2020 devastated US mental health — healing must be a priority

It should have been obvious that a once-in-a century outlier event — shattering economies, throwing millions onto the unemployment rolls, shuttering schools, forcing isolation — combined with an outpouring of fury over racial injustice — would precipitate a tsunami of anguish, depression, anxiety and addiction. 

The result: a pandemic of despair of historic proportions rolled into a broader public health crisis. The crisis is now of such magnitude that a failure by legislators and policy makers to shore-up an overwhelmed mental health care system could cripple recovery. 

On a global scale, mental health and substance use needs are the single largest driver of disability costs worldwide — $2.5 trillion in 2010 and a projected $6 trillion by 2030. In the U.S., the annual economic burden of major depressive disorders exceeds $210 billion, while that of schizophrenia is $156 billion. Post-COVID forecasts warn that the cost of treating widespread anxiety and depression will create a $1.6 trillion drag on the US economy.  

The National Alliance on Mental Illness estimates that untreated mental illness already costs us up to $300 billion annually due to lost productivity and associated costs due to absenteeism, employee turnover and increases in medical and disability expenses. 

Other data show that people suffering from inadequately treated mental health issues disproportionately drive excess medical costs. Only one in 20 of those with health coverage received care for combined medical and mental health or substance use needs, yet this accounted for nearly half of all spending for the entire group.

But the real tragedy is that this spending yields so little in terms of improved health. We believe it’s because care comes so late — typically eight to 10 years post-onset. This same small group of people with complex needs received little early intervention or preventative mental health care that could have stemmed broader health care costs. Instead, we see a pervasive pattern of limited access — 50 percent of all health care patients with mental health and substance use needs received less than $68 per year of mental health treatment. 

Our overwhelmed mental health care system — a patchwork of public, nonprofit and public clinics already inadequate to support the needs of people with serious mental illness prior to the pandemic — is no match for the current escalating need and is in danger of collapse.

In the early days of the pandemic, leaders from 14 of the nation’s top mental health organizations came together to offer their expertise on the spiraling problem. We developed a unified vision statement for transforming mental health and substance use care, detailing proven programs based on sound research and a commitment to supporting the health and well-being of all.  

We offered immediate solutions to congressional leaders and policy makers based on public-private partnerships that could alleviate human suffering while also lessening the economic burden of inadequate care. But to succeed over the long term, there needs to be a cultural shift — a recognition that physical health and mental health are inextricably bound — and that our priority for recovery must be prevention, early intervention and expanded access to treatment in communities, schools, prisons and in primary medical care.

Longitudinal research has shown how the integration of behavioral health and general medical services — known as the collaborative care model — improves outcomes, saves money and reduces stigma. Researchers at the Meadows Mental Health Policy Institute examined the potential impact of expanding access to collaborative care and medication-assisted treatment. They projected that these approaches could prevent up to a third of deaths from suicide and nearly every death from opioid overdose. 

The costs for building out these systems are manageable and offset over time. In fact, collaborative care models alone would save six and a half dollars for every dollar invested and thus save the Medicaid system $15 billion annually. Similarly, an analysis by Brandon Staglin, president of One Mind and a member of our mental health leadership collaboration, found that $1 billion in annual funding for expansion of coordinated specialty care for serious mental illness would save over $260 billion over 20 years.  

As Arundhati Roy says, the pandemic is a portal, offering the opportunity to rebuild for the future. There is a viable pathway for turning around the economics of mental health care. Given the severity of the crisis, can we afford not to seize this opportunity for real change?

Daniel H. Gillison, Jr. is the CEO of the National Alliance on Mental Illness. Andy Keller, Ph.D., is president and CEO of the Texas-based Meadows Mental Health Policy Institute.