2019 N-MHSS

DEPARTMENT OF HEALTH AND HUMAN SERVICES
Substance Abuse and Mental Health Services Administration

Acknowledgments

This report was prepared for the Substance Abuse and Mental Health Services Administration (SAMHSA), U.S. Department of Health and Human Services (HHS). Work was performed under Contract No. HHSS283201600001C. The Contracting Officer’s Representative (COR) at SAMHSA/CBHSQ was Nichele Waller.

SAMHSA complies with applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. SAMHSA cumple con las leyes federales de derechos civiles aplicables y no discrimina por motivos de raza, color, nacionalidad, edad, discapacidad o sexo.

Public Domain Notice

All material appearing in this report is in the public domain and may be reproduced or copied without permission from SAMHSA. Citation of the source is appreciated. However, this publication may not be reproduced or distributed for a fee without the specific, written authorization of the Office of Communications, SAMHSA, U.S. Department of Health and Human Services.

Recommended Citation

Substance Abuse and Mental Health Services Administration, National Mental Health Services Survey (N-MHSS): 2019. Data on Mental Health Treatment Facilities. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2020.

Electronic Access of the Publication

Originating Office

List of Tables

Description of the National Mental Health Services Survey (N-MHSS)

Trends in Facility Characteristics

Facility Characteristics and Services

Selected Facility Characteristics at the Regional and State Levels

Veterans Affairs Facilities

Appendix C

List of Figures

Facility Characteristics and Services

Highlights

This report presents findings from the 2019 National Mental Health Services Survey (N-MHSS), an annual census of all known facilities in the United States, both public and private, that provide mental health treatment services to people with mental illness.¹

Planned and directed by the Center for Behavioral Health Statistics and Quality (CBHSQ) of the Substance Abuse and Mental Health Services Administration (SAMHSA), U.S. Department of Health and Human Services, the N-MHSS is designed to collect data on the location, characteristics, and utilization of organized mental health treatment services for facilities within the scope of the survey throughout the 50 states, the District of Columbia, Puerto Rico, and other jurisdictions.²

It is important to note that values in charts, narrative lists, and percentage distributions are calculated using actual raw numbers and rounded for presentation in this report; calculations using rounded values may produce different results.

Trends in Facility Characteristics 2015–2019

Facility Characteristics and Services

Selected Facility Characteristics at the Regional and State Levels

Chapter 1. Description of the National Mental Health Services Survey (N-MHSS)

This report presents findings from the 2019 National Mental Health Services Survey (N-MHSS) conducted from March 2019 through November 2019. The N-MHSS collects information from all known facilities within the scope of the survey in the United States, both public and private, that provide mental health treatment services to people with mental illness.³ The Center for Behavioral Health Statistics and Quality (CBHSQ) of the Substance Abuse and Mental Health Services Administration (SAMHSA), U.S. Department of Health and Human Services, plans and directs the N-MHSS.

The N-MHSS provides a mechanism for quantifying the dynamic character and composition of the U.S. mental health treatment delivery system. It is the only source of national- and state-level data on the mental health services delivery system reported by both publicly and privately operated specialty mental health treatment facilities. The N-MHSS is designed to collect data on the location, characteristics, and utilization of organized mental health treatment services for facilities within the scope of the survey throughout the 50 states, the District of Columbia, Puerto Rico, and other jurisdictions.⁴ The N-MHSS complements, but does not duplicate, the information collected through SAMHSA’s survey of substance abuse treatment facilities, the National Survey of Substance Abuse Treatment Services (N-SSATS).

Data Collection Procedures for the 2019 N-MHSS

Field period and reference date

The field period for the 2019 N-MHSS, which included mailing and data collection operations, ran from March 26, 2019, through November 30, 2019. The reference date was April 30, 2019.

Survey universe

The survey universe for the 2019 N-MHSS included 14,936 facilities across the United States and other jurisdictions [Table 1.1]. Most facilities in the 2019 N-MHSS frame were identified from the updated database produced after fielding the 2010 and 2014 N-MHSS, and further supplemented by the 2015, 2016, 2017, and 2018 mental health augmentations, as well as by new facilities that states requested be added to the I-BHS.

Survey coverage

The following types of mental health treatment facilities were included in the 2019 N-MHSS:

Exclusions

The survey universe for the 2019 N-MHSS excluded: (1) Department of Defense (DoD) military treatment facilities, (2) individual private practitioners or small group practices not licensed as a mental health clinic or center, and (3) jails or prisons.

Facilities are not eligible for inclusion in the survey universe if they only provide one or more of the following services: crisis intervention services, psychosocial rehabilitation, cognitive rehabilitation, intake, referral, mental health evaluation, health promotion, psychoeducational services, transportation services, respite services, consumer-run/peer support services, housing services, or legal advocacy. Residential facilities whose primary function is not to provide specialty mental health treatment services are also not eligible for inclusion in the survey universe for the N-MHSS.

