Stigma is Only Part of the Mental Health Price Tag

By Emily Newhook

Mental health patients and their families already pay a hefty price with the stigma of mental illness and the emotional rollercoaster they often face dealing with symptoms. But insufficient mental health resources across the United States also means that they must pay a financial price as well in the form of lost productivity, out-of-pocket costs for treatment and sometimes periods of unemployment. A recent USA Today special report estimates that benefits for those who cannot support themselves, cost of care and lost productivity cost the U.S. economy more than $444 billion each year.

The U.S. health care system at large struggles with inefficiencies and an inability to meet demand. The World Health Organization (WHO) reports that the U.S. spends more than two and a half times more on health care per person than most developed nations in the world. For 2010, the U.S.’s average per capita total expenditure on health was $8,233 compared to $5,257 in Canada and $5,174 in Australia (adjusted for U.S. dollars). This infographic contains more health care stats from WHO.

While the country’s health services in general leave room for improvement, the deficiencies in its mental health system are particularly troubling. Individuals with serious mental health issues such as depression, schizophrenia or bipolar disorder have historically not had insurance coverage for treating those issues at the same level as medical issues such as cancer or diabetes. Mental health conditions can be debilitating when left untreated, but patients have not always sought appropriate treatment or had access to treatment due to a lack of insurance or a limit on the number of visits covered by insurers.

Mental health patients who do not have access to regular psychiatric services may strain resources at hospital emergency rooms, because these patients often feel they have few alternatives. This is partly due to the decentralized nature of mental health services and the deinstitutionalization of mental health patients during the 1960s. According to a recent New York Times article, general hospitals will spend $38.5 billion this year caring for patients whose primary issue was a mental health diagnosis or substance abuse, compared to $20.3 billion in 2003. Some of these patients require 24-hour watchers to prevent harm to themselves or hospital staff, further straining hospital resources.

Some health care organizers and policymakers are working to improve access to mental health services and reduce the strain on more general providers. In North Carolina, explains the Times, the psychiatric bed shortage and a reduction in funding for mental health services means that the number of patients with mental health issues who entered emergency rooms across the state was twice the national average in 2010. Under a new pilot program, however, paramedics are giving patients the option to receive more appropriate care at psychiatric facilities instead of the emergency room. In other parts of the world there is the option to be placed in mental health housing for those who need to be in a safe and nurturing environment. This encourages positive results when the patients have been placed in the best possible housing following assessment to support their needs.

The Mental Health Parity and Addiction Equity Act of 2008 now prevents group health plans and health insurance issuers from creating stricter treatment limitations or financial requirements for mental health issues as opposed to other medical/surgical benefits. Medicare coverage had offered more limited treatment for mental health issues, but the law began covering a larger share of outpatient medical health services. Earlier this year, Medicare began paying 80 percent of the bill for psychological therapy, the same portion it covers for most medical services.

These improvements to the nation’s mental health care systems offer hope to patients and their families. However, providers, payers, patient advocates and health care administrators must all take an active role in shaping new policies and practices to improve access to mental health services and reduce the social stigma associated with these issues.


Emily Newhook is the community relations manager for the executive MHA program and MPH program at The George Washington University. Outside of work, she enjoys writing, film studies and powerlifting. Follow Emily on Twitter and Google+.

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