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Current Issues
Components of the Economic Burden of Serious Mental Illness in the US
Thomas R Insel, MD,
1
Michael Schoenbaum, PhD
2
and Philip S Wang, MD, DrPH
3
1. Director; 2. Senior Advisor; 3. Deputy Director, National Insitute of Mental Health (NIMH)
Abstract
Mental disorders impose considerable socioeconomic costs due to their episodic/chronic nature, their relatively early ages at onset, and
the highly disabling nature of inadequately treated mental illness. Despite substantial increases in the volume of mental health treatment
for disorders in the past two decades, particularly pharmacotherapies, the level of morbidity and mortality from these disorders does not
appear to have changed substantially over this period. Improving outcomes will require the development and use of more efficacious
treatments for mental disorders. Likewise, implementation of cost-effective strategies to improve the quality of existing care for these
disabling conditions is required.
Keywords
Mental illness, costs, efficacy, effectiveness
Disclosure: The views expressed in this article do not necessarily represent the views of the National Institute of Mental Health, the National Institutes of Health, the Department of
Health and Human Services, or the US government. The authors have no conflicts of interest to declare.
Received: December 8, 2008 Accepted: March 12, 2009
Correspondence: Thomas R Insel, MD, Director, National Institute of Mental Health, National Institutes of Health, 6001 Executive Blvd, Rm 8235, Bethesda, MD 20892.
E:
tinsel@mail.nih.gov
As readers of this publication are certainly aware, mental disorders impose costs ensuing from the high rate of medical complications associated
very considerable costs on society. This is due to many factors, including with serious mental illness. In terms of direct costs, spending on mental
their episodic/chronic nature, their relatively early age at onset, and the health treatment in the US was $100 billion in 2003, representing at least
highly disabling nature of inadequately treated mental illness. 6.2% of total health spending.
3
How can we quantify what mental disorders cost the nation? One Indirect costs—which certainly exceed direct mental health treatment
method, developed by the World Health Organization (WHO), is to use costs—have been more challenging to quantify comprehensively.
disability-adjusted life-years (DALYs), where one DALY is equal to the Indeed, the most recent published study to do so provided estimates for
loss of one healthy life-year. Based on this metric, mental disorders 1985,
4
which pre-dates the sweeping changes in mental health treatment
‘cost’ the US and Canada a total of 6.9 million DALYs in 2001, which patterns associated with, for example, managed behavioral healthcare
corresponds to 7.6 days of healthy life lost for every person in the and developments in psychopharmacology.
5
A recent study, however,
population that year; this represents 15% of the total DALY burden, examined one major component of indirect costs: reduced individual
essentially equal to cardiovascular diseases as the most burdensome earnings associated with having a mental illness, a proxy for reduced
among the 23 categories used by the WHO, and 24% higher than the labor output due to mental-health-related absenteeism, presenteeism,
next largest disease category, malignant neoplasms.
1
turnover, unemployment, and non-participation in the labor force.
Another way to determine the impact of mental illness, based on the Using US data from 2001–2003 on non-institutionalized adults 18–64
common ‘cost of illness’ methodology,
2
is to monetize the direct and years of age, those with a serious mental illness (defined as having a
indirect financial costs incurred by society due to mental disorders. In diagnosable mental disorder severe enough to cause substantial
this framework, ‘direct’ costs are those associated with mental health impairment) were found to have lower individual earnings of $16,306
treatment per se (e.g. medication, clinic visits, or hospitalization), per year, on average, compared with those without such a mental
whereas ‘indirect costs’ are incurred through premature mortality, illness. At the population level, this corresponds to an annual reduction
reduced labor output (and public and private income support programs, of $193.2 billion in reduced earnings associated with mental illness; of
which serve to replace labor income among the disabled), reduced this, 75% was attributable to workers with mental illness having lower
educational attainment, increased incarceration and homelessness, and earnings than workers without, and 25% to a higher rate of zero
10 © TOUCH BRIEFINGS 2009
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