According to the National Association of Mental Illness, 1 in 4 Americans suffer from mental illness. With numbers like these, it is highly likely that either you or someone you love are dealing with the realities of mental illness on a daily basis. As someone that lost a best friend to mental health issues this year, I am very well acquainted with the real cost of mental illness. Much like the shame we feel around money, the shame that follows mental health is real and consequential, and the two are very much linked. Financial health is impacted by mental health and mental health is impacted by financial health. The relationship between the two can create quite a dreadful downward spiral. Let’s explore how we can best keep both our mental health and our financial health strong…mostly by ridding ourselves of the shame tied to both.
The Direct Costs of Mental Illness
First and foremost, it is important for us to manage our brain health just as we manage our heart health or body weight. Some of the challenge here is that insurance companies vary in the way they cover mental health. This variance is most often present in the form of the “deductible”. This is the amount you need to pay every year before your insurance company will begin to cover your expenses. You do not need to pay your deductible for preventative wellness visits. Many times it doesn’t even factor in with primary care and specialist doctor’s visits. It typically only comes into play for certain “inpatient and outpatient services”, and the definition for what services this includes vary plan by plan. Some health insurance plans require that the deductible be paid before they will cover mental health services while others consider those a specialist visit where the deductible does not apply. The idea of having to first pay $500, $1000, $1500 or more in out of pocket costs before insurance kicks in can be a deterrent towards seeking out mental health services. If this is a concern for you, please do check with your plan on telemedicine options. Telemedicine has proven to be very effective at offering lower cost care with the added benefit of helping alleviate concerns over social stigma.
Pharmaceutical costs are also sometimes associated with mental health care. In our post “10 Big Healthcare Cost Questions Answered by a Doctor“, pediatrician Nanette Nuessle recommends using a mail order prescription service to have a 3 month supply sent to your home as opposed to the 30 day supply you fill at the pharmacy. She also recommends that you always ask your provider if cheaper options are available. This doesn’t just mean generic choices but also other brand name choices. She says that it is best to avoid the drugs that are brand new if you can. They tend to be 3-10 times more expensive as the drug they just replaced, often without any substantial benefit. Fortunately, many of the available mental health drug options now offer a generic version.
Indirect Costs of Mental Illness
Unlike the more obvious costs of mental illness, there are quite a few indirect costs as well. We will explore data provided by the National Alliance on Mental Illness below while understanding that many of these costs are associated with the non treatment of mental illness, which is driven by shame and stigma. Do your part by going to the Bring Change 2 Mind website and pledging to end the stigma and discrimination associated with mental illness.
Here are some of the “indirect” costs of mental illness:
- Higher Rates of Death: Suicide takes more lives than any other form of injury. Suicide is a risk of untreated depression, and it is the 11th leading cause of death in the United States. I learned, following my friend’s death, that a person commits suicide in the U.S. every 16 minutes. A suicide attempt is estimated to occur every minute. Many of those that commit suicide never reach out for help. This is particularly true of college aged individuals. The best advice I received was in this TedTalk by Kevin Briggs. He is the highway patrolman that was tasked with responding to suicide attempts on the Golden Gate Bridge. He stated that if you fear a friend or loved one may commit suicide, then say to them, “Sometimes when people are going through the types of things that you are going through they think about suicide. Is that something you are considering?” Prior to popular belief, speaking about suicide with someone that is contemplating it will not “push them over the edge”. Rather, it often pops the bubble of secrecy that empowers their decision making.
- Added Complications for Those with Chronic Disease: When you are suffering from a chronic condition, such as cancer, Parkinson’s, or heart disease, you have a much greater risk of depression than the general population. Likewise, depression has a negative impact on the course of these diseases. For example, depressed heart disease patients are more likely to die from a heart attack than heart disease patients that are not depressed. Depression also impacts whether or not patients follow their disease protocol such as diet, exercise, and medication adherence.
- Impact on the Marketplace: Even with what I know about mental illness, this statistic was surprising to me: major depression is associated with more annual sick days and higher rates of short-term disability than any other chronic disease. In one study that compared the cost to treat depression with the cost of lost productivity in not treating depression, 45-98% of the treatment costs were offset by an increase in productivity due to treatment. This one is a challenging fact to follow for those that suffer from bipolar disorder. As I read in “An Unquiet Mind” our society actually rewards manic behavior because it results in an otherwise superhuman level of productivity. However, this productivity during mania is cut short by the dramatic decline in productivity during a depressed state. In the end, bipolar depression must be treated to provide the greatest benefit to all involved…both employer and patient.
- Unemployment: The national unemployment rate for individuals receiving public mental health services is approximately 80%. I am reminded of an instance where an employee of a health insurance company had a mental health emergency. This employer opted to forcibly remove the employee from their post. This individual, barefoot and in the rain, was forced to find their way to safety while ill. Can you even imagine an employee being kicked out into the streets while they are having a heart attack? This is one area where ending stigma will have real and tangible benefits.
- Impact on the Family: Mental health has a big impact on the lives of patients, but it doesn’t stop there. There are widespread costs to the family as well. The burden on the caregiver is quite significant in terms of their own work productivity. Similarly, children of mothers that suffer from chronic depression are more likely to have problems at school.
- Substance Abuse: When mental health is not treated clinically it can sometimes be treated by way of substance abuse problems by the patient. A federal study showed that adults that used illicit drugs were twice as likely to suffer from mental health illness when compared to those adults that were not drug users. Added to this is the fact that undetected depression from drug and alcohol users are estimated to be upwards of 30%.
- Prison System as the “New Asylum”: As documented in a joint study between the Treatment Advocacy Center and the National Sherrifs’ Association, prisons and jails across the country have become the “new asylums”. The report states:
The number of individuals with serious mental illness in prisons and jails now exceeds the number in state psychiatric hospitals tenfold. Most of the mentally ill individuals in prisons and jails would have been treated in the state psychiatric hospitals in the years before the deinstitutionalization movement led to the closing of the hospitals, a trend that continues even today. The treatment of mentally ill individuals in prisons and jails is critical, especially since such individuals are vulnerable and often abused while incarcerated.
In order to stymy these trends we have to treat them at the root. It is important to end the stigma associated with mental illness. You can do that by advocating to end the stigma around mental health at home, at work, and in the community. Here is a link to that Bring Change 2 Mind pledge again.
Also, if you or someone you love may need to, please reach out to the National Suicide Prevention Lifeline. This world needs you, and the cost of losing you is too high to bear.