findings regarding co-occurring conditions in this setting: substantial prevalence, higher total costs, spending greater than the sum of two treatments, use of most costly services, higher use of medications for severe mental illness (SMI), different client characteristics, primary responsibility with MH/SA agencies, highest level of spending on outpatient but not inpatient, comparable spending levels with clients with MI alone, and higher spending for youth versus adults.
Download the full report (PDF): Expenditures on Clients Receiving Treatment for Both Mental Illness and Substance-Use Disorders Results from an Integrated Data Base of Mental Health Substance Abuse and Medicaid Agencies.pdf (738.21 kb)
