Mental Health Spending: A Story of Failed Supply and Demand

Several weeks ago I was in Palo Alto, California walking along Camino Real abutting the Stanford University campus. I noticed a newly-constructed high-link fence isolating the commuter train tracks from the pedestrian walkways. Another “shovel-ready” infrastructure project to nurture the economy? Sadly, no.  Rather, a weak attempt to physically prevent the increasing number of students at the highly competitive academic environment from throwing themselves under the onrushing rail cars.

 

Suicide rates are also an epidemic in rural areas and, disturbingly, in high power financial firms. Recently, bucking the trends for all other cohorts, the death rate of poorly educated Caucasian males has actually increased, not only from suicide, but additionally from afflictions stemming from substance abuse. Post-traumatic stress syndrome plagues 25-35% of our returning Middle East combat veterans. The “normalcy” of mass-shooting is attributed to the second obvious cause, untreated psychiatric illness. Despite being common and easily diagnosed, anorexia nervosa carries the highest mortality of any mental illness, yet remains stubbornly refractory to effective treatment.

 

Even our politicians are waking up to the grave harm caused by mental illness. The problem is widespread, costly, and growing. According to the Organization for Economic Co-operation and Development, mental illness costs 4% of GDP in lost productivity, disability and healthcare bills. Mental illness is more prevalent in younger people, further sapping our workforce productiveness. Seriously ill psychiatric patients die 15-20 years prematurely.

 

Evidently, there is a hard-nosed case for spending money on mental health, particularly researching causation, preclinical recognition, and new effective treatments. Yet direct mental health spending accounts for about 1% of the US economy, a figure that has not grown since 1986, even though total healthcare spending has ballooned from 10% to 18% of the GDP. Moreover, charitable giving for mental illness is minuscule compared to other diseases.

 

Why is there such a mismatch between obvious need and resource allocation? Maybe mental illness still suffers from stigmatization and lack of representation-- it certainly does lack the effective lobby to compete with groups representing cancer and cardiovascular disease. It is not as obviously fatal as physical illnesses, but its human and economic toll pose a clear and present danger that our profession, charitable organizations, industry and government must address.

 

By Norman Silverman, MD, with Ryan McKennon, DO and Ren Carlton

Making Money With Your Business, Profit and Cash Flow, Five Sustainable Companies That Make a Lot of MoneyFind Angel Funding & Venture Capital for Business Startups, Entrepreneurs, & First Time Founders – Episode 10

It is time to make money! You have been through a couple of rounds of market testing now you feel like you are on to something. The next step is to run the numbers to make sure that the business is sustainable. There are two sides to making money, profitability and cash flow.

Why Competition Is Good For Entrepreneurs and How Blockbuster’s $50 Million Mistake Helped Reed Hastings and Netflix Destroy a $6 Billion Empire Find Angel Funding & Venture Capital for Business Startups, Entrepreneurs, & First Time Founders – Epis

When battling for resources or investment, early-stage entrepreneurs may believe that competition is a bad thing. On the surface, they are correct. There are a limited number of angel investors willing to provide a finite amount of venture capital to founders.

Upscaling and Scaling Business Ideas into Reality – Jeff Bezos takes Amazon from Online Bookstore to Global DominanceFind Angel Funding & Venture Capital for Business Startups, Entrepreneurs, & First Time Founders – Episode 4

Congratulations, your market testing worked and you were able to find customers, or at least one customer. Your beta test was successful and you are confident that you are ready for more. What do you do when you start getting customers or users? I recommend you do some scaling or upscaling.

What Kind of Business Should You Start? – How Mark Zuckerberg Pivoted From Rating Hotness to FacebookFind Angel Funding & Venture Capital for Business Startups, Entrepreneurs, & First Time Founders – Episode 1

When it comes to brainstorming startup ideas, new entrepreneurs and even seasoned ones scratch their heads in confusion. Living in the information age, you can scan the current market and see countless new business ideas. With so many options out there, how do you know which one is right for you?

Why Would a Doctor Abandon a Steady Paycheck to Become an Entrepreneur?

As physicians, we are expected to be compliant with rules, restrictions, and regulations. We are expected to be risk averse. We are expected to be “providers,” but not necessarily innovators or leaders. As the healthcare system becomes increasingly consolidated into large overcrowded clinics, we are required to perform to the standards set by bureaucrats and clinic managers. These rules are often at odds with the best interests of patients and with our sanity.

The Alienation Of America’s Best Doctors

The best and the brightest simply don’t want to become doctors anymore. Physicians are burning out. They are leaving the profession. They are going bankrupt. They are selling their private practices to big hospitals. They are retiring early. We are facing a growing doctor shortage.

Better to Live and Die in the U.S.A.

The United States healthcare system is often berated for how it treats patients near the end of life. They are purportedly attached to tubes and machines and subjected to unnecessary invasive procedures that cause inordinate pain with no potential benefit, there is underutilization of more compassionate hospice services. This “travesty” is expensive, as the care of dying seniors consumes over 25% of Medicare expenditures. We hear this story so often; it is almost taken as gospel-- but is it actually true? Is it more expensive and invasive to die in America than in other developed countries?

Gun Ownership and Doctors?

According to the Pew Research Center, there are approximately 32,000 gun-related deaths annually in the United States; 19,000 are suicide, 11,000 are homicide, and the rest are accidents, police shootings or of unknown causation. Moreover, there are more than 78,000 nonfatal gun wounds each year. Given the disproportionate number of victims that are less than 40 years of age, the morbidity and mortality of gun violence is significant. Physicians are involved with many types of public health issues, but few are as controversial or divisive as gun safety. Is it really an issue that falls within the medical domain?

O Tempora, O Mores: Affordable Care Act - Big Dream or Big Let Down?

I confess I was a strong proponent of the Affordable Care Act. My reasoning was subtler than the hallowed pantheons of its staunch supporters and the apocalyptic predictions of its detractors. Forty years after graduating medical school I concluded, after many stutter steps, the American healthcare delivery system was economically unsustainable and the citizenry was neither living longer, nor better, despite medical expenditures that dwarf any other developed nation. My career also allowed me to personally interact with cardiac surgeons from all continents and see that their clinical results and research efforts were laudatory by any standards.
Page: 123 - All