Inpatient Hospitalizations and Emergency Department Visits for Patients with a Behavioral Health Diagnosis in California: Patient Demographics
The number of Emergency Department visits with a behavioral health diagnosis decreased by nearly 6.2 percent (132,000) between 2020 and 2022 despite an overall increase in the number of Emergency Department visits.
What is Behavioral Health?
Behavioral health is an umbrella term that covers mental health (e.g., depression, anxiety disorders, schizophrenia and other psychoses) and substance use disorders. It includes our emotional, psychological, and social well-being. It helps determine how we handle stress, relate to others, and make healthy choices. Behavioral health is important at every stage of life, from childhood and adolescence through adulthood.
Key Findings
The findings below apply to 2022 demographic categories, but the patterns for 2020 and 2021 are similar.
- Overall: In 2022, patients with behavioral health diagnoses accounted for 1,189,129 Inpatient (IP) hospitalizations and 1,989,896 Emergency Department (ED) treat and release visits, which is approximately one third of all IP hospitalizations (3,603,421) and one sixth of all ED visits (12,280,042).
- Race/Ethnicity: Regardless of setting or type of disorder, Whites and Hispanics make up roughly 75 percent of encounters where there is a behavioral health diagnosis. The information is based on total numbers and not analyzed by the size each race/ethnicity group represents of the total population.
- Age: For age groups, care setting matters. Adults over age 60 comprised over 42 percent of IP hospitalizations, while younger adults (aged 19 to 39) comprised nearly 40 percent of ED visits.
- Assigned Sex at Birth: Males had a higher total number of diagnoses. Females are more likely to have a Mental Health Disorder and males are more likely to have a Substance Use Disorder.
- Expected Payer: Medi-Cal and Medicare were the expected source of payment for over two-thirds of all encounters where a behavioral health diagnosis was present.
The data visualizations below present patient demographic information (race/ethnicity, age, assigned sex at birth, and expected payer) for IP hospitalizations and ED visits for patients with a behavioral health diagnosis in California hospitals. For these visualizations, “behavioral health diagnoses” have been divided into three categories: Mental Health Disorders, Substance Use Disorders, and Co-occurring Disorders (the patient has both Mental Health Disorders and Substance Use Disorders). This information includes behavioral health conditions identified as the primary and secondary diagnosis. The behavioral health information is limited to hospital settings and does not represent information on services delivered in other parts of the behavioral health delivery system.
Note: For the visualization above, the denominator is the total number of encounters within each of the behavioral health categories (Mental Health Disorders, Substance Use Disorders, and Co-Occurring Disorders).
Why look at Behavioral Health Disorders?
According to the National Institute of Mental Health, nearly one in five U.S. adults live with a mental illness1. In California, that equates to nearly 8 million people in 2021.
According to the California Health Care Foundation, an average of 2.9 million Californians per year, age 12 and older (8.8%), had a substance use disorder in 2018-20192.
Types of Behavioral Health Diagnoses
‘Behavioral health’ describes a wide range of disorders. The data visualization below gives a broad overview of the types of disorders being seen in the ED or during IP hospitalizations.
- For both care settings, there were nearly 834,000 encounters with a mood disorder present and just over 808,000 with an anxiety disorder.
- Alcohol-related disorders was the third most prevalent category in both the ED and inpatient settings in 2022.
Note: Encounters with multiple behavioral health diagnoses will be counted for each separate diagnosis.
Race/Ethnicity
- For each of the behavioral health categories, Whites comprised between 40 and 50 percent of the encounters regardless of care setting.
- Asian/Pacific Islanders were nearly 1.5 times more likely to be seen for a Mental Health Disorder than a Substance Use Disorder, regardless of care setting.
- Hispanics presenting to the ED were nearly equally as likely to be seen for a Mental Health Disorder or a Substance Use Disorder; with substance use disorder being only 1.2 times more likely.
Note: Other Race/Ethnicity includes Multi-Racial, Other, Unknown, Invalid, and Missing.
Age
- The “60+” age group comprises just over half (52.8 percent) of all inpatient hospitalizations where a patient had a Mental Health Disorder diagnosis.
