general medical setting). Respondents could indicate multiple reasons for the last time they received mental health care; thus, the response categories are not mutually exclusive.⁶ Note that NSDUH does not collect data on the presence of one or more mental disorders among adolescents. Therefore, this report focuses on the use of mental health services among all adolescents.

This issue of The CBHSQ Report uses 2014 NSDUH data from approximately 17,000 adolescents aged 12 to 17 to examine the prevalence of mental health service use among adolescents and the reasons these adolescents receive mental health services. Results are presented for adolescents aged 12 to 17 overall, and by age subgroups (i.e., 12 or 13, 14 or 15, and 16 or 17), gender, race/ethnicity, and rural residence status.^7,8 Only comparisons that are statistically significant at the .05 level are discussed in this report.

In 2014, an estimated 13.7 percent of adolescents aged 12 to 17 received mental health services in a specialty mental health setting (inpatient or outpatient care) for problems with emotions or behaviors in the past 12 months. This represents an estimated 3.4 million adolescents out of the 24.9 million in the United States who are receiving mental health services in a specialty mental health setting. The adolescents who received mental health services in a specialty mental health setting could receive these services as part of inpatient and/or outpatient care. In 2014, approximately 606,000 adolescents received inpatient or residential specialty mental health services, and 3.1 million received outpatient specialty mental health services in the past year.⁹

To present a more complete picture of adolescent mental health service use, this report examines the demographic characteristics of adolescents aged 12 to 17 who received mental health services in a specialty mental health setting in the past 12 months. There were no statistically significant differences in receipt of mental health services by age group; however, adolescent females were more likely to have received mental health services in a specialty setting than adolescent males (17.0 vs. 10.6 percent; Figure 1). Asian adolescents were less likely to have received mental health services in a specialty setting than adolescents of other races/ethnicities (Figure 2). There were no statistically significant differences in adolescent receipt of mental health services in a specialty setting by rural residence status (13.8 percent among those living in urban areas and 11.3 percent among those living in rural areas).

Adolescents were also asked whether they had received mental health services in an educational setting in the past 12 months for an emotional or behavioral problem. Because most adolescents are in school and mental health concerns may affect performance or behavior in school, an educational setting is an opportunity to identify and provide services to adolescents who may need mental health services. Receipt of mental health services in an educational setting is defined in NSDUH as a nonspecialty mental health setting. In 2014, 13.2 percent of adolescents aged 12 to 17 received mental health services in an educational setting in the past year. This translates to approximately 3 million adolescents receiving services in an educational setting.¹⁰

Adolescents aged 16 or 17 were less likely to receive mental health services in an educational setting than those aged 12 or 13 and 14 or 15 (11.3 vs. 15.1 and 13.5 percent, respectively; Figure 3). Adolescent females were more likely to have received mental health services in an educational setting than adolescent males (15.2 vs. 11.4 percent). Black adolescents were more likely to receive mental health services in an educational setting than white, Hispanic, American Indian or Alaska Native, or Asian adolescents (16.7 vs. 13.1, 12.6, 10.1, and 8.0 percent, respectively; Figure 4). There were no statistically significant differences in adolescent receipt of mental health services in an educational setting by rural or urban residence status (13.3 percent among those living in urban areas and 12.3 percent among those living in rural areas).

The 3.4 million adolescents who received mental health services in a specialty setting were asked to identify one or more reasons why they received mental health treatment.⁶ Reasons that adolescents received mental health services were based on respondent self-reports and therefore do not necessarily indicate clinical diagnoses for specific mental disorders.

Of the 3.4 million adolescents aged 12 to 17 in 2014 who received specialty mental health services, about half (56.5 percent) reported receiving services because they felt depressed (Figure 7). Other commonly reported reasons for receiving services in a specialty setting included thinking about or attempting suicide (29.1 percent), feeling very afraid or tense (29.0 percent), having problems with home or family situations (26.6 percent), having broken rules or "acted out" (20.8 percent), having problems at school (18.1 percent), having trouble controlling anger (16.7 percent), having problems with friends (13.0 percent), and having eating problems (12.0 percent). Other less frequently reported reasons for receiving mental health services in a specialty setting are shown in Figure 7. 

Adolescents who received mental health services in an educational setting were asked to identify one or more reasons why they received mental health treatment.⁶ Similar to adolescents who received mental health services in a specialty setting, nearly half (44.3 percent) of adolescents who received mental health services in an educational setting reported receiving services because they felt depressed (Figure 8). Other commonly mentioned reasons adolescents received mental health services in an educational setting were having problems at school (22.9 percent), feeling very afraid or tense (21.2 percent), having broken rules or "acted out" (18.6 percent), having problems with friends (17.9 percent), thinking about or attempting suicide (15.8 percent), having problems with home or family situations (14.6 percent), and having trouble controlling anger (10.0 percent). Other less frequently reported reasons for receiving mental health services in an educational setting are shown in Figure 8.

