MHBG Application U MHBG Application URS Tables

Treatment Episode Data Set (TEDS)

Attachment 3_MHBG Application URS Tables.xlsx

TEDS MHCLD Tools

OMB: 0930-0335

Document [xlsx]

Download: xlsx | pdf

Overview

Table2A
Table2B
Table2C
Table2D
Table3
Table4
Table4A
Table5A
Table5B
Table14A
Table14B
Table14C
Table15
Table20A
Table20B

Sheet 1: Table2A

URS Table 2A (MHBG Table 8A). Profile of Persons Served, All Programs by Age, Gender, and Race

												OMB No. 0930-0168
												Expiration Date: 6/30/2026
Public Burden Statement: An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. The OMB control number for this project is 0930-0168. Public reporting burden for this collection of information is estimated to average 187 hours per respondent, per year, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to SAMHSA Reports Clearance Officer, 5600 Fishers Lane, Room 15E57-A, Rockville, Maryland, 20857.

This table provides an unduplicated aggregate profile of persons served in the reporting year. The reporting year should be the latest state fiscal year for which data are available. This profile is based on a client receiving services in programs provided or funded by the state mental health agency. The client profile takes into account all institutional and community services for such programs. States and jurisdictions are to provide this information on all programs by age, gender, and race.

PLEASE DO NOT ADD, DELETE OR MOVE ROWS, COLUMNS AND/OR CELLS!


MHBG Table 8A
Reporting Period:	From:						To:
State Identifier:
	Total								American Indian or Alaska Native							Asian							Black or African American							Native Hawaiian or Other Pacific Islander							White							Some Other Race							More than One Race Reported							Not Available
	Female	Male	Transgender (Male to Female)	Transgender (Male to Female)	Two Spirit [AI/AN only]	Other	Not Available	Total	Female	Male	Transgender (Male to Female)	Transgender (Male to Female)	Two Spirit [AI/AN only]	Other	Not Available	Female	Male	Transgender (Male to Female)	Transgender (Male to Female)	Two Spirit [AI/AN only]	Other	Not Available	Female	Male	Transgender (Male to Female)	Transgender (Male to Female)	Two Spirit [AI/AN only]	Other	Not Available	Female	Male	Transgender (Male to Female)	Transgender (Male to Female)	Two Spirit [AI/AN only]	Other	Not Available	Female	Male	Transgender (Male to Female)	Transgender (Male to Female)	Two Spirit [AI/AN only]	Other	Not Available	Female	Male	Transgender (Male to Female)	Transgender (Male to Female)	Two Spirit [AI/AN only]	Other	Not Available	Female	Male	Transgender (Male to Female)	Transgender (Male to Female)	Two Spirit [AI/AN only]	Other	Not Available	Female	Male	Transgender (Male to Female)	Transgender (Male to Female)	Two Spirit [AI/AN only]	Other	Not Available
0-5 years	0	0	0	0	0	0	0	0
6-12 years	0	0	0	0	0	0	0	0
13-17 years	0	0	0	0	0	0	0	0
18-20 years	0	0	0	0	0	0	0	0
21-24 years	0	0	0	0	0	0	0	0
25-44 years	0	0	0	0	0	0	0	0
45-64 years	0	0	0	0	0	0	0	0
65-74 years	0	0	0	0	0	0	0	0																																																													Duplicated between Hospitals & Community	Duplicated between Community Programs	Duplicated between Adults & Kids
75+ years	0	0	0	0	0	0	0	0
Not Available	0	0	0	0	0	0	0	0																																																																Other, describe:
Total	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0					Unduplicated
Pregnant Women	0			0				0																																																													Unduplicated
Are these measures unduplicated?																																																																	0	0	0	0	0


Comments on Data (Age):
Comments on Data (Gender):
Comments on Data (Race):
Comments on Data (Overall):

Sheet 2: Table2B

Table 2B (MHBG Table 8B). Profile of Persons Served, All Programs by Age, Gender, and Ethnicity

This table provides an unduplicated aggregate profile of persons served in the reporting year. The reporting year should be the latest state fiscal year for which data are available. This profile is based on a client receiving services in programs provided or funded by the state mental health agency. The client profile takes into account all institutional and community services for such programs. States and jurisdictions are to provide this information on all programs by age, gender, and ethnicity. Total persons served would be the same as the total indicated in MHBG Table 8A.

PLEASE DO NOT ADD, DELETE OR MOVE ROWS, COLUMNS AND/OR CELLS!


