Health And Chemical Dependency

• Key Indicators
• The Uninsured
• Co-occurring Disorders
• Other Health Indicators
• Equal Opportunity
• Service System
• Best and Promising Practices

Vision

Residents of King County enjoy optimum physical and mental health, including recovery and reaching their potential to the greatest extent possible despite having complex health conditions. We envision a community in which individuals with serious physical health, mental health and chemical dependency problems have access to prevention & early intervention services as well as on-going integrated care that minimize adverse health consequences and promote recovery. We want these individuals to experience a greater ability to contribute and to participate fully in their community.

Key Indicators

 Changes sought at the community level would include decreases in chronic homelessness and incarceration, improvements in school performance, reductions in unemployment, fewer involuntary mental health commitments and reductions in chemical dependency among youth and adults at high risk for or experiencing serious health, mental health and chemical dependency problems.

• Percent of adults in King County age 18-64 without health insurance
• Percent of children in King County under age 18 without health insurance
• Number of visits to emergency rooms for mental health and an alcohol and other drug (AOD) disorder
• Rate of chemical dependency among homeless individuals with mental illness
• Average number of days mentally ill individuals spend in jail compared to those who do not have mental illness

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The Uninsured

In an assessment of the consequences of lack of insurance, the Institute of Medicine reported that people who don’t have insurance are substantially less likely to receive essential health care such as:

• preventive care like cancer screenings and cholesterol checks
• regular checkups and a regular source of care
• treatment for mental illness
• admission to the hospital after traumatic injury or
• recommended treatment for chronic conditions like diabetes.

Uninsured people have an increased risk of mortality from preventable disease as well as for all causes of death.^[1]

Uninsured Rates

• In King County, lack of health insurance coverage in adults has been increasing and is at its highest point since 1991. In 2004, 15.5% of King County adults aged 18-64, or approximately 190,000 people, did not have health insurance coverage.^[2]
• From 1995-2001, the percentage of King County residents without health insurance decreased. However, since 2001, there has been a sharp upward trend with the highest uninsured rates occurring in South King County.^[3]
• In 2004, almost 16,000 children aged 0-17 (4.1%) were uninsured.^[4]
• In 2002-2004, East Region had the lowest percentage (9%) of adults lacking insurance coverage. South Region (18%) and Seattle (14%) had significantly higher percentages of uninsured residents than the East Region. The North Region (12%) was not significantly different from any other region.
• Residents of South Region were twice as likely to be uninsured as residents of East Region.

• Four in 10 (42%) of the near-poor--those in households earning between $15,000 and $24,999 lacked health insurance in 2002-2004, an increasing trend, compared to less than 5% in households earning more than $50,000 annually.^[5]

• Adults who lacked health insurance were almost seven times more likely to have not gotten care they felt they needed due to cost (41%), than their insured counterparts (6%).

• Adults who lacked insurance were also significantly more likely to report that a child in their household was unable to get needed care for any reason. 7.2% of these adults reported that a household child could not get care, compared to only 3.4% of children of insured adults.

• Overall, the percentage of adults not getting needed medical care due to cost significantly increased in the last five years. In 2004, 12.6% of King County adults were unable to get medical care.

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Equal Opportunity and Racial Equity

• Hispanic/Latinos had the highest non-coverage rates (36%). This was significantly higher than all other racial/ethnic groups except the American Indian/Alaska Natives (AI/AN).

• While Asian/Pacific Islanders (A/PIs) and Whites have the lowest percentages of insurance coverage, their lack of coverage has increased in the last 5 years.

• While results for specific A/PI groups are not available, analyses from the California Health Interview Survey and the King County Ethnicity and Health report demonstrated that rates of coverage vary among different A/PI groups and that recent immigrants tend to have the highest risk.

Download Data

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Comorbidity of Mental Health and Chemical Dependency

Nationally, an estimated 16% of all inmates in city and county jails suffer from mental illness; between 50 - 70 percent of homeless individuals with mental illness abuse substances. This creates major obstacles to ever leaving the streets. Homeless individuals with co-occurring disorders tend to fall through the cracks. They often have trouble navigating the complex systems necessary to obtain housing, health care and employment. Without their basic needs meet, they often end up in emergency systems including ER, jail and shelters.

Frequent Users of Emergency Rooms

Among those individuals who visited the emergency room (ER) 31 times or more in 2002,

• 56% had diagnoses of both an Alcohol and Other Drug (AOD) disorder and mental illness;

• 10% had an AOD disorder only;

• 23% had a mental illness disorder only; and

• Only 11% had no indication of an AOD disorder or mental illness.^[6]

Chemical Dependency Treatment

From January 2004 through June 2006, there were a total of 18,857 assessments in King County with 90% resulting in an outpatient admission (includes intensive outpatient, outpatient and mentally ill chemically addicted (MICA) outpatient). 

