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Mental Illness is One of the Most Costly Conditions

Cheryl Clark, for HealthLeaders Media, September 29, 2009

For anyone focused on the corporeal side of medicine, it's always a grim reminder to see just how much of the healthcare bill stems from treatment of maladies of the mind.

A report from the federal Agency of Health Research and Quality analyzed numerous research papers published in the last three years to conclude that mental disorders, including violent behavior between intimate partners, were one of the five most costly conditions in the U.S. in 2006.

In its analysis, the agency makes the following points in a series of bulleted items based on published research during the last three years:

  • One in four adults in the U.S. suffers from a mental disorder in any given year, and one in 17 suffers from a serious mental illness, which typically takes a toll on overall health leading to death 25 years earlier than for those in the general population.
  • Care for mental disorders rose from $35.2 billion in 1996 to $57.5 billion in 2006.
  • Substance abuse and domestic violence affect nearly one in three U.S. adults. About 1.3 million women are abused physically by their intimate partners each year. And of those women who seek care in hospital emergency rooms, one in four has an injury related to domestic violence. More than one in four men have been victims of intimate partner violence in their lifetime. An estimated 551,000 older adults are victims of family abuse or neglect.
  • One million abused children are identified each year, with 1,500 dying of abuse and neglect. Abused children are more likely to have behavior problems, developmental delays, and school failure.
  • Those who have been abused are more likely to be depressed, have issues with substance abuse, attempt suicide, and those who are women have poor pregnancy outcomes.
  • Settings where patients are treated for these illnesses are changing. Primary care clinicians instead of psychiatrists are more likely to diagnose and treat children and adults, and "telepsychiatry and new medications are extending the reach and type of treatment available."
  • Access to mental health care is an ongoing problem, especially for people in rural or frontier areas of the country. And many of those who know they should seek help don't do so because of inability to pay, belief that the problem will go away or lack of time.

In a second category of research, the agency looked at access to care and cost of care issues as they relate to mental health. It concluded that the cost of treatment for mental health issues is not well appreciated. For example, individuals nationwide spent an average of 10% of family income out-of-pocket for mental health or substance abuse treatment.

The report contains significant findings important findings in a series of bullets on access and cost of care:

  • The five most costly children's conditions in 2006 were mental disorders, asthma, trauma disorders including fractures, acute bronchitis and infectious diseases. Treating depression and other mental illnesses in children cost $8.9 billion compared with $8 billion for asthma and $6.1 billion for trauma-related disorders. And Medicaid paid for more than one third the bill for mental disorders although private insurance paid the largest percentage.
  • The number of people using services for mental disorders nearly doubled from 19.3 million to 36.2 million from 1996 to 2006.
  • People with psychotic and bipolar disorder are 45% and 26% less likely, respectively, to have a primary care doctor than those without mental disorders. Those with psychotic, bipolar or major depressive disorders had 2.5 to 7 times greater odds of any barriers to care. For example, they are more likely to delay care or get a needed prescription filled.
  • States have a wide variation in allowing people with mental illness to be admitted to nursing homes. For example, homes in Connecticut, Ohio, and Massachusetts had the highest rates of admission for such patients while homes in Wyoming, Nevada, Arkansas, and South Dakota had the lowest.

Cheryl Clark is senior quality editor and California correspondent for HealthLeaders Media. She is a member of the Association of Health Care Journalists.
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