MHGB Table 8B.
Reporting Period:	From:							To:
State Identifier:
	Not Hispanic or Latino							Hispanic or Latino							Hispanic or Latino Origin Not Available							Total
	Female	Male	Transgender (Male to Female)	Transgender (Male to Female)	Two Spirit [AI/AN only]	Other	Not Available	Female	Male	Transgender (Male to Female)	Transgender (Male to Female)	Two Spirit [AI/AN only]	Other	Not Available	Female	Male	Transgender (Male to Female)	Transgender (Male to Female)	Two Spirit [AI/AN only]	Other	Not Available	Female	Male	Transgender (Male to Female)	Transgender (Male to Female)	Two Spirit [AI/AN only]	Other	Not Available	Total
0-5 years																						0	0	0	0	0		0	0
6-12 years
13-17 years																						0	0	0	0	0		0	0
18-20 years																						0	0	0	0	0		0	0
21-24 years																						0	0	0	0	0		0	0
25-44 years																						0	0	0	0	0		0	0
45-64 years																						0	0	0	0	0		0	0
65-74 years																						0	0	0	0	0		0	0
75+ years																						0	0	0	0	0		0	0
Not Available																						0	0	0	0	0		0	0
Total	0	0	0	0	0		0	0	0	0	0	0		0	0	0	0	0	0		0	0	0	0	0	0		0	0
Pregnant Women
Comments on Data (Age):
Comments on Data (Gender):
Comments on Data (Race/Ethnicity):
Comments on Data (Overall):

Sheet 3: Table2C

Table 2C (MHBG Table 8C) Profile of Persons Served, All Programs by Sexual Orientation and Race (Optional Reporting Table)

This table provides an unduplicated aggregate profile of persons served in the reporting year. The reporting year should be the latest state fiscal year for which data are available. This profile is based on a client receiving services in programs provided or funded by the state mental health agency. The client profile takes into account all institutional and community services for such programs. States and jurisdictions are to provide this information on all programs by sexual orientation and race. Total persons served would be the same as the total indicated in MHBG Table 8A.

PLEASE DO NOT ADD, DELETE OR MOVE ROWS, COLUMNS AND/OR CELLS!

MHBG Table 8C

Reporting Period:

From:

To:

State Identifier:

American Indian or Alaska Native

Asian

Black or African American

Native Hawaiian or Other Pacific Islander

White

More Than One Race Reported

Some Other Race

Race Not Available

Total

Straight or Heterosexual

Lesbian or Gay

Bisexual

Two Spirit (if Client is AI/AN)

Other

Not Available

Total

Comments on Data (Sexual Orientation):

Comments on Data (Race):

Comments on Data (Overall):

Sheet 4: Table2D

Table 2D (MHBG Table 8D) Profile of Persons Served, All Programs by Sexual Orientation and Ethnicity (Optional Reporting Table)

This table provides an unduplicated aggregate profile of persons served in the reporting year. The reporting year should be the latest state fiscal year for which data are available. The profile is based on a client receiving services in programs provided or funded by the state mental health agency. The client profile takes into account all institutional and community services for such programs. States and jurisdictions are to provide this information on all programs by sexual orientation and ethnicity. Total persons served would be the same as the total indicated in MHBG Table 8B.

PLEASE DO NOT ADD, DELETE OR MOVE ROWS, COLUMNS AND/OR CELLS!

MHBG Table 8D
Reporting Period:	From:		To:
State Identifier:
	Not Hispanic or Latino	Hispanic or Latino	Hispanic or Latino Origin Not Available	Total
Straight or Heterosexual				0
Lesbian or Gay				0
Bisexual				0
Two Spirit (if Client is AI/AN)				0
Other				0
Not Available
Total	0	0	0	0
Comments on Data (Sexual Orientation):
Comments on Data (Ethnicity):
Comments on Data (Overall):

Sheet 5: Table3

Table 3 (MHBG Table 9). Profile of Persons Served in Community Mental Health Setting, State Psychiatric Hospitals, and Other Settings

This provides an aggregate profile of the number of persons that received public mental health services in community mental health settings, in state psychiatric hospitals, in other psychiatric inpatient settings, residential treatment
centers, and institutions under the justice system. The reporting year should be the latest SFY for which data are available. States and jurisdictions are to provide this information on all programs by age and gender.

PLEASE DO NOT ADD, DELETE OR MOVE ROWS, COLUMNS AND/OR CELLS!

