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Why do we ask this question?
Mental illnesses are common in the United States. Nearly one in five U.S. adults live with a mental illness (51.5 million in 2019). Many people suffer from more than one mental disorder at a given time. In particular, depressive illnesses tend to co-occur with substance abuse and anxiety disorders. Approximately 9.5% of American adults ages 18 and over, will suffer from a depressive illness (major depression, bipolar disorder, or dysthymia) each year.
Mental health disorders account for several of the top causes of disability in established market economies, such as the U.S., worldwide, and include: major depression (also called clinical depression), manic depression (also called bipolar disorder), schizophrenia, and obsessive-compulsive disorder. Women are nearly twice as likely to suffer from major depression than men. However, men and women are equally likely to develop bipolar disorder. While major depression can develop at any age, the average age at onset is the mid-20s. With bipolar disorder, which affects approximately 2.6% of Americans age 18 and older in a given year — the average age at onset for a first manic episode is during the early 20s.
Most people who commit suicide have a diagnosable mental disorder — most commonly a depressive disorder or a substance abuse disorder. Four times as many men than women commit suicide. However, women attempt suicide more often than men. The highest suicide rates in the U.S. are found in Caucasian men over age 85. However, suicide is also one of the leading causes of death in adolescents and adults ages 15 to 24. Approximately about 18% of people ages 18- 54 in a given year, have an anxiety disorder in a given year. Anxiety disorders include: panic disorder, obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), generalized anxiety disorder (GAD), and phobias (social phobia, agoraphobia, and specific phobia).
In recent years, encouraging trends highlight the growing possibility of addressing some challenges. Medicaid expansion in 39 states has extended affordable coverage to millions of Americans. Medicaid is now the leading payer for U.S. mental health care among adults with serious mental illness. Mental health parity, the once-controversial idea that mental health benefits should equal other medical benefits, is now the law of the land. Recent research has substantially strengthened the evidence base supporting the effectiveness of new treatments for depression, anxiety, and psychosis, as well as for new models for delivering care. Reforming the U.S. mental health system has received strong bipartisan support at both the federal and state levels.
Against this background, a RAND research team sought to identify goals for transforming the U.S. mental health care system and to pinpoint opportunities to drive systemic improvements. To develop these recommendations, the team interviewed mental health experts throughout the country—including government officials, public administrators, health system executives, and academicians. In parallel, the team conducted a comprehensive review of the scientific literature to identify best practices and recent innovations in mental health care.
