Post by Former NIMH Director Thomas Insel: The Global Cost of Mental Illness
The economic costs of mental illness have never been easy to pin down.1 The costs of mental health care can be estimated much the way we estimate other health care costs. The Agency for Healthcare Research and Quality, cites a cost of $57.5B in 2006 for mental health care in the U.S., equivalent to the cost of cancer care.2 But unlike cancer, much of the economic burden of mental illness is not the cost of care, but the loss of income due to unemployment, expenses for social supports, and a range of indirect costs due to a chronic disability that begins early in life.
A report last week from the World Economic Forum (WEF) attempts to capture the costs of several classes of non-communicable diseases (NCDs) and projects the economic burden through 2030. Recognizing there is no ideal method, the authors adopted three approaches to estimate global economic burden: (a) a standard cost of illness method, (b) macroeconomic simulation, and (c) the value of a statistical life. The results of all three methods project staggering costs over the next two decades, with cardiovascular disease, chronic respiratory disease, cancer, diabetes, and mental health representing a cumulative output loss of $47T, roughly 75% of the global GDP in 2010.3
The WHO has already reported that mental illnesses are the leading causes of disability adjusted life years (DALYs) worldwide, accounting for 37% of healthy years lost from NCDs.4 Depression alone accounts for one third of this disability.5 The new report estimates the global cost of mental illness at nearly $2.5T (two-thirds in indirect costs) in 2010, with a projected increase to over $6T by 2030. What does $2.5T or $6T mean? The entire global health spending in 2009 was $5.1T. The annual GDP for low-income countries is less than $1T. The entire overseas development aid over the past 20 years is less than $2T.3
The WEF report also provides comparisons across NCDs to give some sense of the drivers of global economic burden. Mental health costs are the largest single source; larger than cardiovascular disease, chronic respiratory disease, cancer, or diabetes. Mental illness alone will account for more than half of the projected total economic burden from NCDs over the next two decades and 35% of the global lost output. Considering that those with mental illness are at high risk for developing cardiovascular disease, respiratory disease, and diabetes, the true costs of mental illness must be even higher.3
What makes these numbers especially important is the realization that they can be reduced. The WHO recently provided a list of "best buys" — low-cost interventions such as tobacco control and reductions in alcohol and substance use that can dramatically alter the prevalence and cost of NCDs. The WEF advises governments and corporations not medical practitioners and patients. But the message should be of broad interest: the economic health of both developing and developed nations will depend on controlling the staggering growth in costs from NCDs. The unmistakable message from this report is that mental illnesses are the largest single driver to these costs. These costs can be controlled. As the report concludes: "Economic policy-makers are naturally concerned about economic growth. The evidence presented in this report indicates that it would be illogical and irresponsible to care about economic growth and simultaneously ignore NCDs. Interventions in this area will undeniably be costly. But inaction is likely to be far more costly."3
Mental health researchers, clinicians, and advocates from around the world who participated in the Grand Challenges in Global Mental Health clearly recognized many of the complexities of the frequent chronicity of mental disorders and their interplay with other chronic diseases. As they highlighted specific challenges for the field, they identified the need to redesign health systems to integrate mental disorders with other chronic-disease care, and create parity between mental and physical illness in investment into research, training, treatment and prevention.6 How might a mental health research agenda respond? By studying the costs of integrated care in high- and low-income setting health care systems and by expanding a set of "best buys" for mental health.
1. Insel TR. 2008. Assessing the economic costs of serious mental illness. Am. J Psychiatry. 165(6):703-711. PMID: 18519528
2. Soni, Anita. The Five Most Costly Conditions, 1996 and 2006: Estimates for the U.S. Civilian Noninstitutionalized Population. Statistical Brief #248. July 2009. Agency for Healthcare Research and Quality, Rockville, MD. http://www.meps.ahrq.gov/mepsweb/data_files/publications/st248/stat248.pdf
3. Bloom DE, Cafiero ET, Jané-Llopis E, Abrahams-Gessel S, Bloom LR, Fathima S, Feigl AB, Gaziano T, Mowafi M, Pandya A, Prettner K, Rosenberg L, Seligman B, Stein A, Weinstein, C. (2011). The Global Economic Burden of Non-communicable Diseases. Geneva: World Economic Forum.
4. World Health Organization. ( WHO 2011a). Global status report on non-communicable diseases 2010. Geneva: WHO.
5. World Health Organization. (WHO 2008). The Global Burden of Disease:2004 Update.
6. Collins PY, Patel V, Joestl SS, March D, Insel TR, Daar A, on behalf of the Grand Challenges in Global Mental Health Scientific Advisory Board and Executive Committee. Grand Challenges in Global Mental Health. Nature. 2011 July 7. 474(7354):27-30. PMID 21734685