Mental illness has been an increasingly significant health concern over the past several decades, but it’s now becoming an economic one too. The number of Americans who receive Social Security Disability Insurance for mental disorders has doubled during the past 15 years. Eliza is now one of an estimated 11.5 million American adults with a debilitating mental illness, on whom the country spends about $150 billion annually on direct medical costs — therapy, drugs, hospitalizations and so forth. But the biggest blow to the overall economy are the many hidden, indirect costs. People with serious mental illness earn, on average, $16,000 less than their mentally well counterparts, totaling about $193 billion annually in lost earnings, according to a 2008 study published in The American Journal of Psychiatry. And many mentally ill workers, who are more likely to miss work, also suffer from what social scientists call presenteeism — the opposite of absenteeism — in which they are very likely to be less productive on the job when they show up.
Reduced earnings and a lower likelihood of being, or staying, married compound the problem. The mentally ill are at higher risk of poverty than their peers, which subsequently increases their need for other public safety-net services like food stamps and subsidized housing. Their use of those services, according to one recent estimate, probably costs taxpayers another $140 billion to $160 billion a year. All together, our cumulative mental-health issues — depression, schizophrenia and bipolar disorder, among others — are costing the U.S. economy about a half-trillion dollars. That’s more than the government spent on all of Medicare during the last fiscal year.
With a major expansion of health insurance slated to take effect next year under Obamacare, policy makers are obsessing over how to bring down such costs. But listening to Eliza talk about getting back to work, it was hard not to wonder whether the best way to cut the long-term costs associated with mental illness was, paradoxically, to spend more money on directly treating it now. Economists refer to this as the cost offset, and it’s sort of like a return on an investment that comes from helping mentally ill people become more productive and less dependent on taxpayers.
It’s time we treat mental illness like every other medical condition.