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

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