Consistent with adolescents who received services in a specialty setting or in an educational setting, about half (52.1 percent) of adolescents receiving services in a general medical setting in 2014 reported that they received services because they felt depressed (Figure 9).⁶ Nearly 1 in 5 adolescents reported that they received mental health services in a general medical setting because they were thinking about or attempting suicide (23.4 percent), and about 1 in 4 adolescents were receiving services because they felt very afraid or tense (21.7 percent). Other commonly mentioned reasons for receiving mental health services in a general medical setting were having eating problems (12.3 percent) or having broken rules or "acted out" (12.3 percent). Other less frequently reported reasons for receiving mental health services in a general medical setting are shown in Figure 9. 

Receiving services for behavioral health needs can improve health and social outcomes for adolescents as they transition into adulthood.¹¹ About 1 in 4 adolescents experience mental disorders that result in severe impairment, which highlights the need for early intervention.² This report shows that of the 24.9 million adolescents in the United States, approximately 3.4 million received services in a specialty setting, 3.2 million received services in an educational setting, and 700,000 received services in a general medical setting.⁹ Across all three types of settings, female adolescents were more likely than males to have received mental health services. Adolescents aged 16 or 17 were less likely to receive services in an educational setting than younger adolescents. The use of mental health services among adolescents by race/ethnicity varied across the three settings. Although white adolescents were more likely to receive mental health services in a specialty setting or in a general medical setting, black adolescents were more likely to receive services in an educational setting. Compared with their counterparts, Asian adolescents were least likely to receive mental health services across any of the three settings. Adolescents living in rural areas were less likely than adolescents living in more urban areas to receive services in a specialty setting or in a general medical setting. 

This report also examined the variety of reasons that adolescents receive mental health services. Across all three settings, approximately half reported that they received services because they felt depressed. Another common reason for receiving mental health services across all three settings was feeling afraid or tense. The percentage of adolescents reporting that they were receiving services because they were thinking about or attempting suicide ranged from 15.8 percent in an educational setting to 29.1 percent in a specialty setting. Although adolescents were accessing mental health services in a variety of settings, their reasons for obtaining help were similar. 

The Substance Abuse and Mental Health Services Administration provides information about where to find mental health treatment at https://findtreatment.samhsa.gov. When adolescents feel that they are in an immediate crisis, they can call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255). Resources to help parents, teachers, and caregivers locate mental health services are available from www.samhsa.gov.

1. Kessler, R. C., Chiu, W. T., Demler, O., Merikangas, K. R., & Walters, E. E. (2005, June). Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62(6), 617–627.
2. Merikangas, K. R., He, J.-P., Burstein, M., Swanson, S. A., Avenevoli, S., Cui, L., et al. (2010). Lifetime prevalence of mental disorders in US adolescents: Results from the National Comorbidity Study-Adolescent Supplement (NCS-A). Journal of the American Academy of Child and Adolescent Psychiatry, 49(10), 980–989.
3. Center for Behavioral Health Statistics and Quality. (2013). Results from the 2012 National Survey on Drug Use and Health: Mental health findings (HHS Publication No. SMA 13-4805, NSDUH Series H-47). Rockville, MD: Substance Abuse and Mental Health Services Administration.
4. Merikangas, K. R., He, J.-P., Burstein, M., Swendsen, J., Avenevoli, S., Case, B., et al. (2011). Service utilization for lifetime mental disorders in U.S. adolescents: Results of the National Comorbidity Survey Adolescent Supplement (NCS-A). Journal of the American Academy of Child and Adolescent Psychiatry, 50(1), 32–45.
5. Center for Behavioral Health Statistics and Quality. (2014). The CBHSQ Report: Serious mental health challenges among older adolescents and young adults. Rockville, MD: Substance Abuse and Mental Health Services Administration.
6. Respondents who did not indicate receiving mental health care from a particular mental health service category for any of the reasons listed were excluded.
7. NSDUH collects information on race following guidance from the U.S. Office of Management and Budget's 1997 Revisions to the Standards for the Classification of Federal Data on Race and Ethnicity. NSDUH first asks respondents if they are of Hispanic or Latino origin; respondents are then asked to identify which racial groups describe them: white, black or African American, American Indian or Alaska Native, Native Hawaiian, Other Pacific Islander, Asian, or other. Respondents could choose more than one racial group. 
8. Rural residence status is based on the characteristics of the county in which an adolescent resides. Counties were grouped based on the Rural-Urban Continuum Codes developed by the U.S. Department of Agriculture. Large metropolitan (large metro) areas have a population of 1 million or more. Rural residence status was defined as living in counties with a population of fewer than 2,500 in urbanized areas. Adolescents living in rural areas were compared with their counterparts not living in rural areas.
9. Adolescents can receive mental health services in more than one setting, including specialty mental health services, mental health services in an educational setting, and mental health services in a general medical setting. For example, adolescents could have received both outpatient specialty mental health services and inpatient or residential specialty mental health services. As a result, the number of adolescents receiving either outpatient or inpatient or residential services may exceed the total number (3.4 million) of adolescents receiving any mental health services in a specialty mental health setting.
10. Respondents with unknown receipt of mental health services information were excluded.
11. Government Accountability Office. (2008). Young adults with serious mental illness: Some states and federal agencies are taking steps to address their transition challenges (GAO-08-678). Washington, DC: Author.

Lipari, R.N., Hedden, S., Blau, G. and Rubenstein, L. Adolescent mental health service use and reasons for using services in specialty, educational, and general medical settings. The CBHSQ Report: May 5, 2016. Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration, Rockville, MD.