MHGB Table 9

Reporting Period:

From:

To:

State Identifier:

Age 0-5

Age 6-12

Age 13-17

Age 18-20

Age 21-24

Age 25-44

Age 45-64

Age 65-74

Age 75+

Age Not Available

Total

Female

Male

Transgender (Male to Female)

Two Spirit [AI/AN only]

Other

Not Available

Female

Male

Transgender (Male to Female)

Two Spirit [AI/AN only]

Other

Not Available

Female

Male

Transgender (Male to Female)

Two Spirit [AI/AN only]

Other

Not Available

Female

Male

Transgender (Male to Female)

Two Spirit [AI/AN only]

Other

Not Available

Female

Male

Transgender (Male to Female)

Two Spirit [AI/AN only]

Other

Not Available

Female

Male

Transgender (Male to Female)

Two Spirit [AI/AN only]

Other

Not Available

Female

Male

Transgender (Male to Female)

Two Spirit [AI/AN only]

Other

Not Available

Female

Male

Transgender (Male to Female)

Two Spirit [AI/AN only]

Other

Not Available

Female

Male

Transgender (Male to Female)

Two Spirit [AI/AN only]

Other

Not Available

Female

Male

Transgender (Male to Female)

Two Spirit [AI/AN only]

Other

Not Available

Female

Male

Transgender (Male to Female)

Two Spirit [AI/AN only]

Other

Not Available

Total

Community Mental Health Programs

#REF!

State Psychiatric Hospitals

#REF!

Other Psychiatric Inpatient

#REF!

Residential Treatment Centers

#REF!

Institutions under the Justice System

Comments on Data (Age):

Comments on Data (Gender):

Comments on Data (Race):

Comments on Data (Overall):

Note: Clients can be duplicated between Rows: e.g., The same client may be served in both state psychiatric hospitals and community mental health centers during the same year and thus would be reported in counts for both rows.

Instructions:

States that have county psychiatric hospitals that serve as surrogate state hospitals should report persons served in such settings as receiving services in state hospitals.

If forensic hospitals are part of the state mental health agency system include them.

Persons who receive non-inpatient care in state psychiatric hospitals should be included in the Community MH Program Row

Persons who receive inpatient psychiatric care through a private provider or medical provider licensed and/or contracted through the SMHA should be counted in the "Other Psychiatric Inpatient" row. Persons who receive Medicaid funded inpatient services through a provider that is not licensed or contracted by the SMHA should not be counted here.

A person who is served in both community settings and inpatient settings should be included in both rows

RTC: CMHS has a standardized definition of RTC for Children: “An organization, not licensed as a psychiatric hospital, whose primary purpose is the provision of individually planned programs of mental health treatment services in conjunction with residential care for children and youth primarily 17 years old and younger. It has a clinical program that is directed by a psychiatrist, psychologist, social worker, or psychiatric nurse who has a master’s degree or doctorate. The primary reason for the admission of the clients is mental illness that can be classified by DSM-IV codes-other than the codes for mental retardation, developmental disorders, and substance-related disorders such as drug use and alcoholism (unless these are co-occurring with a mental illness).” If your state serves adults in residential treatment centers, these adults should be reported in the residential treatment center row using the appropriate age group columns.

Sheet 6: Table4

Table 4 (MHBG Table 15A). Profile of Adult Clients by Employment Status

This table provides an unduplicated aggregate profile of adults served in the report year by the public mental health system in terms of employment status. The focus is on employment for adults, recognizing, however, that there are clients who are disabled, retired or who are homemakers, caregivers, etc., and not a part of the labor force. These persons should be reported under the “Not in Labor Force” category. Unemployed refers to persons who are looking for work but have not found employment. Data should be reported for clients in non-institutional settings at time of discharge or last evaluation. The reporting year is the latest SFY for which data are available.

PLEASE DO NOT ADD, DELETE OR MOVE ROWS, COLUMNS AND/OR CELLS!

MHBG Table 15A
Reporting Period:	From:						To:
State Identifier:
	Age 18-20							Age 21-24							Age 25-44							Age 45-64							Age 65-74							Age 75+							Age Not Available							Total
	Female	Male	Transgender (Male to Female)	Transgender (Male to Female)	Two Spirit [AI/AN only]	Other	Not Available	Female	Male	Transgender (Male to Female)	Transgender (Male to Female)	Two Spirit [AI/AN only]	Other	Not Available	Female	Male	Transgender (Male to Female)	Transgender (Male to Female)	Two Spirit [AI/AN only]	Other	Not Available	Female	Male	Transgender (Male to Female)	Transgender (Male to Female)	Two Spirit [AI/AN only]	Other	Not Available	Female	Male	Transgender (Male to Female)	Transgender (Male to Female)	Two Spirit [AI/AN only]	Other	Not Available	Female	Male	Transgender (Male to Female)	Transgender (Male to Female)	Two Spirit [AI/AN only]	Other	Not Available	Female	Male	Transgender (Male to Female)	Transgender (Male to Female)	Two Spirit [AI/AN only]	Not Available	Not Available	Female	Male	Transgender (Male to Female)	Transgender (Male to Female)	Two Spirit [AI/AN only]	Other	Not Available	Total
Competitively Employed Full- or Part-Time (includes Supported Employment)																																																		0	0	0	0	0	0	0	0
Unemployed																																																		0	0	0	0	0	0	0	0
Not In Labor Force (retired, sheltered employment, sheltered workshops, homemaker, student, volunteer, disabled, etc.)																																																		0	0	0	0	0	0	0	0
Not Available																																																		0	0	0	0	0	0	0	0
Total	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0
How often does your state measure employment status?
What populations are included in reported data?
Comments on Data (Age):
Comments on Data (Gender):
Comments on Data (Overall):

