Programs That Provide Housing Supports

Other programs provide housing supports. This estimate is likely to be low because it is based on a  survey that did not include individuals who were homeless,  institutionalized, or incarcerated—populations that likely suffer high rates  of mental illness. Our analysis also found that about 186,000  young adults received disability benefits from SSA in 2006 because their  mental illness was so severe that they were found to be unable to engage  in substantial gainful activity. At Least 2.4 Million Young Adults Had a Serious Mental Illness in 2006, and Many Suffered from Multiple Disorders and Did Not Graduate from High School

According to our analysis of the NCS-R, an estimated 2.4 million young  adults aged 18 through 26 had a serious mental illness in 2006— approximately 6.5 percent of the estimated 37 million young adults living  in U.S. households. 1.) We also found  that nearly all young adults with serious mental illness were diagnosed  with more than one mental disorder. Young Adults with Serious Mental Illness Face Challenges Accessing Appropriate Support

According to researchers, public officials, and advocates, young adults  with serious mental illness can have difficulty finding services tailored to  their needs, qualifying for adult programs, and navigating multiple  programs and delivery systems. Selected States Provide Multidimensional Services to Young Adults with Serious Mental Illness Using Various Strategies

Recognizing the challenges faced by young adults with serious mental  illness, the four states we visited—Connecticut, Maryland, Massachusetts,  and Mississippi—have designed programs with multidimensional services  to help them transition into adulthood. They include broadening eligibility criteria for  mental health services, employing some of the evidence-based practices  promoted by SAMHSA, coordinating efforts across multiple state agencies,  leveraging federal and state funding sources, and involving consumers and  family members in developing policies and aligning services. They also try to  integrate the services so that young adults do not have to navigate multiple  discrete programs. Federal Agencies Have Supported Demonstrations, Provided Technical Assistance and Research, and Formed Interagency Working Groups

The needs of young adults with serious mental illness have also received  some attention from the federal government, which has, to some extent,  supported state efforts to serve them through demonstrations, technical  assistance, and research. This number is likely to include young adults who may not have  been included in the NCS-R, such as those living in an institution and many  with schizophrenia or psychosis. More  specifically, to provide information on the number and demographic  characteristics of young adults with serious mental illness, which we  defined as individuals aged 18 through 26, we analyzed data from the  federally funded National Comorbidity Survey-Replication, 2001-2003  (NCS-R), of the 2006 Current Population Survey, Annual Social and  Economic Supplement (CPS), and two sources of data on individuals  receiving disability benefits from the Social Security Administration (SSA):  the 2006 Ticket Research File (TRF) and the National Beneficiary Survey,  2004 (NBS). To identify these  states, we reviewed published research and interviewed federal and state  officials, mental health researchers, and advocacy groups to learn of states  that were viewed as offering progressive statewide or state-organized  programs that focus specifically on young adults with serious mental  illness. Appendix II: Federal Programs Identified by Bazelon as Helping Young Adults with a Serious Mental Illness (SMI)

Appendix II: Federal Programs Identified by  Bazelon as Helping Young Adults with a  Serious Mental Illness (SMI)
Engaging Persons with Disabilities in National and Community  Services Grants  Drug-Free Communities Support Program Grants  Juvenile Justice and Delinquency Prevention State Formula  Grant   Title V Community Prevention Grants Program  National Guard Youth ChalleNGe Program  Elementary and Secondary School Counseling Program   Federal Direct Student Loan and Family Education Loan  Programs  Grants for the Integration of Schools and Mental Health  Systems   Federal Supplemental Educational Opportunity Grants  Safe and Drug Free Schools  Vocational and Adult Education State Basic Grants  Vocational Rehabilitation: Supported Employment State Grants  Vocational Rehabilitation, Title I Formula Grants  Community Mental Health Services Block Grant  Comprehensive Community Mental Health Services for Children  and Their Families  Educational and Training Vouchers Program for Youths Aging  out of Foster Care  Health Care for the Homeless  Healthy and Ready to Work Initiative  John H. Chafee Foster Care Independence Program  Maternal & Child Health Block Grant  Medicaid  Partnerships for Youth in Transition  Projects for Assistance in Transition from Homelessness -  PATH   Runaway and Homeless Youth Act Programs  State Adolescent Substance Abuse Treatment Coordination  Substance Abuse Prevention and Treatment Block Grant  Temporary Assistance for Needy Families  Title IV-B and Promoting Safe and Stable Families  Title IV-E – Payments for Children in Foster Care  Youth Transition Into the Workplace Grant  Safe Schools and Healthy Students Initiative  Section 8 Housing Choice Vouchers  Workforce Investment Act Youth Formula Grants  Ticket-To-Work and Work Incentives Improvement  Special Supplemental Nutrition for Women, Infants and Children  (WIC)

Appendix III: Evidence-Based Practices Promoted by SAMHSA

Helps people stay out of the hospital and develop  skills for living in the community, through  treatment customized to individual needs  delivered by a team of practitioners, available 24  hours a day. This program assists  young adults in developing healthy relationships that can motivate them to  change their behavior. The Transition to Adulthood  among Adolescents Who Have Serious Emotional Disturbance. Kessler, R., and others. 2 (1995): 90-112.
Why GAO Did This Study

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.

What GAO Found

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.