THE COLORADO SOCIAL HEALTH SURVEY OF MENTAL-HEALTH-SERVICE NEEDS - SAMPLING, INSTRUMENTATION, AND MAJOR FINDINGS

A stratified probability sample of 4,745 adult Colorado household residents was surveyed using three measures of need for alcohol, drug abuse, and mental health (ADM) services. diagnosable disorders assessed by the Diagnostic Interview Schedule, dysfunction in everyday living assessed with locally developed scales, and "demoralization"assessed with the Center for Epidemiologic Studies - Depression (CES-D) scale. The interviews, collectively termed the Colorado Social Health Survey (CSHS), were conducted in 48 randomly selected small areas of the state (metropolitan census tracts or rural census county divisions) to obtain estimates of prevalence of need for ADM services in those areas and for the state as a whole. The overall response rate for the survey was 72%. Concurrent validity as measures of need for services was apparent from significantly higher mean need scores for current users of ADM outpatient and inpatient services in comparison to nonusers. Results indicated that 26.5% of Colorado's general population was in need of ADM services by at least one measure. Statewide mean need prevalence rates were 16.3% for diagnosable disorders, 11.1% for everyday dysfunction, and 11.0% for demoralization. Importantly, there was only limited overlap in need "caseness" assessed by each of the three measures for both service-users and nonusers; these measures appear to assess substantially independent constructs or domains of need. Interestingly, diagnosable disorder alone was unrelated to respondents' use of ADM specialty services. Instead, combinations of "caseness" by two or more need measures were more typical for service users. Variation in need prevalence across the 48 subareas was substantial, ranging from 3% to 30% for diagnosable disorders, from 1% to 25% for everyday dysfunction, and from 3% to 28% for demoralization. These findings challenge the usual assumption of a uniform rate of need for ADM services in all subareas of a state.