Sheet 7: Table4A

Table 4A (MHBG Table 15B) Profile of Adult Clients by Employment Status and Primary Diagnosis

This table provides information on the status of adult clients served in the report year by the public mental health system in terms of employment status by primary diagnosis. Data should be reported for clients in non-institutional settings at time of discharge or last evaluation. The reporting year is the latest SFY for which data are available. Total persons reported on this table would be the same as the total indicated in MHBG Table 15A.

PLEASE DO NOT ADD, DELETE OR MOVE ROWS, COLUMNS AND/OR CELLS!

MHBG Table 15B
Reporting Period:	From:		To:
State Identifier:
Clients Primary Diagnosis	Competitively Employed Full- or Part-Time (including Supported Employment)	Unemployed	Not in Labor Force (retired, sheltered employment, sheltered workshops, homemaker, student, volunteer, disabled, etc.)	Employment Status Not Available	Total
Schizophrenia & Related Disorders (F20, F25)					0
Bipolar and Mood Disorders (F30, F31, F32, F32.9, F33, F34.0, F34.1)					0
Other Psychoses (F22, F23, F24, F28, F29)					0
All Other Diagnoses					0
No Diagnosis and Deferred Diagnosis (R69, R99, Z03.89)					0
Total	0	0	0	0	0
Comments on Data:
Comments on Data:

Sheet 8: Table5A

Table 5A (MHBG Table 10A). Profile of Clients by Type of Funding Support

This table provide an aggregate profile of the unduplicated number of persons served in the reporting period by type of funding support (Medicaid Only, Non-Medicaid Sources Only, Both Medicaid and Non-Medicaid, and Status Not Available). The reporting period should be the latest SFY for which data are available. The client profile takes into account all institutional and community services for all such programs. States and jurisdictions are to provide this information on all programs by gender and race. Persons are to be counted in the Medicaid row if they received a service reimbursable through Medicaid.

PLEASE DO NOT ADD, DELETE OR MOVE ROWS, COLUMNS AND/OR CELLS!



MHBG Table 10A
Reporting Period:	From:						To:
State Identifier:
	Total							American Indian or Alaska Native							Asian							Black or African American							Native Hawaiian or Other Pacific Islander							White							Some Other Race							More than One Race Reported							Race Not Available
	Female	Male	Transgender (Male to Female)	Transgender (Male to Female)	Two Spirit [AI/AN only]	Other	Not Available	Female	Male	Transgender (Male to Female)	Transgender (Male to Female)	Two Spirit [AI/AN only]	Other	Not Available	Female	Male	Transgender (Male to Female)	Transgender (Male to Female)	Two Spirit [AI/AN only]	Other	Not Available	Female	Male	Transgender (Male to Female)	Transgender (Male to Female)	Two Spirit [AI/AN only]	Other	Not Available	Female	Male	Transgender (Male to Female)	Transgender (Male to Female)	Two Spirit [AI/AN only]	Other	Not Available	Female	Male	Transgender (Male to Female)	Transgender (Male to Female)	Two Spirit [AI/AN only]	Other	Not Available	Female	Male	Transgender (Male to Female)	Transgender (Male to Female)	Two Spirit [AI/AN only]	Other	Not Available	Female	Male	Transgender (Male to Female)	Transgender (Male to Female)	Two Spirit [AI/AN only]	Other	Not Available	Female	Male	Transgender (Male to Female)	Transgender (Male to Female)	Two Spirit [AI/AN only]	Other	Not Available
Medicaid Only	0	0	0	0	0	0	0
Non-Medicaid Sources Only	0	0	0	0	0	0	0
People Served by Both Medicaid and Non-Medicaid	0	0	0	0	0	0	0
Medicaid Status Not Available	0	0	0	0	0	0	0																																																									Data based on Medicaid Paid Services	Data based on Medicaid Eligibility not Medicaid Paid Services	Data are duplicated
Total	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0
																																																																0	0	0


Comments on Data (Race):
Comments on Data (Gender):
Comments on Data (Overall):

Each row should have a unique (deduplicated) count of clients: (1) Medicaid Only, (2) Non-Medicaid Only, (3) Both Medicaid and Other Sources funded their treatment, and (4) Medicaid Status Not Available. If a state is unable to deduplicate counts of people whose care is paid for by Medicaid only or Medicaid and other funds, then all data should be reported into the 'People Served by Both Medicaid and Non-Medicaid Sources' and the 'People Served by Both includes people with any Medicaid' checkbox should be checked.