Content

The 2019 N-MHSS instrument, which appears in its print format as Appendix A, is an eight-page document with 32 numbered questions. Topics included:

A two-page addendum to the 2019 N-MHSS instrument, also presented in Appendix A, included questions for Veterans Affairs (VA) facilities about standardized processes or workflows for appropriate referrals; suicide prevention services offered; follow-up of mental health clients with suicidal thoughts and behavior; the timing of staff training in suicide prevention strategies, suicide risk screening programs implemented; identification of warning signs for suicide and violence; universal client suicide risk assessment; and the number of full-time suicide prevention coordinators (SPCs), care managers for high suicide risk clients, and program support assistants for high risk clients employed. Data from the VA addendum is presented in Chapter 5.

Data collection

There were three data collection modes employed: a secure web-based questionnaire, a paper questionnaire sent by mail, and a computer-assisted telephone interview (CATI). Approximately four weeks before the survey reference date (April 30, 2019), SAMHSA mailed letters to the attention of the facility directors of all eligible facilities to alert them to expect the survey and to request their participation in the N-MHSS (Appendix B). The letter also served to update records with new address information received from the U.S. Postal Service. A data collection packet (including SAMHSA cover letter, state-specific letter of support, information on completing the survey on the web, and fact sheet of frequently asked questions) was mailed to each facility on April 30, 2019. The web-based survey also became available at the same time. At this point, each facility had the option of completing the questionnaire via the secure survey website or asking for a paper questionnaire to complete and return via postal mail. In August 2019, another, similar packet was sent to non-responding facilities, this time including a copy of the questionnaire, a definitions packet, and a postage-paid return envelope.

During the data collection phase, contract personnel were available by telephone to answer facilities’ questions concerning the survey. Facilities completing the questionnaire on the Internet had access to hyperlinks to an information site containing definitions of the survey elements. Multiple reminder letters were sent to non-respondents over the course of the data collection period via fax, mail, and e-mail. To increase the survey response rate, state mental health agency representatives were contacted during the data collection period to inform them of their state’s progress and to request additional help in encouraging responses. Blaise^®-to-web follow-up (assisted telephone interviews) of non-respondents began in August 2019 and ended in late November 2019.

Eligibility and unit response rate

Table 1.1 presents a summary of eligibility and response rate information. Of the 14,936 mental health treatment facilities in the survey, 6 percent were found to be ineligible for the survey, because they did not provide mental health treatment services, had a primary treatment focus of substance abuse services or general health care, provided treatment for incarcerated persons only (i.e., in jails or prisons), were an individual or small group mental health practice not licensed or certified as a mental health center or clinic, or were closed.

Table 1.1. N-MHSS facilities, by status and mode of response: 2019

	Number	Percent
Total facilities in universe	14,936	100.0
Closed/ineligible	923	6.2
Eligible	14,013	93.8

Total eligible	14,013	100.0
Non-respondents	1,301	9.3
Respondents	12,712	90.7
Excluded from report (administrative only)	240	1.7
Eligible for report	12,472	89.0

Mode of response	12,472	100.0
Internet	11,678	93.6
Mail	145	1.2
Telephone	649	5.2

SOURCE: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration, National Mental Health Services Survey (N-MHSS), 2019.

Facility Reporting and Selection for the 2019 N-MHSS Report

Of the 14,013 facilities eligible for the survey, 91 percent completed the survey, including 240 facilities that did not provide direct mental health treatment services [Table 1.1]. (These 240 facilities, which provided administrative services only, were excluded from the report but have been included in SAMHSA’s online Behavioral Health Treatment Services Locator.) After excluding the 240 facilities that provided only administrative services, data from 12,472 eligible respondent facilities were included in the 2019 N-MHSS report. Of the respondents that were eligible for the report, 94 percent completed the survey on the web, 1 percent through the mail, and 5 percent on the telephone.

Quality Assurance

All completed mail questionnaires underwent a manual review for consistency and missing data. Calls to facilities clarified questionable responses and obtained missing data. After data entry, automated quality assurance reviews were conducted. The reviews incorporated the rules used in manual editing plus consistency checks not readily identified by manual review. The web-based questionnaire was programmed to be self-editing; that is, respondents were prompted to complete missing responses and to confirm or correct inconsistent responses on critical items. The CATI questionnaire was similarly programmed.

Response Rates

The final unit response rate among facilities eligible for the survey was 91 percent. Extensive follow-up during data collection and careful editing maximized item response; the item response rates averaged more than 99 percent across all 149 separate items (see Appendix C).

Data Considerations and Limitations

As with any data collection effort, certain procedural considerations and data limitations must be taken into account when interpreting data from the 2019 N-MHSS. Some general issues are listed below. Considerations and limitations of specific data items are discussed where the data are presented.

