Week of May 15, 2002

What are the hidden costs of mental illnesses? In recent weeks, the White House and Capitol Hill have weighed the potential benefits and costs of requiring health insurers to provide treatment for psychiatric disorders. This week on "The Infinite Mind" we turn to the cost of NOT treating them. Dr. Peter Kramer guest hosts this program for the vacationing Dr. Fred Goodwin. Guests include Ronald Kessler, a sociologist at the Harvard Medical School Department of Health Care Policy; Paul Greenberg, an economist at the Analysis Group in Cambridge, Massachusetts; and Dr. Greg Simon of Seattle's pioneering Group Health Cooperative. And sharing a front-line view of the frequent intersections between untreated psychiatric illnesses and hospital emergency rooms are Dr. Herbert Pardes, president and chief executive officer of the New York Presbyterian Hospital; and Dr. David Goldschmitt, who runs the emergency room at New York University Downtown Hospital. Commentary by John Hockenberry.

In an introductory essay, Dr. Kramer points out that the American Psychiatric Association places the annual costs of untreated mental illness at a staggering 70 billion dollars. Untreated depression alone costs the nation a staggering 40 billion dollars a year. While anyone who's ever suffered from a mental illness, or had a family member of friend suffer from a mental illness, can easily understand the human cost of untreated mental illnesses, there is also strong evidence for the financial tolls involved. Recent research indicates that mental health treatment can more than pay for itself. Says Dr. Kramer, "Mental health treatment seen in this light is actually an investment opportunity for employers, one that can pay dividends through sustaining a healthy workforce --enhancing what can be viewed as 'human capital.'"

Next, we visit a real life "E-R." Dr. David Goldschmitt runs the emergency department at the busy New York University Downtown hospital in lower Manhattan. His busy ER is on "psychiatric diversion" - cases involving mental illness are supposed to be directed to other hospitals. All the same, he says, mental illness continues to present itself in many forms. He tells the story of a schizophrenic woman, formerly a very successful businesswoman and artist, who routinely shows up at his emergency room. Not only is the emergency room not the best place to get psychiatric care, but inappropriate patients, says Goldschmitt, increases the emergency room's case load and leads to longer emergency room waits for all patients. A few miles uptown from Dr. Goldshmitt, Dr. Herbert Pardes, president and chief executive officer of the New York Presbyterian Hospital, faces similar dilemmas. Untreated mental illness, he points out, can show up in symptoms that lead doctors to refer patients to a series of specialists-- endocrinologists, cardiologists, gastroenterologists - and tests that ultimately prove to be besides the point- and expensive.

Next, Dr. Kramer interviews Ronald Kessler and Paul Greenberg. Ronald Kessler is a sociologist at the Harvard Medical School Department of Health Care Policy. He is a leading expert on the prevalence and impact of mental illness. Paul Greenberg is an economist at the Analysis Group in Cambridge, Massachusetts, where he studies the costs of health care and the economic effects of public policy proposals. Kessler and Greenberg begin by establishing that mental illnesses are widespread. Each year, one in four people in the United States have at least one episode of a mental illness or disorder, and five percent of the population is seriously impaired by a mental disorder. One of the biggest financial drains that untreated mental illnesses exacts is in the work place. Not only do untreated mental illnesses lead to absenteeism, but they can also lead to what's being called "presenteeism," when employees show up but are not able to work to the best of their abilities due to the impairment of psychiatric symptoms. A recent study sponsored by the Rand corporation showed that an annual investment of $500 per employee in mental health more than pays for itself by an increase in worker productivity. On the medical front, it's also been shown that untreated psychiatric illnesses exacerbate chronic conditions like arthritis, asthma, and diabetes, leading to an increase in patient visits to primary care physicians that could potentially have been averted. The early onset of most psychiatric illnesses, which typically strike in adolescence, also adds to the long-lasting effects and costs of not treating these illnesses. You can contact Ronald Kessler at Harvard Medical School at 617-432-3587 or by e-mail at kessler@hcp.med.harvard.edu. Paul Greenberg can be reached at the Analysis Group at 617-425-8000 or by e-mail at agweb@analysisgroup.com

Next, Dr. Kramer interviews Dr. Wayne Katon. Dr. Katon is professor of psychiatry at the University of Washington in Seattle. He discusses how anxiety disorders can result in symptoms that mimic symptoms of other medical illnesses, and which can result in unnecessary - and expensive - referrals to specialists and tests. For instance, an anxiety disorder can lead to stomach upsets, heart irregularities, and muscle tension that can lead to ultimately unnecessary referrals to gastroenterologists, cardiologists, and back doctors. A recent study showed that integrating psychiatric care with primary care for people with anxiety disorders leads to an increase in likelihood that they will follow through with treatment for the anxiety disorder and can lead to potential annual savings of $800 to $1,000 per patient. Wayne J. Katon can be reached at 206-543-3925 or by e-mail at wkaton@u.washingrton.edu

Then the Infinite Mind's Emily Fisher speaks with Dr. Greg Simon of the Group Health Cooperative in Seattle. Dr. Simon is a psychiatrist who also heads up research aimed at improving care and ultimately reducing costs for treating members of this HMO who have psychiatric illnesses. The Group Health Cooperative has found that most patients with depression do not get adequate treatment and that a big problem is posed by patients who voluntarily go off their treatment plan, whether they stop taking medication prescribed to them or stop their psychotherapy, without discussing this with their health care providers in the first place. The cooperative is pioneering innovative outreach techniques aimed at keeping patients who need treatment IN treatment. Dr. Simon can be reached at 206-287-2979 or by e-mail at simon.g@ghc.org

Finally, commentary from John Hockenberry wraps up the show. "There are no 'hidden' costs to mental illness," says Hockenberry. "The hidden costs are just the ones we choose to ignore."

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