health or substance abuse disorders can reduce the productivity of other workers, particularly if the job affects the work of others (e.g., assembly line work).

Utilization of Services

As one would expect, mental disorders and substance abuse are strongly associated with increased utilization of mental health and substance abuse services. Ringel and Sturm (2001) estimated the annual national costs of mental health treatment for children under age 18, as of 1998, at $11.68 billion, or $172 per child. They found that expenditures were $293 per child for ages 12-17, $163 per child for ages 6-11, and $35 per child for ages 0-5. Adjusted to current dollars using the consumer price index, the annual national costs in 2007 would be $14.8 billion. We are not aware of analogous estimates for substance abuse treatment of young people, although estimates are available for adults for alcohol abuse (Harwood, 2000) and drug abuse treatment (Office of National Drug Control Policy, 2004). In the past 15 to 20 years, the mix of mental health services for young people has shifted from inpatient to outpatient settings (Ringel and Sturm, 2001), as in the adult population (Wang, Demler, et al., 2006). Also, as in the adult population, the relative treatment mix for children’s mental health has shifted from specialty settings to primary care (Wang, Demler, et al., 2006) and from therapy and counseling to medication (Glied and Cuellar, 2003) (although this latter shift was interrupted in 2003 by the Food and Drug Administration’s warnings about the use of antidepressant medications for children) (Libby, Brent, et al., 2007). These changes are also not fully reflected in the estimates cited.

Young people with MEB disorders have higher utilization of mental health services across a range of social service systems, not just health care. Costello, Copeland, and colleagues (2007) considered data from a range of settings and demonstrated that mental health service costs in health care settings represent only a modest fraction of the total costs incurred by children with mental disorders for these services. Using a sample of adolescents ages 13-16 in western North Carolina, they estimated that mental health service costs for adolescents with mental disorders equated to $894 per adolescent in the local population, with more than one-quarter (27 percent) of the total costs incurred in the school and juvenile justice systems.6 The overall estimate is over three times that in the Ringel and Sturm (2001) study,

6

This number is based on converting the total costs per 100,000 population in Table 2 in Costello, Copeland, and colleagues (2007) to total costs per person. The percentage attributable to the school and the juvenile justice systems is based on dividing the sum of these costs ($10.9 million and $13.2 million, respectively) by the total costs ($89.4 million).



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