Organization of the Report

It should be noted that the 2019 N-MHSS findings as discussed in Chapters 2–5 of this report, as well as all figures, have been rounded to whole numbers to assist the reader. Please note that percentage distributions in Chapter 2–5 tables and figures may not add to 100 percent due to rounding.

To Chapter 1 Table

Chapter 2. Trends in Facility Characteristics

Number of Facilities

Table 2.1. The total number of mental health treatment facilities remained stable between 2015 and 2019. There was considerable turnover from year to year in the individual facilities responding to the survey: Between 86 and 92 percent of the facilities responding to a survey had also responded to the previous year’s survey. Between 9 and 16 percent of the facilities from year-to-year closed, were no longer providing mental health treatment services, or did not respond to the current year’s survey. However, those facilities were replaced by similar facilities that had not responded in the previous year.

There was a net increase of 790 eligible responding facilities between 2018 and 2019, from 11,682 to 12,472 facilities. Of the facilities that responded to the 2019 survey, 86 percent had also responded to the 2018 survey, and 14 percent were new to the 2019 survey or did not respond in 2018. Of the facilities that responded in 2018, 9 percent had closed, were no longer providing mental health treatment, or did not respond in 2019.

Facility Operation

Table 2.2. The operational structure of the mental health treatment system (i.e., the types of entities responsible for operating facilities) had some notable changes between 2015 and 2019.

To Chapter 2 Tables

Chapter 3. Facility Characteristics and Services

This chapter describes key features of mental health treatment facilities included in the 2019 N-MHSS. See Chapter 1 for definitions of the types of mental health treatment facilities included in the N-MHSS.

Facility Type and Facility Operation

Table 3.1 and Figure 1. Facilities were classified according to one of the following facility type categories: psychiatric hospitals, general hospitals, residential treatment centers (RTCs) for children, RTCs for adults, community mental health centers, outpatient mental health facilities (including facilities that provide mental health treatment services in outpatient or partial hospitalization/day treatment settings), other types of residential treatment facilities, multi-setting mental health facilities, Veterans Affairs (VA) medical centers, or other.

Figure 1 presents the percent distribution of the 12,472 facilities by type of facility.

Figure 1. Facility type: 2019

Table 3.2 and Figure 2. Facilities were asked about the type of entity responsible for their operation. Of all 12,472 facilities, 61 percent were operated by private non-profit organizations. Next were private for-profit organizations (20 percent) and regional/district authorities or county, local, or municipal governments (7 percent).

Figure 2. Facility operation: 2019

Bar chart comparing types of facility operations in 2019 between private non-profit, private for-profit, regional/district authority, Department of Veterans Affairs, other state government agency, state mental health authority (SMHA), tribal government, Indian Health Service, and other. More details found in the text.

Service Settings Offered

Table 3.1 and Figure 3. The four service settings (levels of care) in which facilities offered mental health treatment services were 24-hour hospital inpatient settings (inpatient), 24-hour residential settings (residential), less-than-24-hour partial hospitalization/day treatment settings (partial hospitalization/day treatment), and less-than-24-hour outpatient settings (outpatient). A facility could offer care in more than one service setting.

Figure 3. Of all 12,472 mental health treatment facilities, 78 percent offered less-than-24-hour mental health treatment services in outpatient settings, 16 percent offered 24-hour residential settings, 15 percent offered 24-hour inpatient settings, and 15 percent offered less-than-24-hour partial hospitalization/day treatment settings.

Among outpatient mental health facilities, more than 99 percent offered less-than-24-hour outpatient mental health treatment service settings, 5 percent offered less-than-24-hour partial hospitalization/ day treatment service settings, and less than 1 percent offered either 24-hour residential or 24-hour hospital inpatient service settings.

Figure 3. Service settings: 2019

Bar chart comparing service settings in 2019 between outpatient, residential, inpatient, and partial hospitalization/day treatment. More details found in the text

Treatment Approaches

Tables 3.3a–b. Facilities indicated whether or not they offered specific types of mental health treatment approaches.

Services and Practices

Tables 3.4a–b. Facilities were asked if they provided specific supportive services and practices. A facility could provide supportive services and practices for more than one type of service or practice.

Age Groups

Table 3.5 and Figure 4. Facilities were asked if they accepted the following age groups for treatment: children (aged 12 years or younger), adolescents (aged 13 to 17 years), young adults (aged 18 to 25 years), adults (aged 26 to 64 years), and seniors (aged 65 years or older). Facilities could accept more than one age group for treatment.

Figure 4. Age groups accepted for treatment: 2019

Figure 4 is a bar chart comparing proportions of facilities that accepted various age groups for treatment.

Dedicated or Exclusively Designed Treatment Programs or Groups for Specific Client Types

Tables 3.6a–b and Figure 5. Facilities were asked if they offered dedicated or exclusively designed programs or groups for specific client types.

