Behavioral Health Disparities by Area

Data compiled about mental health and substance use related disorders in the City of St. Louis, St. Louis County and the State of Missouri

Mental Health and Substance Use Related Disorders in the United States

According to the 2020 National Survey on Drug Use and Health (NSDUH), 29.3% (73.8 million) Americans had a mental illness and/or substance use disorder. This rise reflects a growing problem across the nation as one of the leading causes of preventable injury fatalities.

  • 15.4% (38.7 million) People aged 18 or older had a substance use disorder (SUD)
    Among those with a substance use disorder:
    • 4 in 9 (44.4% or 17.2M) struggled with illicit drugs
    • 7 in 10 (71.4% or 27.6M) struggled with alcohol use
    • 2 in 13 (15.8% or 6.1M) struggled with illicit drugs and alcohol
  • 21.0% (52.9 million) People aged 18 or older had a mental illness
    Among those with a mental illness:
    • 1 in 4 (26.9% or 14.2M) had a serious mental illness
  • In 2020, 29.3% (73.8M) Americans had a mental illness and/or substance use disorder.
  • 6.7% (17.0 MILLION) People 18 or older had BOTH an SUD and a mental illness

(PAST YEAR. 2020 NSDUH. 18*)

Mental Illness and Substance Use Disorders in America in the Past Year

Disparities in Behavioral Health Outcomes in St. Louis City

Mental Health Disorders Related Trends

  • According to a Missouri Suicide Prevention Report for the period 2016 through 2021, as reported by the Missouri Behavioral Health Council, Lifeline calls and texts increased dramatically in the early part of the COVID-19 pandemic and were trending upward in 2021.
  • Mental illness rates are highest in the City of St. Louis for all races. It was also noted that Black individuals have higher rates of mental health disorders like anxiety, schizophrenia, mood disorders along with substance use disorders than White individuals. 
  • Even though there are more mental illness treatment services in the City of St Louis compared to St. Louis County and State of Missouri, the City of St. Louis has the highest rate of mental health-related emergency room (ER) visits in all age categories compared to St. Louis County and the State of Missouri. This data shows that there are evident disparities in the ER and clinical services use related to mental health conditions.
ER visits for mental health disorders 2015-2019
  Under 15 15-24 25-44 45-64 65+
Missouri 121.3 330.4 681.1 446.2 290.4
STL City 130.6 333.3 905.6 885 373.7
STL County 118.5 329.4 597.3 319.8 270.6
  • In 2021, Black individuals receiving services from psychiatric programs for mental illness had a rate of 40 individuals per 1,000 population compared to White individuals with a rate of 15 individuals per 1,000 population. These race disparities are consistent with the trends seen in 2019 and 2020 data.
2020 mental illness treatment services by race
  Missouri STL City STL County
Caucasian 967 670 286
African-American 292 1813 361
Native American/Alaskan 4 3 1
Asian/Pacific Islander 4 10 5
Hispanic 37 26 12
2 or more races 99 119 49
2020 mental illness treatment services by gender
  Missouri STL City STL County
Female 711.30 1,282.92 356.12
Male 654.05 1,332.33 345.15

Substance Use Disorders Related Trends

The overall trend in drug overdose fatalities and non-fatalities in the City of St. Louis has increased over the past five years.

Non-Fatal Drug Overdoses

The incidence in the City of St. Louis increased by 29% in 2020 when compared to the previous year, especially in Black men and women who had the highest counts of non-fatal overdose incidents where Narcan was used by EMS.

Fatal Drug Overdoses

According to the Medical Examiner’s Office data, drug overdose fatalities increased by 30% from 2017 to 2021. The St. Louis Metro Region accounted for 79% of all drug overdose fatalities among Black individuals in Missouri compared to 82% the year prior. The impact of fatal drug overdoses was unevenly distributed across demographic groups. Males have 2.5 times as many overdoses related fatalities as females over the five-year average, and Black individuals have the highest fatalities, nearly two-fold when compared with White individuals.

Fatality Trends by Drug-Type/Race

In 2021, fentanyl was the illicit drug responsible for most fatalities followed by cocaine.

The rate of opioid overdose fatalities among Black people in Missouri is the third highest in the nation, with fatalities in St. Louis City and County driving statewide rates. The disparity in opioid overdose-related fatalities between Black and White individuals have increased profoundly, with a 54% increase seen among Black people in 2020 and only 11% among White people.

From 2017-2021, Black males in the City of St. Louis had the highest rates of stimulant-involved fatalities followed by City of St. Louis White males.

It's not just the illness itself, it's what surrounds the illness that makes it possible for someone to survive and thrive. We have evidence that the wear and tear of racism, the stress of it, is responsible for the differences in health outcomes in the black population compared to the white population. Dr. Jones, in a 2019 study comparing 71 individuals, 48 of them Black, with a team of UCLA scientists found evidence that racist experiences may lead to increased inflammation in Black Americans, heightening the risk of serious illness, indicating that antiracist practices and the promotion of health equity are essential to improving health in St. Louis.

Overdose Fatalities by Drug Type 2017-2021
  2017 2018 2019 2020 2021
Fentanyl 218 331 348 406 400
Heroin 100 127 67 41 13
Rx Opioid 36 36 31 24 28
Cocaine 42 37 58 97 104

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