Sheet 9: Table5B

Table 5B (MHBG Table 10B). Profile of Clients by Type of Funding Support

This table provide an aggregate profile of the unduplicated number of persons served in the reporting period by type of funding support (Medicaid Only, Non-Medicaid Sources Only, Both Medicaid and Non-Medicaid, and Status Not Available). The reporting period should be the latest SFY for which data are available. The client profile takes into account all institutional and community services for all such programs. States and jurisdictions are to provide this information on all programs by gender and ethnicity. Persons are to be counted in the Medicaid row if they received a service reimbursable through Medicaid. Total persons served would be the same as the total indicated in MHBG Table 10A.

PLEASE DO NOT ADD, DELETE OR MOVE ROWS, COLUMNS AND/OR CELLS!



MHBG Table 10B.
Reporting Period:	From:						To:
State Identifier:
	Not Hispanic or Latino							Hispanic or Latino							Hispanic or Latino Origin Not Avaliable							Total
	Female	Male	Transgender (Male to Female)	Transgender (Male to Female)	Two Spirit [AI/AN only]	Other	Not Available	Female	Male	Transgender (Male to Female)	Transgender (Male to Female)	Two Spirit [AI/AN only]	Other	Not Available	Female	Male	Transgender (Male to Female)	Transgender (Male to Female)	Two Spirit [AI/AN only]	Other	Not Available	Female	Male	Transgender (Male to Female)	Transgender (Male to Female)	Two Spirit [AI/AN only]	Other	Not Available	Total
Medicaid Only																						0	0	0	0	0	0	0	0
Non-Medicaid Sources Only																						0	0	0	0	0	0	0	0
People Served by Both Medicaid and Non-Medicaid																						0	0	0	0	0	0	0	0
Medicaid Status Not Available																						0	0	0	0	0	0	0	0
Total																						0	0	0	0	0	0	0	0
Comments on Data (Ethnicity):
Comments on Data (Gender):
Comments on Data (Overall):

Each row should have a unique (deduplicated) count of clients: (1) Medicaid Only, (2) Non-Medicaid Only, (3) Both Medicaid and Other Sources funded their treatment, and (4) Medicaid Status Not Available. If a state is unable to deduplicate counts of people whose care is paid for by Medicaid only or Medicaid and other funds, then all data should be reported into the ‘People Served by Both Medicaid and Non-Medicaid Sources’ and the ‘People Served by Both includes people with any Medicaid’ checkbox should be checked.

Sheet 10: Table14A

Table 14A (MHBG Table 13A). Profile of Persons with SMI/SED served by Age, Gender, and Race

This table provides an unduplicated aggregate profile of the number of persons with SMI or SED served in the reporting year. The profile is based on a client receiving services in programs provided or funded by the state mental health agency. States and jurisdictions should report data using the Federal Definitions of SMI and SED if they can, if not, please report using the state’s definition of SMI and SED and provide information below describing your state’s definition. The reporting period should be the latest SFY for your which data are available. States and jurisdictions are to provide this information on all programs by age, gender, and race.

PLEASE DO NOT ADD, DELETE OR MOVE ROWS, COLUMNS AND/OR CELLS!