Figure 5. Facilities that offered programs for persons with co-occurring mental and substance use disorders, by facility type: 2019

Figure 5 is a bar chart comparing, by facility type, the proportions of facilities that offered exclusively designed programs or groups for persons with co-occurring mental and substance use disorders. Refer to the preceding text for details about dedicated or exclusively designed programs or groups for specific client types.

Treatment Services Provided in Languages Other Than English and for the Deaf and Hard-of-Hearing

Table 3.7. Facilities were asked if treatment services were provided in a language other than English, if staff provided the services in other languages, and in what other languages staff provided services. Facilities were also asked if they offered treatment services for the deaf and hard-of-hearing.

Crisis Intervention Teams

Table 3.8. Facilities were asked whether or not they employ a crisis intervention team.

Types of Payment or Insurance Accepted

Tables 3.9a–b and Figure 6. Facilities were asked to indicate the types of client payments, insurance, or funding that were accepted for the treatment services they provided.

Medicaid was accepted by at least 75 percent of all facility types except VA medical centers (21 percent).

Figure 6. Types of payment or insurance accepted, by facility type: 2019

Figure 6 is a bar chart comparing Types of payment or insurance accepted, by facility type during the 2019 reporting period. The preceding paragraphs and bullets provide details about the topic.

Smoking Policy

Facility Licensing, Certification, or Accreditation

Tables 3.11a–b. Facilities were asked if they have any licensing, certification, or accreditation. A facility could be licensed, certified, or accredited by one or more agencies or organizations.

To Chapter 3 Tables

Chapter 4. Selected Facility Characteristics at the Regional and State Levels

This chapter presents the data for the U.S. Census regions, states, and jurisdictions that were discussed at the national level in Chapters 2 and 3. Throughout this chapter, states/jurisdictions are defined as the 50 states, the District of Columbia, Puerto Rico, and the combined jurisdictions of American Samoa, Guam, the Commonwealth of the Northern Mariana Islands, and the U.S. Virgin Islands. Note that facilities operated by federal agencies (i.e., Department of Veterans Affairs, and Indian Health Service) are included in the states in which the facilities are located, although these facilities may provide services to clients from other states.

Of the 12,472 mental health treatment facilities that responded to, and were included in, the 2019 N-MHSS, California and New York had the largest total numbers of facilities (952 and 860 facilities, respectively). There were three other states that had more than 500 facilities each: Florida, Ohio, and Pennsylvania [Tables 4.2a–b]. These five states combined accounted for 28 percent of all mental health treatment facilities that responded to the survey in 2019.

Figure 7 presents the U.S. Census regions for the 50 states and the District of Columbia. Throughout this chapter and in the Chapter 4 tables, data for all U.S. territories included in the 2019 N-MHSS, except Puerto Rico, have been aggregated and are discussed as a single category, other jurisdictions.

Figure 7. U.S. Census regions and divisions

Figure 7 is a map of the United States divided into the four census regions and their divisions. West contains: Pacific and Mountain; Midwest contains: West North Central and East North Central; Northeast contains: Middle Atlantic and New England; and South contains: West South Central, East South Central and South Atlantic divisions. Refer to footnote 3 on page 9 for more details.

Survey Response

Table 4.1. Among the 12,712 facilities that responded the survey, Kentucky had the highest response rate (97 percent), and North Carolina has the lowest response rate (82 percent).

Facility Type

Tables 4.2a–b and Figure 8. Of the 12,472 mental health treatment facilities, outpatient mental health facilities and community mental health centers accounted for the greatest proportions of facilities (42 and 22 percent, respectively).

Figure 8. States in which 40 percent or more of all mental health treatment facilities were outpatient mental health facilities: 2019

Figure 8 is a Map of the United States comparing States in which 40 percent or more of all mental health treatment facilities were outpatient mental health facilities in 2019. More details in the text

Facility Operation

Figure 9. States in which 80 percent or more of all mental health treatment facilities were operated by private non-profit organizations: 2019

Figure 9 is a choropleth that presents the states and other jurisdictions in which 80 percent or more of all mental health treatment facilities were operated
by private non-profit organizations. More information can be found in the preceding text.

Service Settings Offered

Tables 4.4a–4.7b present the service settings offered by type of facility, region, and state/jurisdiction. Overall findings by service setting include:

Treatment Approaches

Tables 4.8a–b present data on treatment approaches offered by mental health treatment facilities by region and state/jurisdiction.

Services and Practices

Tables 4.9a–b present data on the services and practice approaches offered by mental health treatment facilities. Figure 10 displays the proportion of mental health treatment facilities that offered psychiatric emergency walk-in services, by region.

Figure 10. Mental health treatment facilities that offered psychiatric emergency walk-in services, by region: 2019

Figure 10 is a bar chart comparing the percent of Mental health treatment facilities that offered psychiatric emergency walk-in services, by region in 2019. The body text before the chart gives more details.

