By Cate Carrejo
The cost of mental illness in the United States is alarmingly high. Serious mental illness costs society $193 billion per year in lost earnings alone, as well as more than $100 billion in health care costs, according to a study conducted by the National Institute of Mental Health. It might seem callous to reduce the devastating effects of mental illness to hard numbers, but the staggering economic cost of mental illness is really just another indicator of the need for reform in the mental health care system in America.
The $193 billion is a huge loss for the American economy in terms of tax revenue and stimulation from spending. However, lost earnings from mental illness are much more harmful to the individual or family whose life is impacted by mental illness. According to the World Health Organization, low socioeconomic status is one of the leading factors associated with mental illness — low-income groups have a two-time higher prevalence rate for depression and an eight times higher relative risk for schizophrenia. Under the Americans with Disabilities Act, it is illegal to fire someone for having a mental illness, but missing work for doctors’ appointments or treatments does not have to be paid leave, which can be a huge problem for those already at the bottom of the socioeconomic ladder. Mental illness and poverty combine to create a very slippery slope: the individual misses treatment to earn enough money for treatment, then loses income and career opportunities to go to treatment, thereby increasing stress and exacerbating the underlying mental illness.
Even if an individual can afford it, proper mental health care is not easily accessible in many places. The nationwide shortage of doctors is predicted to reach over 90,000 by 2025, according to the Association of American Medical Colleges, and much of that burden is likely to fall on lower-income areas. In neighborhoods such as the Bronx community surrounding Fordham, where the financial incentive to be a physician is significantly decreased, accessing care is almost impossible.
James Hickey, LCSW-R, is a part owner of Comprehensive Counseling LSCWs, a cooperative practice of mental health care workers located on Bainbridge Avenue near the Montefiore Medical Center. The clinic, one of the only of its kind in the Bronx, opened in April 2014 and already treats about 1,000 patients per week. “We have been told by a number of people, doctors working in the area and patients coming to see us for the first time, that they had been looking for a type of place like we have now for a very long time and they had a lot of difficulty finding something similar,” said Hickey. “We’re just working in one small corner [of the Bronx…] and the services that we provide are much needed.”
Seventy to 90 percent of patients with serious mental illnesses who receive adequate care see a significant reduction of symptoms and improvement in their quality of life, but when care is either too expensive or inaccessible, people’s lives can deteriorate quickly. According to the National Coalition for the Homeless, approximately 20 to 25 percent of all homeless people suffer from a serious mental illness which creates an endless cycle of illness and homelessness. Government programs are chronically underfunded, preventing the most vulnerable members of society from getting the help they need. Even when housing is provided, it is unlikely to help the mentally ill achieve residential stability unless trained psychological support is also available.
The final aspect of the nationwide cost of mental illness is disability benefits, which allocates about $24 billion in public funds to supporting mentally ill individuals. Ultimately, some of this funding is absolutely necessary — just as there will always be physical conditions which make working entirely impossible for some people, there are some cases of mental illness where having a job is simply not feasible. However, there are also cases where the need for public assistance could be avoided. In 2013, The New York Times reported on a woman named Eliza whose severe depression had not responded to conventional treatments, but was denied coverage for an experimental treatment that would have significantly improved her quality of life. Rather than pay for her treatment, her healthcare company allowed Eliza to become sicker, to the point that she could no longer keep her job and had to go on welfare.
New laws and programs like the Affordable Care Act are helping to secure justice for patients like Eliza, but extensive reforms are needed to prevent the cycle of mental illness from continuing. With more efficiency and accessibility, not only can the shockingly high societal cost of mental illness significantly decrease, but the people most in need can actually take advantage of proper care and improve their lives.