A landmark study examines the economic burden and lives lost due to mental health inequities.
Mental health inequities cost billions of dollars and thousands of lives annually, according to a new report.
Indigenous populations such as Native Americans and minority groups such as African Americans experience mental health inequities that limit access to care. These inequities result in poor clinical outcomes such as suicide.
The new report was produced by the Satcher Health Leadership Institute at the Atlanta-based Morehouse School of Medicine, with support from Otsuka America Pharmaceutical Inc. The researchers examined data from 2016 to 2020.
The report features two key data points:
- From 2016 to 2020, 116,722 members of indigenous populations and racial and ethic minority groups experienced premature mental and behavioral health-related deaths.
- From 2016 to 2020, the costs associated with premature mental and behavioral health-related deaths among indigenous populations and racial and ethnic groups linked to mental illness, substance abuse, and suicide were $278 billion.
The new report is unique, according to the study's executive summary. "Previous studies have attempted to highlight how health disparities affect economic and lifespan outcomes for indigenous populations and racial and ethnic minoritized groups, but none have specifically analyzed the economic burden of mental and behavioral health inequities. This first-of-its-kind report is designed to inform all stakeholders on the ramifications of a chronically underfunded and siloed system of mental health care, with a particular focus on underserved and under-represented communities."
The full report, which has not been published yet, calls for actions and solutions on three fronts:
- Long-term investments in mental and behavioral health, including solutions that advance mental health equity
- Development of socio-culturally crafted approaches to mental and behavioral health services
- Tackling the social and political determinants of health inequities
Interpreting the data
The report represents a call-to-action, Daniel Dawes, JD, director of the Satcher Health Leadership Institute, told HealthLeaders. "We must do something about mental health inequities. This is a first step in helping our policymakers and our political influencers to have a better understanding of this issue that has eluded us for decades in America. It took me 15 years to finally get an organization that was aligned with our vision and our research agenda to say, 'Yes, this is worthy of studying and reporting out.' We appreciate the efforts that Otsuka America Pharmaceutical have helped us to finally get this work done."
Payers have a key role to play in addressing mental health inequities, he says. "Insurance coverage is a major systemic issue that we have been trying to address, and the lack of health insurance is often flagged as one of the most statistically significant determinants of depression, low educational attainment, and poor self-rated health."
Several factors drive mental health inequities among indigenous populations and minority groups, Dawes says. "The fact that we have not addressed stigma and cultural beliefs about psychiatric issues as we should has posed significant barriers to mental health care among communities of color. Then you tie that to the rural geographic variations that we have seen, and these communities report that more than two-thirds of their communities have no psychiatrists, no psychologists, and no behavioral health professionals. These disparities are even worse when you break them out by race and ethnicity."
The economic cost of mental health inequities is deeply rooted, he says.
"The economic burden of behavioral health conditions is even greater for mentally unwell persons who are representative of indigenous populations or racial and ethnic minority groups. This is due to a hindered ability to participate in economic activities such as employment, workforce training, and educational opportunities. They are exacerbated by having historically disadvantaged socio-economic status because of their indigenous, racial, or ethnic status. From an economic standpoint, the structural barriers in accessing care, the cultural differences to pursuing behavioral health care, the biased delivery of behavioral health care, as well as the social and political determinants of health including insurance status all perpetuate systemic inequities."
Addressing mental health inequities would result in significant cost savings, Dawes says. "We could save billions of dollars in this country if access to behavioral health services was more equitable. Health equity will not be achieved unless there is adequate coverage and payment for behavioral health services among all public and private insurance programs. Whether it is Medicaid, Medicare, or commercial payers, there needs to be enforcement of mental health parity. We need better enforcement of the parity law to cover mental health services in line with physical health services."
Thousands of live could be saved if mental health inequities were mitigated, he says. "We found during the period from 2016 to 2020 that nearly 117,000 people of color lost their lives prematurely due to behavioral health conditions, and the inability to access the treatments, interventions, and the services that they needed. We could save lives if we could rectify and repair the structures of behavioral health and if we were to do a better job building and repairing the behavioral health infrastructure."
Christopher Cheney is the CMO editor at HealthLeaders.
KEY TAKEAWAYS
From 2016 to 2020, the costs associated with premature mental and behavioral health-related deaths among indigenous populations and racial and ethnic groups linked to mental illness, substance abuse, and suicide were $278 billion.
Solutions for mental health inequities include development of socio-culturally crafted approaches to mental and behavioral health services as well as tackling the social and political determinants of health inequities.