- The “19 to 39” age group have the largest proportion of ED visits (nearly 40 percent) across all three behavioral health categories: Co-occurring, Mental Health Disorders, and Substance Use Disorders.
- The “0 to 18” age group comprises the smallest proportion of ED visits and IP hospitalizations across all three behavioral health categories. Although a smaller proportion when compared to other age groups, the “0 to 18” age group had significantly more Mental Health Disorders compared to Co-occurring and Substance Use Disorders.
Note: Unknown age is not included.
Assigned Sex at Birth
- Females account for the majority of ED visits and IP hospitalizations for Mental Health Disorders.
- Males account for the majority of ED visits and IP hospitalizations for Substance Use Disorders.
- Males are more likely (1.3 times) than females to have a Co-occurring Disorder in both care settings.
Expected Payer
- Medi-Cal was the most common expected primary payer for all disorders and healthcare settings with one exception – inpatient care for Mental Health Disorders. Medicare comprised nearly half (47%) of IP Mental Health Disorders.
- In both care settings, Private Coverage covers more Mental Health Disorders than either Co-occurring or Substance Use Disorders.
- Uninsured patients were more likely to be treated in the ED for Substance Use Disorders than for Mental Health or Co-occurring Disorders.
How HCAI Created this Product:
Payer Categories
- Payer categories used in this report are based on the standard regulatory definitions used in Hospital Annual Financial Data reporting, sourced from the HCAI Accounting and Reporting Manual for California Hospitals.
- County Indigent Programs: Programs that cover indigent patients under Welfare and Institutions Code Section 17000 and those funded in whole or in part by County Medical Services Program (CMSP), California Health Care for Indigents Program (CHIP) and/or Realignment Funds. Includes traditional (fee-for-service), managed care, and other indigent programs.
- Medi-Cal: A public health insurance program that provides free or low-cost medical services and healthcare benefits to low-income individuals, financed from state and federal funds; California’s version of Medicaid. Includes Medi-Cal Managed Care and Medi-Cal Fee-for-Service.
- Medicare: A federal health insurance program funded by the Centers for Medicare & Medicaid Services (CMS) under the Social Security Amendments of 1965 that provides healthcare benefits to those aged 65 years and over and to disabled beneficiaries of any age. Includes Medicare Advantage and Medicare Fee-for-Service (traditional Medicare).
- Private / Other Third-Party: This payer category includes product types for which the coverage premium is paid by a private party –also called Commercial in most other HCAI data sources– and other payers such as Workers’ Compensation and Short-Doyle. Includes both traditional (fee-for-service) and managed care products.
- All Other: Includes all payers who do not belong in any of the other categories, including uninsured patients and self-paid patients.
- Definitions for behavioral health categories were adopted from the Massachusetts Center for Health Information and Analysis, which consulted with clinicians and the Agency for Healthcare Research and Quality.
- Clinical Classification Software Refined (CCSR V2023.1) codes were used to define the categories: Mental Health Disorders (e.g., mood disorders; intentional self-harm, suicidal ideation, and suicide attempts; schizophrenia and other psychotic disorders), Substance Use Disorders (e.g., alcohol-related disorders; cannabis-related disorders, hallucinogens-related disorders), and Co-Occurring Disorders (at least one Mental Health Disorder and at least one Substance Use Disorder).
- The visualizations include behavioral health diagnoses as a primary or secondary diagnosis but the counts may still be under-represented due to undiagnosed behavioral health conditions.
- For the demographic visualizations, each patient encounter is counted one time. Patients with at least one mental health diagnosis and at least one substance use diagnosis were placed in the “Co-occurring Disorder” group.
- 1National Institute of Mental Health, Statistics, Mental Illness
- 2California Health Care Foundation, Substance Use in California, 2022: Prevalence and Treatment
Additional Information
Topic: Healthcare Utilization
Source Link: Healthcare Utilization – Patient Level Administrative Data
Citation: HCAI – Patient Discharge Data, Emergency Department Data – Hospital Encounters for Behavioral Health, 2020 – 2022
Temporal Coverage: 2020 – 2022
Spatial/Geographic Coverage: Statewide
Frequency: Annually