National Academy of Medicine

Improving Access to Effective Care for People Who Have Mental Health and Substance Use Disorders: A Vital Direction for Health and Health Care

By James Knickman, K. Ranga Rama Krishnan, Harold A. Pincus, Carlos Blanco, Dan G. Blazer, Molly J. Coye, John H. Krystal, Scott L. Rauch, Gregory E. Simon, and Benedetto Vitiello
September 19, 2016 | Discussion Paper
About the Vital Directions for Health and Health Care Series

Vital DirectionsThis publication is part of the National Academy of Medicine’s Vital Directions for Health and Health Care Initiative, which commissioned expert papers on 19 priority focus areas for U.S. health policy by more than 100 leading researchers, scientists, and policy makers from across the United States. The views presented in this publication and others in the series are those of the authors and do not represent formal consensus positions of the NAM, the National Academies of Sciences, Engineering, and Medicine, or the authors’ organizations.
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Mental health and substance use disorders affect people of all ages and demographics and are extremely burdensome to society. At least 18.1% of American adults experience some form of mental disorder, 8.4% have a substance use disorder, and about 3% experience cooccurring mental health and substance use disorders. In 2013, health-related spending on mental health disorders in the United States was about $201 billion. Moreover, four of the top five sources of disability in people 18–44 years old are behavioral health conditions. While knowledge regarding recognition and treatment has steadily advanced, the public health effects of that knowledge have lagged. More effective and specific treatments exist now than in the past, and increased numbers of people who have these conditions can now lead productive, useful lives if they are treated properly.

Behavioral health is an essential component of overall health. People seen in primary care settings with chronic medical conditions—such as diabetes, asthma, and cardiovascular disorders—have a higher probability of having a substance use disorder or more common mental health disorders, such as depression and anxiety disorders. Coexistence of mental health or substance use disorders with general medical conditions complicates the management of both. Read more >>

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Disclaimer: The views expressed in this paper are those of the authors and not necessarily of the authors’ organizations, the National Academy of Medicine (NAM), or the National Academies of Sciences, Engineering, and Medicine (the National Academies). The paper is intended to help inform and stimulate discussion. It is not a report of the NAM or the National Academies. Copyright by the National Academy of Sciences. All rights reserved.