California Psychiatric Association Documents

Volume I No. 2
August 1993

Effectiveness of Psychiatric Treatment

Comparisons With Other Medical Disorders

In recent years, enormous strides have been made in the effective treatment of severe mental illness. Studies have shown that new treatments for mental illness, including, medication therapy, can drastically reduce the costs associated with treating these patients as well as returning them to society as fully productive individuals. Because of this ever-increasing success in treating mental illness, a joint Congressional Resolution was passed recognizing the 1990s as the "Decade of the Brain."

A recent report of the National Advisory Mental Health Council (NAMHC), released by the National Institute of Mental Health (NIMH) states that prior to the recent advances in mental health treatment "patients diagnosed with manic- depressive illness typically spend one-fourth of their adult life in the hospital and fully one-half of their life disabled. " With modern medications roughly 75-80% of manic depressive patients lead relatively normal lives. Without medications these patients would have spent most of their lives disabled, as indicated by the NIMH report. Drug therapy is remarkably less expensive than hospitalization. It has been estimated that the medication Lithium has saved the U.S. economy more than $40 billion since 1970.

Severe depression which can lead to suicide, alcoholism, abuse, or the use of other drugs is reported to have a 65% success rate when treated with antidepressant medication. When used in conjunction with psychotherapy, the success rate approaches 85%. Depression accounts for more "bed days" (people out of work and in bed) than any other physical disorder except cardiovascular disorders. These "bed days" cost employers untold millions of dollars, which could be saved with effective treatment for these patients.

Millions of Californians, including public policymakers, are unaware that the efficacy of a broad array of treatments for specific mental disorders has been extensively tested in scientifically controlled clinical trials. These studies demonstrate that mental illnesses can now be diagnosed and treated as precisely and effectively as other physical disorders.

Effectiveness of Treatment

The scientific breakthroughs in recent years have provided a variety of new treatment modalities, particularly for the severely mentally ill, which are now being widely used by physicians to help their patients return to normal and productive lives. The following chart compares treatment success rates for five specific categories of severe mental disorders and two specific cardiovascular disorders.

A high proportion of treatments for severe mental disorders (including all of the above) have been proven efficacious through controlled clinical studies. In many areas of general medicine and (especially) surgery, there is less controlled data regarding efficacy.

Comparison of Illnesses and Costs

The NAMHC Report clearly shows the incidence of mental illness is comparable to other physical disorders in our society. For example, the full spectrum of mental disorders affects 22% of the adult population in a given year. This figure refers to all mental disorders and is comparable to rates for other physical disorders when similarly broadly defined, e.g., respiratory disorders affect 50% of adults and cardiovascular disease 20% of the adult U.S. population.

The direct annual cost of treating all mental disorders is $67 billion. The direct annual cost of treating all cardiovascular disease is $85 billion. The following chart from the Report compares both direct and indirect costs of treating respiratory, cardiovascular, and mental illnesses.

Potential Cost Savings

The 2.8% of the population (approximately 7 million people) who constitute the severely mentally ill are, indeed, costly to the health care system. Of the $67 billion spent on direct costs of mental illness each year just over 40% ($27 billion) is spent on treating the severely mentally ill. However, given the advances in psychiatric treatments, many of these dollars could be saved. The roadblock is often limited access to needed services. The existence of effective treatments is only relevant to those who can obtain them. Too many Americans with severe mental illness, and their families, find that the appropriate treatment is inaccessible because they lack insurance or the coverage is inadequate for mental illness.

In today's managed care environment, it is imperative to ensure that patients are accurately diagnosed by a qualified physician and receive appropriate referrals and treatment in a timely manner. Without an adequate initial evaluation and medical input, patients may receive inappropriate or sub-optimal care. This may result in ineffective treatment and costly delays in returning patients to productive living.

As an advocate for quality mental health care, the California Psychiatric Association is dedicated to educating patients, public policy makers, and Californians in general about the effective medical treatment options that are available.

"The direct costs of an illness represent the resources needed to treat the person affected by the illness.
They include hospitalization costs, payments to physicians and other health care personal, the costs of
medications, and other costs. Indirect costs are the costs imposed on society because of the missed
productivity of those who are ill or die prematurely. For mental illness, there are also other costs, mainly
related to the criminal justice system and family care-giving, that are not relevant for other types of
illnesses. The direct costs of cardiovascular and respiratory diseases comprise more than on-half of the total
cost of these illnesses (53 percent and 57 percent, respectively), while the direct costs of mental illness
comprise less than one-half of the total costs of this disease (47 percent). "

The purpose of this newsletter is to provide brief information on important developments and ideas in the medical specialty of psychiatry that can contribute to cost-effective mental health care.

Published by the California Psychiatric Association
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