Who created this ugly baby?

We who have dedicated our life work to behavioral health tend to view our avocations as tenderly as a mother with a new babe. And, most of the time, the baby is beautiful: we conduct our work with dedication and integrity; we improve the quality of life in our communities; indeed, we save lives. But even today, after decades of accomplishment, we all too often must justify our existence and legitimize our profession to payers, public policy makers, and the public at large.

Consider our “small player” role in the healthcare reform debate (as well as most public policy matters); the omission of behavioral health providers in the EMR component of the ARRA legislation; the fact that 91% of state mental health authorities experienced funding cuts this year; and, of course, the continued belittlement of behavioral health consumers and providers within the popular media.

Making our case is the President’s New Freedom Commission on Mental Health report https://www.mentalhealthcommission.gov/reports/FinalReport/toc.html :

"Mental illnesses rank first among illnesses that cause disability in the United States, Canada, and Western Europe.¹² This serious public health challenge is under-recognized as a public health burden. In addition, one of the most distressing and preventable consequences of undiagnosed, untreated, or under-treated mental illnesses is suicide. The World Health Organization (WHO) recently reported that suicide worldwide causes more deaths every year than homicide or war .¹³

In addition to the tragedy of lost lives, mental illnesses come with a devastatingly high financial cost. In the U.S., the annual economic, indirect cost of mental illnesses is estimated to be $79 billion. Most of that amount - approximately $63 billion - reflects the loss of productivity as a result of illnesses. But indirect costs also include almost $12 billion in mortality costs (lost productivity resulting from premature death) and almost $4 billion in productivity losses for incarcerated individuals and for the time of those who provide family care.¹⁴

In 1997, the latest year comparable data are available, the United States spent more than $1 trillion on health care, including almost $71 billion on treating mental illnesses. Mental health expenditures are predominantly publicly funded at 57%, compared to 46% of overall health care expenditures. Between 1987 and 1997, mental health spending did not keep pace with general health care because of declines in private health spending under managed care and cutbacks in hospital expenditures.¹⁵

"In 1997, the United States spent more than $1 trillion on health care, including almost $71 billion on treating mental illnesses."

So, why does the baby always have stepchild status within the healthcare industry and public policy domains? If our nation tended to the care and feeding of behavioral health, the fiscal and quality of life impacts would be stunning indeed.

At times I wonder if all this goes back to the not-too-distant past when people with mental illnesses were viewed as demon possessed, when the ‘science’ consisted of phrenology or similar bogus approaches, when the general public would visit the “lunatics” at the state asylum as a form of Sunday afternoon entertainment. But I also have to ponder on what we could have done differently—and what we should be doing differently in the future.

If it has to be about money, why haven’t we been able to convince the public that the behavioral health investment more than pays for itself? Why haven’t we achieved front row status as keys to the future when the Wall Street Journal tells us that 75-90% of all visits to the doctor are due to behavioral health conditions and 60% of lost work days each year can be attributed to stress-related disorders?

I know—it’s that ubiquitous lament of parents everywhere, “Where did we go wrong?”

My question for all of you is where should we go from here?