Age Groups

Table 4.10 and Figure 11 present data on facilities that accepted children (aged 12 years and younger), adolescents (aged 13 to 17 years), young adults (aged 18 to 25 years), adults (aged 26 to 64 years), and seniors (aged 65 years and older) for treatment.

Figure 11. Mental health treatment facilities that accepted clients of all ages for treatment, by region: 2019

Figure 11 is a bar chart comparing the percent of Mental health treatment facilities that accepted clients of all ages for treatment, by region iduring 2019. Refer to the previous text for more specific detail about the facilities and their data.

Dedicated or Exclusively Designed Treatment Programs or Groups for Specific Client Types

Tables 4.11a–b and Figure 12 present data on facilities that offered dedicated or exclusively designed treatment programs or groups for specific client types.

Figure 12. Mental health treatment facilities that offered dedicated or exclusively designed treatment programs or groups for persons with post-traumatic stress disorder, by region: 2019

Figure 12 is a bar chart comparing the percent of Mental health treatment facilities that offered dedicated or exclusively designed treatment programs or groups for persons with post-traumatic stress disorder, by region in 2019. The text gives more details

Treatment Services Provided in Languages Other Than English and for the Deaf and Hard-of-Hearing

Table 4.12 presents data on facilities providing treatment services in a language other than English and on facilities that offered treatment services in sign language for the deaf and hard-of-hearing; Figure 13 presents data on facilities that offered treatment services in sign language for the deaf and hard-of-hearing.

Figure 13. Mental health treatment facilities that offered treatment services in sign language for the deaf and hard-of-hearing, by region: 2019

Figure 13 is a bar chart comparing the proportions mental health treatment facilities, by region, that offered treatment services in sign language for the deaf and hard-of-hearing in 2019. More information can be found in the preceding text.

Crisis Intervention Teams

Table 4.13 presents data on whether or not facilities employ a crisis intervention team by region and state/jurisdiction.

Types of Payment or Insurance Accepted

Tables 4.14a–b and Figure 14 present data on the specific types of payment or insurance accepted by facilities.

Figure 14. Mental health treatment facilities that accepted Medicare, by region: 2019

Figure 14 is a bar chart comparing the percent of Mental health treatment facilities that accepted Medicare, by region during the 2019 reporting period. Specific information on the subject can be found in the previous paragraphs and bulleted text

Facility Licensing, Certification, or Accreditation

Tables 4.15a–b. Facilities were asked if they have any licensing, certification, or accreditation.

To Chapter 4 Tables

Chapter 5. Veterans Affairs Facilities

Suicide Prevention-Related Services

Table 5.1 presents data on the availability of suicide prevention-related services in VA facilities, methods for assessment of suicide risk, and the timing of staff training in suicide prevention strategies.

VA Facilities With Suicide Prevention-Related Staff

Table 5.2 offers information on how many full-time suicide prevention-related staff VA facilities have.

To Chapter 5 Tables

Appendix A. 2019 N-MHSS Questionnaire

To 2019 N-MHSS Questionnaire

Addendum for Mental Health VA Facilities

Appendix B. Data Collection Procedures

Survey Frame

The survey frame for the 2019 N-MHSS originally consisted of 14,936 known facilities. Most facilities in the 2019 N-MHSS frame were identified from the updated database produced after fielding the 2010 and 2014 N-MHSS; the 2015, 2016, 2017, and 2018 mental health augmentations; and new facilities that states requested be added to the I-BHS.

Data Collection

Data collection took place between March 26, 2019, and November 30, 2019. During that period, facilities were contacted through mail, e-mail, fax, and telephone to remind them to complete the survey. Of the total 14,936 facilities included in the survey frame, 923 (6 percent) were closed or ineligible. Ineligible facilities included those that did not provide mental health treatment, were a satellite site⁶ focused primarily on substance abuse treatment or general health care, provided treatment only for incarcerated persons in jail or prison, or were an individual or small group mental health practice not licensed or certified as a mental health clinic or center.