MHGB Table 13A.
Reporting Period:	From:							To:
State Identifier:
	Total							American Indian or Alaska Native								Asian							Black or African American							Native Hawaiian or Other Pacific Islander							White							Some Other Race							More than One Race Reported							Not Available
	Female	Male	Transgender (Male to Female)	Transgender (Male to Female)	Two Spirit [AI/AN only]	Other	Not Available	Total	Female	Male	Transgender (Male to Female)	Transgender (Male to Female)	Two Spirit [AI/AN only]	Other	Not Available	Female	Male	Transgender (Male to Female)	Transgender (Male to Female)	Two Spirit [AI/AN only]	Other	Not Available	Female	Male	Transgender (Male to Female)	Transgender (Male to Female)	Two Spirit [AI/AN only]	Other	Not Available	Female	Male	Transgender (Male to Female)	Transgender (Male to Female)	Two Spirit [AI/AN only]	Other	Not Available	Female	Male	Transgender (Male to Female)	Transgender (Male to Female)	Two Spirit [AI/AN only]	Other	Not Available	Female	Male	Transgender (Male to Female)	Transgender (Male to Female)	Two Spirit [AI/AN only]	Other	Not Available	Female	Male	Transgender (Male to Female)	Transgender (Male to Female)	Two Spirit [AI/AN only]	Other	Not Available	Female	Male	Transgender (Male to Female)	Transgender (Male to Female)	Two Spirit [AI/AN only]	Other	Not Available
0-5 years	0	0	0	0	0	0	0	0
6-12 years	0	0	0	0	0	0	0	0
13-17 years	0	0	0	0	0	0	0	0
18-20 years	0	0	0	0	0	0	0	0
21-24 years	0	0	0	0	0	0	0	0
25-44 years	0	0	0	0	0	0	0	0
45-64 years	0	0	0	0	0	0	0	0
65-74 years	0	0	0	0	0	0	0	0
75+ years	0	0	0	0	0	0	0	0
Not Available	0	0	0	0	0	0	0	0
Total	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0
Comments on Data (Age):
Comments on Data (Gender):
Comments on Data (Race):
Comments on Data (Overall):

Do the state definitions of SMI/SED match the Federal definitions?
					Adults with SMI, If no, describe or attach state definition:

				Diagnoses included in state SMI definition:

					Children with SED, if no, describe or attach state definition:

					Diagnoses included in state SED definition:

Sheet 11: Table14B

Table 14B (MHBG Table 13B). Profile of Persons with SMI/SED served by Age, Gender and Ethnicity

This provides an aggregate profile of unduplicated number of persons with SMI or SED served in the reporting year. The profile is based on a client receiving services in programs provided or funded by the state mental health agency. States and jurisdictions should report data using the Federal Definitions of SMI and SED if they can, if not, please report using the state’s definition of SMI and SED and provide information below describing your state’s definition. The reporting period should be the latest SFY for your which data are available. States and jurisdictions are to provide this information on all programs by age, gender, and ethnicity. The total persons served who meet the Federal definition of SMI or SED would be the same as the total in MHBG Table 13A.

PLEASE DO NOT ADD, DELETE OR MOVE ROWS, COLUMNS AND/OR CELLS!

MHBG Table 13B.

Reporting Period:

From:

To:

State Identifier:

Not Hispanic or Latino

Hispanic or Latino

Hispanic or Latino Origin Not Available

Total

Female

Male

Transgender (Male to Female)

Two Spirit [AI/AN only]

Not Available

Female

Male

Transgender (Male to Female)

Two Spirit [AI/AN only]

Not Available

Female

Male

Transgender (Male to Female)

Two Spirit [AI/AN only]

Not Available

Female

Male

Transgender (Male to Female)

Two Spirit [AI/AN only]

Not Available

0-5 years

6-12 years

13-17 years

18-20 years

21-24 years

25-44 years

45-64 years

65-74 years

75+ years

Not Available

Total

Comments on Data (Age):

Comments on Data (Gender):

Comments on Data (Ethnicity):

Comments on Data (Overall):

Sheet 12: Table14C

Table 14C (MHBG Table 14). Profile of Persons Served in Community Mental Health Setting, State Psychiatric Hospitals, and Other Settings for Adults with SMI and Children with SED

This table provides an aggregate profile of the number of adults with serious mental illness (SMI) and children with serious emotional disturbance (SED) that received publicly funded mental health services in community mental
health settings, in state psychiatric hospitals, in other psychiatric inpatient programs, in residential treatment centers, and institutions under the justice system. The reporting year should be the latest SFY for which data are available.
States and jurisdictions are to provide this information on all programs by age and gender.

PLEASE DO NOT ADD, DELETE OR MOVE ROWS, COLUMNS AND/OR CELLS!

