Inpatient Hospitalizations and Emergency Department Visits for Patients with a Behavioral Health Diagnosis in California: Patient Demographics
The number of hospital encounters with a behavioral health diagnosis increased by almost 165,000 from 2023 to 2024, with Mental Health Disorders accounting for more than 90% of the increase in emergency department encounters.
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 health disorder. In California, that equates to nearly 8 million people. The California Health Care Foundation reported that an average of 5.6 million Californians, per year, age 12 and older (17%) had a substance use disorder from 2022 to 2023.
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). Behavioral health conditions were identified based on the primary and secondary diagnosis. This analysis is limited to hospital settings and does not represent information on services delivered in other parts of the behavioral health delivery system.
This analysis of patient characteristics with a behavioral health diagnosis is one of many HCAI analyses that focus on or include behavioral health. For a more comprehensive understanding of behavioral health care utilization, cost and workforce please visit:
- Hospital and Workforce Behavioral Health Data in California
- Data Brief: Behavioral Health Spending in California’s Commercial Market
- Hospital Utilization Trends
- Alcohol-Related Emergency Department Encounters in California
- Supply and Demand Modeling for California’s Behavioral Health Workforce
- Healthcare Payments Data (HPD) Measures: Health Conditions, Utilization, and Demographics
Key Findings
- Overall: In 2024, patients with behavioral health diagnoses accounted for nearly one third (29%) of all IP hospitalizations and approximately one eighth (12%) of all ED treat and release visits.
- Diagnosis: In 2024, Mood Disorders were the most common behavioral health diagnosis (504,840 encounters) in the IP setting, while Anxiety Disorders were most common (465,778 encounters) in the ED setting.
- Age: The number of encounters with a behavioral health diagnosis for adults aged “60+” increased at a faster rate than for each of the other age groups. It increased by approximately 15% for IP hospitalizations and 12% for ED visits from 2020 to 2024.
- Expected Payer: The expected payer differs by diagnosis category. In 2024, Medi-Cal was the most common expected payer in the ED setting (45% of encounters with a behavioral health diagnosis). By contrast, Medicare was the most common expected payer in the IP setting (39% of encounters with any behavioral health diagnosis, and 49% of encounters with a Mental Health Disorder diagnosis).
- Assigned Sex at Birth: In both the IP and ED settings in 2024, females accounted for more than 60% of encounters with Mental Health Disorders in the IP and in the ED settings. Males accounted for close to 70% of encounters with Substance Use Disorders and close to 60% of encounters with Co-Occurring Disorders.
- Race/Ethnicity: Hispanic patients comprised 19% more IP hospitalizations with a behavioral health diagnosis from 2020 to 2024 (approximately 13,044 visits per year), and Asian patients comprised 15% more (approximately 1,618 visits per year). Hispanic patients comprised 30% more ED visits with a Substance Use Disorder from 2020 to 2024 (approximately 11,421 visits per year), a greater increase over this period than for other race/ethnic groups.
Visualization
How HCAI Created this Product
- 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 once. Patients with at least one mental health diagnosis and at least one substance use diagnosis were placed in the “Co-occurring Disorder” group.
- For the diagnosis visualizations (displaying mood disorders, anxiety disorders, alcohol-related disorders, etc.), encounters with multiple behavioral health diagnoses are counted under each applicable diagnosis.
- The race/ethnicity information is based on numbers of encounters, not on the proportion of each race/ethnic group out of the total population.
- Unknown age, unknown expected payer, and unknown assigned sex at birth are not included.
Glossary
Behavioral Health: 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.
Expected Payer: The payer type that was expected to pay the greatest share of the patient’s bill at the time of discharge, not the payer type that actually paid.
| Payer Grouping | Inpatient Discharges | Emergency Department Visits |
|---|---|---|
| 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). | Medicare | Medicare Part A, Medicare Part B, and Health Maintenance Organization (HMO) Medicare Risk |
| 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. | Medi-Cal | Medicaid (Medi-Cal) |
| Private Health Insurance: Coverage by private, non-profit or commercial health plans or through organizations. Includes individual coverage purchased through Covered California, and organized charity payers (e.g., March of Dimes, Shriners). | Private Coverage | Preferred Provider Organization (PPO), Point of Service (POS), Exclusive Provider Organization (EPO), Blue Cross / Blue Shield, Commercial Insurance Company, and Health Maintenance Organization |
| Other Government: Public insurance programs other than Medicare or Medi-Cal, including federal, state, county and veteran-specific programs. | County Indigent, Other Government | CHAMPUS (TRICARE), Other Federal Program, Title V, Veterans Affairs Plan, and Other Non-Federal Programs |
| Self-Pay or Uninsured: Coverage where the greatest share of the patient’s bill is not expected to be paid by any other form of insurance or health plan. Includes uninsured patients, as well as instances when insurance does not cover the treatment, or the patient would like to keep the medical procedure private. | Other Indigent, Self-Pay | Self-Pay |
| All Other Payers: Includes payers not categorized elsewhere: Workers’ Compensation, Automobile Medical, disability insurance, third-party payment not included in any other category or stays for which no payment will be required by the facility (e.g. courtesy patients). | Workers’ Compensation, Other Payer | Automobile Medical, Disability, Workers’ Compensation Health Claim, Other |
Additional Information
Topic: Healthcare Utilization
Source Link: Healthcare Quality
Citation: HCAI – Patient Discharge Data, Emergency Department Data – Hospital Encounters for Behavioral Health, 2020 – 2024
Temporal Coverage: 2020 – 2024
Spatial/Geographic Coverage: Statewide
Frequency: Annually