Appendix C. Response Rates

Table C1. Item response rates, by question number and description: 2019

Question number	Description	Response rate (%)
A1-1	Facility offers mental health intake services	100.0
A1-2	Facility offers mental health diagnostic evaluation	100.0
A1-3	Facility offers mental health information and/or referral services	100.0
A1-4	Facility offers mental health treatment services	100.0
A1-5	Facility offers treatment for co-occurring serious mental illness/serious	100.0
A1-6	Facility offers substance use treatment services	100.0
A1-7	Facility offers administrative services for mental health treatment facilities	100.0
A3-1	Mental health treatment offered 24-hour hospital inpatient services	100.0
A3-2	Mental health treatment offered 24-hour residential services	100.0
A3-3	Mental health treatment offered for less-than-24-hour partial hospitalization/day treatment	100.0
A3-4	Mental health treatment offered for less-than-24-hour outpatient	100.0
A4	Facility type	100.0
A5	Facility is a solo or small group practice	100.0
A5a	Facility is licensed or accredited as MH clinic or center	100.0
A6	Facility is a Federally Qualified Health Center	99.9
A7	Primary treatment focus for the facility	100.0
A8	Facility is a jail, prison, or detention center	100.0
A9	Facility operation/ownership	100.0
A9a	Public agency or department operation/ownership	100.0
A10-1	Facility offers individual psychotherapy	100.0
A10-2	Facility provides couples/family therapy	100.0
A10-3	Facility provides group therapy	100.0
A10-4	Facility provides cognitive behavioral therapy	100.0
A10-5	Facility provides dialectical behavior therapy	100.0
A10-6	Facility provides behavior modification	100.0
A10-7	Facility provides integrated dual disorders treatment	100.0
A10-8	Facility provides trauma therapy	100.0
A10-9	Facility provides activity therapy	100.0
A10-10	Facility provides electroconvulsive therapy	100.0
A10-11	Facility provides telemedicine/telehealth therapy	100.0
A10-12	Facility provides psychotropic medication therapy	100.0
A10-13	Facility provides other treatment approaches	100.0
A10-14	Facility provides none of these treatment approaches	100.0
A11-1	Facility provides assertive community treatment services	100.0
A11-2	Facility provides intensive case management services	100.0
A11-3	Facility provides case management services	100.0
A11-4	Facility provides court-ordered outpatient treatment	100.0
A11-5	Facility provides chronic disease/illness management	100.0
A11-6	Facility provides illness management and recovery	100.0
A11-7	Facility provides integrated primary care services	100.0
A11-8	Facility provides diet and exercise counseling	100.0
A11-9	Facility provides family psychoeducation	100.0
A11-10	Facility provides education services	100.0
A11-11	Facility provides housing services	100.0
A11-12	Facility provides supported housing	100.0
A11-13	Facility provides psychosocial rehabilitation services	100.0
A11-14	Facility provides vocational rehabilitation services	100.0
A11-15	Facility provides supported employment services	100.0
A11-16	Facility provides therapeutic foster care services	100.0
A11-17	Facility provides legal advocacy services	100.0
A11-18	Facility provides psychiatric emergency walk-in services	100.0
A11-19	Facility provides suicide prevention services	100.0
A11-20	Facility provides consumer-run (peer support) services	100.0
A11-21	Facility provides screening for tobacco use services	100.0
A11-22	Facility provides smoking/tobacco cessation counseling services	100.0
A11-23	Facility provides nicotine replacement therapy	100.0
A11-24	Facility provides non-nicotine smoking/tobacco cessation medications (by prescription)	100.0
A11-25	Facility provides other services and practices	100.0
A11-26	Facility provides none of these services or practices	100.0
A12-1	Children (12 years or younger) accepted at facility	100.0
A12-2	Adolescents (13-17 years) accepted at facility	100.0
A12-3	Young adults (18-25 years) accepted at facility	100.0
A12-4	Adults (26-64 years) accepted at facility	100.0
A12-5	Seniors (65 years or older) accepted at facility	100.0
A13-1	Facility offers program/group designed exclusively for children/adolescents with serious emotional disturbance (SED)	100.0
A13-2	Facility offers program/group designed exclusively for transitional age young adults	100.0
A13-3	Facility offers program/group designed exclusively for persons 18 years and older with serious mental illness (SMI)	100.0
A13-4	Facility offers program/group designed exclusively for seniors or older adults	100.0
A13-5	Facility offers program/group designed exclusively for persons with Alzheimer’s or dementia	100.0
A13-6	Facility offers program/group designed exclusively for persons with co-occurring mental and substance use disorders	100.0
A13-7	Facility offers program/group designed exclusively for persons with eating disorders	100.0
A13-8	Facility offers program/group designed exclusively for persons with a diagnosis of post-traumatic stress disorder (PTSD)	100.0
A13-9	Facility offers program/group designed exclusively for persons who have experienced trauma (excluding persons with a PTSD diagnosis)	100.0
A13-10	Facility offers program/group designed exclusively for persons with TBI	100.0
A13-11	Facility offers program/group designed exclusively for veterans	100.0
A13-12	Facility offers program/group designed exclusively for active duty military	100.0
A13-13	Facility offers program/group designed exclusively for members of military families	100.0
A13-14	Facility offers program/group designed exclusively for LGBT clients	100.0
A13-15	Facility offers program/group designed exclusively for forensic clients (referred from the court/judicial system)	100.0
A13-16	Facility offers program/group designed exclusively for persons with HIV or AIDS	100.0
A13-17	Facility offers another special program or group	100.0
A13-18	Facility offers no exclusively designed programs or groups	100.0
A14	Facility offers crisis intervention team	99.8
A15	Facility offers mental health treatment services in sign language for the deaf and hard-of-hearing	99.6
A16	Facility provides mental health treatment services in a language other than English	99.7
A16a	Who provides treatment services in languages other than English?	100.0