MHBG Table 14:

Reporting Period:

From:

To:

State Identifier:

Age 0-5

Age 6-12

Age 13-17

Age 18-20

Age 21-24

Age 25-44

Age 45-64

Age 65-74

Age 75+

Age Not Available

Total

Female

Male

Transgender (Male to Female)

Two Spirit [AI/AN only]

Other

Not Available

Female

Male

Transgender (Male to Female)

Two Spirit [AI/AN only]

Other

Not Available

Female

Male

Transgender (Male to Female)

Two Spirit [AI/AN only]

Other

Not Available

Female

Male

Transgender (Male to Female)

Two Spirit [AI/AN only]

Other

Not Available

Female

Male

Transgender (Male to Female)

Two Spirit [AI/AN only]

Other

Not Available

Female

Male

Transgender (Male to Female)

Two Spirit [AI/AN only]

Other

Not Available

Female

Male

Transgender (Male to Female)

Two Spirit [AI/AN only]

Other

Not Available

Female

Male

Transgender (Male to Female)

Two Spirit [AI/AN only]

Other

Not Available

Female

Male

Transgender (Male to Female)

Two Spirit [AI/AN only]

Other

Not Available

Female

Male

Transgender (Male to Female)

Two Spirit [AI/AN only]

Other

Not Available

Female

Male

Transgender (Male to Female)

Two Spirit [AI/AN only]

Other

Not Available

Total

Community Mental Health Programs

#REF!

State Psychiatric Hospitals

#REF!

Other Psychiatric Inpatient

#REF!

Residential Treatment Centers

#REF!

Institutions under the Justice System

#REF!

Comments on Data (Age):

Comments on Data (Gender):

Comments on Data (Race):

Comments on Data (Overall):

Note: clients can be duplicated between rows, e.g., the same client may be served in both state psychiatric hospitals and community mental health centers during the same year and thus would be reported in counts for both rows.

Instructions:

States that have county psychiatric hospitals that serve as surrogate state hospitals should report persons served in such settings as receiving services in state hospitals.

If forensic hospitals are part of the state mental health agency system include them.

Persons who receive non-inpatient care in state psychiatric hospitals should be included in the Community MH Program Row

A person who is served in both community settings and inpatient settings should be included in both rows

Sheet 13: Table15

Table 15 (MHBG Table 18). Living Situation Profile

*Number of Clients in Each Living Situation as Collected by the Most Recent Assessment in the Reporting Period*
*All Mental Health Programs by Age, Gender, and Race/Ethnicity*
This table provides an unduplicated aggregate profile of persons served in the reporting year by the public mental health system in terms of living situation. Living situation categories include, but are not limited to, private residence, foster care, residential care, jail/correctional facility, homeless shelter, etc. Data should be based on the most recent assessment in the reporting period. Specifically, information is collected on the individual’s last known living situation. The reporting year should be the latest SFY for which data are available.

PLEASE DO NOT ADD, DELETE OR MOVE ROWS, COLUMNS AND/OR CELLS!



Table 15.
Reporting Period:	From:					To:
State Identifier:
	Private Residence	Foster Home	Residential Care	Crisis Residence	Residential Treatment	Institutional Setting	Jail/ Correctional Facility	Homeless/ Shelter	Other	Not Available	Total
0-5											0
6-12											0
13-17											0
18-20											0
21-24											0
25-44											0
45-64											0
65-74											0
75 and Older											0
Not Available											0
TOTAL	0	0	0	0	0	0	0	0	0	0	0
Female											0
Male											0
Transgender (Male to Female)											0
Transgender (Female to Male)											0
Two Spirit (if Client is AI/AN)											0
Other											0
Not Available											0
TOTAL	0	0	0	0	0	0	0	0	0	0	0
American Indian/Alaska Native											0
Asian											0
Black/African American											0
Hawaiian/Pacific Islander											0
White											0
Some Other Race											0
More than One Race Reported											0
Race/Ethnicity Not Available											0
TOTAL	0	0	0	0	0	0	0	0	0	0	0
Hispanic or Latino Origin											0
Non Hispanic or Latino Origin											0
Hispanic or Latino Origin Not Available											0
TOTAL	0	0	0	0	0	0	0	0	0	0	0
Comments on Data:
How often does your state measure living situation?



