Economic and human investment

I am pleased to see the Maine Legislature wants to mandate coverage of mental health and substance abuse care. Indeed, this is an extremely wise human and fiscal investment. Sadly, mental health care has been underfunded or not funded, which only contributes to the stigma of mental illness. Mental illnesses are brain-based disorders not unlike migraine headaches or epilepsy. They require treatment in the same fashion as these other brain based disorders receive.

An examination of the cost of not treating mental illness helps understand the fiscal realities involved. Let me provide some examples. Using 1990 dollars, which would need to be adjusted upward to account for inflation, the total annual cost in the United States for depression was $ 44 billion. Of this enormous cost, 55 percent was due to lost productivity, and twenty-eight percent was spent on treatment. Of the amount spent on treatment, 6 percent went to outpatient treatment, 19 percent to hospital based treatment and 3 percent went to pay for medication. Sadly, 17 percent went to suicide.

Put another way, for every dollar spent on treatment for depression alone, actually saves $3. What a phenomenal return on an investment. The question is not whether we can afford treatment, but instead whether we cannot afford treatment. For every dollar spent on treatment, we save $3. Depression is a common disorder, affecting 16 percent of all Americans over a lifetime. Psychiatry has come a long way in the recent past.

In the “old days,” of roughly five years ago, we looked for response to treatment, measured typically as a fifty percent reduction in symptoms. The problem was that if someone has severe depression, a 50 percent reduction in symptoms is often not good enough. Today, we try to achieve remission, the absence of all symptoms with a return to a pre-illness level of functioning. Aiming only for response and not remission increases the chance of relapse and recurrence of further episodes of depression. Indeed, by combining medication treatment with psychotherapy (talk therapy) we have come a long way in treating individuals suffering from depression.

The economic burden of anxiety disorders such as panic disorder and generalized anxiety disorder is also astounding with $42.3 billion spent in the United States in 1990. Psychiatric treatment accounted for 31 percent, with pharmaceutical costs contributing only 2 percent. Workplace costs accounted for 10 percent. Interestingly, medical treatment accounted for 54 percent. The large medical cost is explained by the physical symptoms of anxiety disorders such as palpitations, chest pain and shortness of breath, leading to expensive emergency room visits and follow-up, typically leading to testing which is very expensive. It is not uncommon to see a patient with panic disorder who has had multiple emergency room visits for fear of heart attack, testing for stomach and gastrointestinal disease owing to the physical symptoms of the panic attacks. Fortunately, modern psychiatry can treat the panic disorder, thus lessening the economic burden to the insurance companies that they are spending on diagnosing physical illness which is not present.

The above economic analysis should not take away from the cruel suffering felt by the patient and their families, which is often intense.

Maine has other economic problems. The high rate of drug use, particularly opiates such as heroin, Oxy-Contin, Dilaudid and Vicodin, has been a severe problem to businesses in Aroostook County and Down East regions. Providing a stable work force against the harsh backdrop of substance abuse has had profound ill effects on many businesses.

At a time when Maine is losing so many manufacturing businesses to other states or bankruptcy, profound cost savings for treating mental illness and substance abuse is no luxury but an economic necessity. We are at a juncture when policy-makers, including the Legislature, ought to work with the insurance industry to insure that patients are being offered the best possible treatments.

It is truly a great economic and human investment. The United States, and Maine, can no longer afford to not treat mental illness and substance abuse. We must not be penny-wise and pound-foolish, but humane and offer the best possible care. Obstacles to care must be identified and eliminated to ensure our family, friends and neighbors get the help they need when they need it.

Jeffrey S. Barkin, M.D. is a psychiatrist at Neurology Associates of Eastern Maine.