A16a1	Staff provides treatment services in Spanish	100.0
A16a2	Staff provides treatment services in any language besides Spanish	99.9
A16b-1	Staff provides treatment services in Hopi	99.9
A16b-2	Staff provides treatment services in Lakota	99.9
A16b-3	Staff provides treatment services in Navajo	99.9
A16b-4	Staff provides treatment services in Ojibwa	99.9
A16b-5	Staff provides treatment services in Yupik	99.9
A16b-6	Staff provides treatment services in other Native American Indian/Alaska Native language	100.0
A16b-7	Staff provides treatment services in Arabic	99.9
A16b-8	Staff provides treatment services in any Chinese language	99.9
A16b-9	Staff provides treatment services in Creole	99.9
A16b-10	Staff provides treatment services in Farsi	99.9
A16b-11	Staff provides treatment services in French	99.9
A16b-12	Staff provides treatment services in German	99.9
A16b-13	Staff provides treatment services in Greek	99.9
A16b-14	Staff provides treatment services in Hebrew	99.9
A16b-15	Staff provides treatment services in Hindi	99.9
A16b-16	Staff provides treatment services in Hmong	99.9
A16b-17	Staff provides treatment services in Italian	99.9
A16b-18	Staff provides treatment services in Japanese	99.9
A16b-19	Staff provides treatment services in Korean	99.9
A16b-20	Staff provides treatment services in Polish	99.9
A16b-21	Staff provides treatment services in Portuguese	99.9
A16b-22	Staff provides treatment services in Russian	99.9
A16b-23	Staff provides treatment services in Tagalog	99.9
A16b-24	Staff provides treatment services in Vietnamese	99.9
A16b-25	Staff provides treatment services in any other language	100.0
A17	Facility's smoking policy	99.7
A18	Facility uses a sliding fee scale	95.7
A18a	Include sliding fee scale in Locator	100.0
A19	Facility offers treatment at no charge or minimal payment	95.6
A19a	Include availability of free treatment in Locator	100.0
A20-1	Facility accepts cash or self-payment	99.8
A20-2	Facility accepts private health insurance	99.8
A20-3	Facility accepts Medicare payments	99.8
A20-4	Facility accepts Medicaid payments	99.8
A20-5	Facility accepts state-financed health insurance plan other than Medicaid	99.8
A20-6	Facility accepts state mental health agency (or equivalent) funds	99.8
A20-7	Facility accepts state welfare or child and family services agency funds	99.8
A20-8	Facility accepts state corrections or juvenile justice agency funds	99.8
A20-9	Facility accepts state education agency funds	99.8
A20-10	Facility accepts other state government funds	99.8
A20-11	Facility accepts county or local government funds	99.8
A20-12	Facility accepts Community Service Block Grants	99.8
A20-13	Facility accepts Community Mental Health Block Grants	99.8
A20-14	Facility accepts federal military insurance	99.8
A20-15	Facility accepts U.S. Department of Veterans Affairs funds	99.8
A20-16	Facility accepts IHS/Tribal/Urban (ITU) funds	99.8
A20-17	Facility accepts other types of client payments	100.0
A21-1	Facility has licensing through state mental health authority	99.8
A21-2	Facility has licensing through state substance abuse agency	99.8
A21-3	Facility has licensing through state department of health	99.8
A21-4	Facility has licensing through state or local department of family and children's services	99.8
A21-5	Facility has licensing through hospital licensing authority	99.8
A21-6	Facility has accreditation through Joint Commission	99.8
A21-7	Facility has licensing through Commission on Accreditation of Rehabilitation Facilities (CARF)	99.8
A21-8	Facility has licensing through Council on Accreditation (COA)	99.8
A21-9	Facility has licensing through Centers for Medicare and Medicaid Services (CMS)	99.8
A21-10	Facility has licensing through other national organization, or federal, state, or local agency	100.0
C1	Facility wants to be listed in SAMHSA’s online Behavioral Health Treatment Services Locator	99.9
C1a-1	Facility wants its street address to be listed in SAMHSA’s online Behavioral Health Treatment Services Locator	86.7
C1a-2	Facility wants its mailing address to be listed in SAMHSA’s online Behavioral Health Treatment Services Locator	86.7
C1a-3	Facility doesn't want its either its street or mailing address to be listed in SAMHSA’s online Behavioral Health Treatment Services Locator	86.7
VA1	Facility has a standardized process or workflow for referring clients to appropriate care settings	100.0
VA2	Facility engages in the follow-up of clients of mental health care with suicidal thoughts and suicidal behavior, beginning in the immediate period following their inpatient facility visits	100.0
VA3-1	Facility offers lethal means safety training	100.0
VA3-2	Facility offers free gun locks	100.0
VA3-3	Facility offers suicide prevention-related community outreach of workshops	100.0
VA3-4	Facility doesn't offer any of these suicide prevention services	100.0
VA4-1	Facility trains staff on suicide prevention strategies when they begin working	100.0
VA4-2	Facility trains staff on suicide prevention strategies at regular intervals	100.0
VA4-3	Facility doesn't train staff on suicide prevention strategies	100.0
VA5-1	Facility implements indicated suicide risk screening program	100.0
VA5-2	Facility implements selected suicide risk screening program	100.0
VA5-3	Facility implements universal suicide risk screening program	100.0
VA5-4	Facility doesn’t implement suicide risk screening programs	100.0
VA6	Facility identifies warning signs for suicide and violence that clinicians should assess	100.0
VA7	Facility assesses each client's level of risk for suicide to determine appropriate action	100.0
VA8	Facility maintains a list of clients who are high risk for suicide	100.0
VA8a	Facility has a process for ensuring that high risk for suicide clients are followed up with when mental health or substance abuse appointments are missed	100.0
VA9-a	Number of full-time suicide prevention coordinators (SPCs)	100.0
VA9-b	Number of full-time care managers for high suicide risk clients	100.0
VA9-c	Number of full-time program support assistants for high suicide risk clients	100.0
LGBT = lesbian, gay, bisexual, or transgender; MH = mental health; PTSD = post-traumatic stress disorder; TBI = traumatic brain injury; SED = serious emotional disturbance; SMI = serious mental illness; VA = Veterans Affairs.

