A Crisis in Search of Data: The Revolving Door of Serious Mental Illness in Super Utilization

Individuals with serious mental illness are well known to be grossly overrepresented in the nation’s criminal justice and social safety-net systems. Making up barely 3% of the adult population, those with diagnoses of schizophrenia or severe bipolar disorder account for far greater proportions of the people served by law enforcement, housed in correctional facilities, presenting in hospital emergency departments and living on the streets.

Treatment Advocacy Center set out in 2015 to identify the role and cost of this population in the phenomenon known as super utilization: the relatively frequent use of high-cost public services by relatively few people. The result, A Crisis in Search of Data, represents the first published effort to systematically and comprehensively survey what government, academic and mass media sources have learned and reported about this public health emergency and its human and economic costs.

Top Takeaway

While widely recognized by service providers, the role of serious mental illness in high utilization is largely uncharted and its costs unknown and unknowable at the state or federal level from the data currently being collected. This dooms policymakers to making critical decisions without essential information. It also severely limits their ability to make decisions based on intersystem costs and benefits.

Fast Facts

• National or state-level data that quantify the role and cost of individuals with serious mental illness on law enforcement, corrections, emergency medical or homelessness services do not exist. Even less information is available about the impacts of the super utilizers within this population.
• Basic definitions that would make it possible to develop meaningful data about larger trends are needed if data that can be combined, compared or scaled up are to be developed.
• Illustrative of the problem: An estimated 20% of the homeless population consumes 50% of the nation’s homelessness services, but estimates of serious mental illness in the chronically homeless population range from 20% to 76%. This is far too extreme a range to provide a reliable basis for data-driven policy making.

Recommendations

• Researchers and government agencies must collaborate to develop a common definition of serious mental illness for use in data collection around super utilization.
• Federal, state and local governments must incorporate serious mental illness as a data point in all government collection of super-utilizer statistics.
• Researchers and government agencies must standardize methodologies for recognizing and reporting the economic costs of serious mental illness in super utilization.
• Government must fund an open-source forum or clearinghouse where organizations that are systematically collecting super-utilizer data, including data on the role and cost of serious mental illness, can share and find related projects and statistics.