*Living Situation Definitions:*

Private Residence: Individual lives in a house, apartment, trailer, hotel, dorm, barrack, and/or Single Room Occupancy (SRO). Foster Home: Individual resides in a Foster Home. A Foster Home is a home that is licensed by a County or State Department to provide foster care to children, adolescents, and/or adults. This includes Therapeutic Foster Care Facilities. Therapeutic Foster Care is a service that provides treatment for troubled children within private homes of trained families. Residential Care: Individual resides in a residential care facility. This level of care may include a Group Home, Therapeutic Group Home, Board and Care, Residential Treatment, or Rehabilitation Center, or Agency-operated residential care facilities. Crisis Residence: A residential (24 hours/day) stabilization program that delivers services for acute symptom reduction and restores clients to a pre-crisis level of functioning. These programs are time limited for persons until they achieve stabilization. Crisis residences serve persons experiencing rapid or sudden deterioration of social and personal conditions such that they are clinically at risk of hospitalization but may be treated in this alternative setting. Children’s Residential Treatment Facility: Children and Youth Residential Treatment Facilities (RTF's) provide fully-integrated mental health treatment services to seriously emotionally disturbed children and youth. An organization, not licensed as a psychiatric hospital, whose primary purpose is the provision of individually planned programs of mental health treatment services in conjunction with residential care for children and youth. The services are provided in facilities which are certified by state or federal agencies or through a national accrediting agency. Institutional Setting: Individual resides in an institutional care facility with care provided on a 24 hour, 7 day a week basis. This level of care may include a Skilled Nursing/Intermediate Care Facility, Nursing Homes, Institutes of Mental Disease (IMD), Inpatient Psychiatric Hospital, Psychiatric Health Facility (PHF), Veterans Affairs Hospital, or State Hospital. Jail/ Correctional Facility: Individual resides in a Jail and/or Correctional facility with care provided on a 24 hour, 7 day a week basis. This level of care may include a Jail, Correctional Facility, Detention Centers, Prison, Youth Authority Facility, Juvenile Hall, Boot Camp, or Boys Ranch. Homeless: A person should be counted in the ""Homeless"" category if he/she was reported homeless at their most recent (last) assessment during the reporting period (or at discharge for patients discharged during the year). The “last” Assessment could occur at Admission, Discharge, or at some point during treatment. A person is considered homeless if he/she lacks a fixed, regular, and adequate nighttime residence and/or his/her primary nighttime residency is: A) A supervised publicly or privately operated shelter designed to provide temporary living accommodations, B) An institution that provides a temporary residence for individuals intended to be institutionalized, or C) A public or private place not designed for, or ordinarily used as, a regular sleeping accommodation for human beings (e.g., on the street). Unavailable: Information on an individual’s residence is not available.

Sheet 14: Table20A

Table 20A (MHBG Table 23A). Profile of Non-Forensic (Voluntary and Civil Involuntary) Patients Readmission to any State Psychiatric Inpatient Hospital Within 30/180 Days of Discharge

PLEASE DO NOT ADD, DELETE OR MOVE ROWS, COLUMNS AND/OR CELLS!
This table provides the total number of civil discharges within the year, the number of readmissions within 30-days and 180-days, and the percent readmitted by age, gender, race, and ethnicity. The reporting year should be the latest SFY for which data are available.

MHBG Table 23A.
Reporting Period:	From:			To:
State Identifier:
	Total number of Discharges in Year	Number of Readmissions to ANY STATE Hospital within		Percent Readmitted
		Number of Readmissions to ANY STATE Hospital within		Percent Readmitted
		30 days	180 days	30 days	180 days
TOTAL	0	0	0

Age
0-5
6-12
13-17
18-20
21-24
25-44
45-64
65-74
75+
Not Available

Gender
Female
Male
Transgender (Male to Female)
Transgender (Female to Male)
Two Spirit (if Client is AI/AN)
Other
Not Available

Race
American Indian/ Alaska Native
Asian
Black/African American
Hawaiian/Pacific Islander
White
Some Other Race
More than one race
Race Not Available

Ethnicity
Hispanic/Latino Origin
Non Hispanic/Latino
Hispanic/Latino Origin Not Available

Are Forensic Patients Included?

Comments on Data:

Sheet 15: Table20B

Table 20B (MHBG Table 23B). Profile of Forensic Patients Readmission to any State Psychiatric Inpatient Hospital Within 30/180 Days of Discharge

PLEASE DO NOT ADD, DELETE OR MOVE ROWS, COLUMNS AND/OR CELLS!
This table provides the total number of forensic discharges within the year, the number of readmissions within 30-days and 180-days, and the percent readmitted by age, gender, race, and ethnicity. The reporting year should be the latest SFY for which data are available.

MHBG Table 23B.
Reporting Period:	From:			To:
State Identifier:
	Total number of Discharges in Year	Number of Readmissions to ANY STATE Hospital within		Percent Readmitted
		Number of Readmissions to ANY STATE Hospital within		Percent Readmitted
		30 days	180 days	30 days	180 days
TOTAL	0	0	0

Age
0-5
6-12
13-17
18-20
21-24
25-44
45-64
65-74
75+
Not Available

Gender
Female
Male
Transgender (Male to Female)
Transgender (Female to Male)
Two Spirit (if Client is AI/AN)
Other
Not Available

Race
American Indian/ Alaska Native
Asian
Black/African American
Hawaiian/Pacific Islander
White
Some Other Race
More than one race
Race Not Available

Hispanic/Latino Origin
Hispanic/Latino Origin
Non Hispanic/Latino
Not Available

Comments on Data:

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