Appendix D. List of Contributors

This report was prepared for the Center for Behavioral Health Statistics and Quality (CBHSQ), Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services (HHS), by Eagle Technologies, Inc. Data collection was performed by Mathematica Policy Research. Work was performed by Eagle and Mathematica under Contract No. HHSS283201600001C.

Contributors and reviewers at Eagle, listed alphabetically, include Anand Borse, Erin Doherty, Shanshan Hao, Alicia McCoy, David Peabody, Parth Thakore, Marty van Duym, Doren Walker (Project Director), and John Zuwasti Curran. Production of the report at SAMHSA was managed by Nichele Waller (COR). SAMHSA contributors and reviewers, listed alphabetically, include Herman Alvarado, Heydy Juarez, Sharon Liu, and Nichele Waller.

National Mental Health Services Survey (N-MHSS): 2019

Data on Mental Health Treatment Facilities

Acknowledgments

Public Domain Notice

Recommended Citation

Electronic Access of the Publication

Originating Office

Table of Contents

List of Tables

Description of the National Mental Health Services Survey (N-MHSS)

Trends in Facility Characteristics

Facility Characteristics and Services

Selected Facility Characteristics at the Regional and State Levels

Veterans Affairs Facilities

Appendix C

List of Figures

Facility Characteristics and Services

Highlights

Trends in Facility Characteristics 2015–2019

Facility Characteristics and Services

Selected Facility Characteristics at the Regional and State Levels

Chapter 1. Description of the National Mental Health Services Survey (N-MHSS)

Data Collection Procedures for the 2019 N-MHSS

Field period and reference date

Survey universe

Survey coverage

Exclusions

Content

Data collection

Eligibility and unit response rate

Facility Reporting and Selection for the 2019 N-MHSS Report

Quality Assurance

Response Rates

Data Considerations and Limitations

Organization of the Report

To Chapter 1 Table

Chapter 2. Trends in Facility Characteristics

Number of Facilities

Facility Operation

To Chapter 2 Tables

Chapter 3. Facility Characteristics and Services

Facility Type and Facility Operation

Service Settings Offered

Treatment Approaches

Services and Practices

Age Groups

Dedicated or Exclusively Designed Treatment Programs or Groups for Specific Client Types

Treatment Services Provided in Languages Other Than English and for the Deaf and Hard-of-Hearing

Crisis Intervention Teams

Types of Payment or Insurance Accepted

Smoking Policy

Facility Licensing, Certification, or Accreditation

To Chapter 3 Tables

Chapter 4. Selected Facility Characteristics at the Regional and State Levels

Survey Response

Facility Type

Facility Operation

Service Settings Offered

Treatment Approaches

Services and Practices

Age Groups

Dedicated or Exclusively Designed Treatment Programs or Groups for Specific Client Types

Treatment Services Provided in Languages Other Than English and for the Deaf and Hard-of-Hearing

Crisis Intervention Teams

Types of Payment or Insurance Accepted

Facility Licensing, Certification, or Accreditation

To Chapter 4 Tables

Chapter 5. Veterans Affairs Facilities

Suicide Prevention-Related Services

VA Facilities With Suicide Prevention-Related Staff

To Chapter 5 Tables

Appendix A. 2019 N-MHSS Questionnaire

To 2019 N-MHSS Questionnaire

Addendum for Mental Health VA Facilities

Appendix B. Data Collection Procedures

Survey Frame

Data Collection

Appendix C. Response Rates

Appendix D. List of Contributors