Outpatient admissions have increased when comparing the six month time period January-June 2000 to January-June 2006 (12.62%); admissions increased considerably when comparing January-June 2003 to time period January-June 2006 (21.24%).^[7]

Youth outpatient admissions in King County have trended down since time period January-June 2000. When comparing January-June 2006 time period to January-June 2004, there was a 24% decline in youth outpatient admissions.^[8]

It has been shown that Chemical Dependency treatment reduces ER costs per client, and reduces the number of ER visits.^[9]  Policy implications include the importance of strengthening capacity and linkages between ER, AOD and mental health treatment systems; and to ensure that treatment systems have sufficient capacity for increased demand that is likely to result from improved screening and referral.

In September 2006 Seattle Mental Health was awarded a grant to evaluate a local option of outreach and access, substance abuse treatment and aftercare. The program is entitled STAR and a Developmental Disabilities (DD) counselor who is also a Chemical Dependency Professional (CDP) provides the treatment and aftercare services tailored to the individual client cognitive needs, and includes other services of team and case management support services, services for mental health needs and psychiatric medication management, and 24/7 crisis services^[10]

King County Jail Utilization

Jails have been called the surrogate mental health system and de facto psychiatric facilities

• Mentally ill offenders who commit felonies spend an average of 158 days in the King County Jail. The range is between 80 to 216 days.

• For offenders with no mental illness who commit felonies, the average stay is 24 days.^[11]

• A national study estimates that 16 percent of all inmates in city and county jails suffer from mental illness, and 70% of those inmates were charged with non-violent offenses.^[12]

• King County Jail has an average daily population of 2,450 inmates.

• King County estimates more than 250 eligible on any given day for placement in community mental health programs.

• Mentally ill offenders who commit felonies spend an average of 158 days in jail at $300 per bed per day, or $47,400 per jail episode.

• The most violent of these offenders may end up at Western State after three to four months of being held in the jails.

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Context: Other Health Indicators

A variety of additional indicators are used to judge the overall health of the population.

Cause of Death & Common Diseases

For the King County population as a whole, stroke, heart disease and cancer alone constitute 56% of all deaths.^[13]

Download Data |Source:  Public Health - Seattle & King County, Health of King County 2006.

Health Risk Factors

• Obesity: 17.7% of those 18 years or older in King County are considered obese.^[14]

• Smoking: 15.2% of King County adults admitted to smoking everyday or some days.

• Physical Activity: 55.7% of adults in King County report a moderate level of activity; while 33.1% report vigorous activity levels.^[15]

• Dental Care: 26.1% of all King County adults did not see a dentist in the past year.^[16]

• Low Birth Weight Rate: The rate was 6.3% in 2003

Read more about other health indicators

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Status of the Service System

Multiple issues and challenges face our communities with regard to physical health, mental health and chemical dependency. We know that barriers, including lack of insurance coverage to routine primary health care and mental health services put individuals at risk for developing more serious / chronic health problems that can result in homelessness, unemployment, social isolation and increasingly debilitating conditions.

Children facing these barriers are also at risk for significant delays in academic, social and emotional development that impact school readiness and school performance.

Eligibility and program restrictions associated with categorical funding streams are among the reasons that service systems are fragmented and difficult to navigate.

Clients with multiple needs, complicated diagnoses and with the fewest personal resources are burdened with the most complex set of requirements. These individuals are often not covered by insurance – a key means to access needed services. They cycle through and become more dependent on crisis and emergency services that are expensive and provide only temporary relief.

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Best Practices

Go to the index to best and promising practices

Resources

Footnotes

^[1] Public Health – Seattle & King County. Public Health Data Watch (September 2005), 8(1). The Uninsured in King County 1995-2004.
^[2] http://www.metrokc.gov/health/datawatch/Uninsured-1995-2004.pdf
^[3] Ibid.
^[4] Ibid.
^[5] Public Health – Seattle & King County. Public Health Data Watch (September 2005), 8(1). The Uninsured in King County 1995-2004.
^[6] DSHS Research & Data Analysis Division, 11.119fs
^[7] http://www.metrokc.gov/dchs/mhd/reports/cd/King%20FINAL%205-30.pdf
^[8] Ibid.
^[9] DSHS Research & Data Analysis Division, 11.120fs
^[10] Ibid.
^[11] Mental Health Diversion Report, King County Department of Adult & Juvenile Detention (DAJD), 2006
^[12] US Bureau of Justice Statistics, Report on Mental Illness, 1999
^[13] http://www.metrokc.gov/health/hokc/ppt/hokc-kccouncil.ppt#321,7,#1 Chronic Diseases: The Leading Cause of Death and Illness
^[14] 2004 Washington State/King County/U.S. Centers for Disease Control Behavioral Risk Factor Surveillance Survey
^[15] 2004 Washington State/King County/U.S. Centers for Disease Control Behavioral Risk Factor Surveillance Survey
^[16] Ibid.