Young Adults With Serious Mental Illness:

Some States and Federal Agencies Are Taking Steps to Address Their Transition Challenges

GAO-08-678: Published: Jun 23, 2008. Publicly Released: Jun 25, 2008.

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The transition to adulthood can be difficult for young adults who suffer from a serious mental illness, such as schizophrenia or bipolar disorder. When these individuals are unsuccessful, the result can be economic hardship, social isolation, and in some cases suicide, all of which can pose substantial costs to society. Due to concerns about young adults with serious mental illness transitioning into adulthood, GAO was asked to provide information on (1) the number of these young adults and their demographic characteristics, (2) the challenges they face, (3) how selected states assist them, and (4) how the federal government supports states in serving these young adults and coordinates programs that can assist them. To do this work, GAO analyzed data based on national surveys, including the National Comorbidity Survey Replication (NCS-R), and administrative data from the Social Security Administration (SSA). GAO also reviewed published research; interviewed federal, state, and local officials, as well as mental health providers, experts, and advocacy groups; and conducted site visits in Connecticut, Maryland, Massachusetts, and Mississippi --four states that focus on this population. GAO did not make any recommendations. HHS made comments intended to clarify the report and we made changes as appropriate.

GAO estimates that at least 2.4 million young adults aged 18 through 26--or 6.5 percent of the non-institutionalized young adults in that age range-- had a serious mental illness in 2006, and they had lower levels of education on average than other young adults. The actual number is likely to be higher than 2.4 million because homeless, institutionalized, and incarcerated persons were not included in this estimate--groups with potentially high rates of mental illness. Among those with serious mental illness, nearly 90 percent had more than one mental disorder, and they had significantly lower rates of high school graduation and postsecondary education. GAO also found that about 186,000 young adults received SSA disability benefits in 2006 because of a mental illness that prevented them from engaging in substantial, gainful activity. Young adults with serious mental illness can have difficulty finding services that aid in the transition to adulthood, according to researchers, public officials, and mental health advocates. Because available mental health, employment, and housing services are not always suited for young adults with mental illness, these individuals may not opt to receive these services. They also can find it difficult to qualify for adult programs that provide or pay for mental health services, disrupting the continuity of their treatment. Finally, navigating multiple discrete programs that address varied needs can be particularly challenging for them and their families. The four states GAO visited help young adults with serious mental illness transition into adulthood by offering programs that provide multidimensional services intended to be age and developmentally appropriate. These programs integrate mental health treatment with employment and other supports. To deliver these services, states use various strategies. They coordinate across multiple state agencies, leverage federal and state funding sources, and involve young adults and their families in developing policies and aligning supports. The needs of young adults with serious mental illness have also received attention from the federal government, and agencies have been providing some support to states through demonstrations, technical assistance, and research. Federal agencies have also established bodies to coordinate programs to serve those with mental health needs, youth with disabilities, and youth in transition, which may help improve service delivery for young adults with serious mental illness, as well.

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