The costs of untreated obesity, hypertension and diabetes are getting all the health headlines of late, but far less attention is being paid to the causes and consequences of mental illnesses that are often undiagnosed, untreated and just as costly.
A recent survey reveals as many as 24 million Americans may need mental-health treatment but aren't getting it. The survey, Therapy in America 2004, conducted by Harris Interactive, found that 27% of adults, or an estimated 59 million people, have received mental-health treatment in the past two years. However, another one in 10 Americans who report sufficient distress to need treatment are not getting it.
Money, stigma, ineffective treatment and trouble in selecting a therapist are the main reasons cited for not getting care. Lack of insurance, not understanding what insurance covers, and out-of-pocket costs are also real and perceived financial barriers.
Although the stigma associated with mental healthcare is fading, some individuals are still concerned that employers, co-workers or friends will think less of them for seeing a therapist. Others, especially men, are skeptical of therapy's efficacy. And some people simply can't find or don't know how to find a therapist who works well with them.
The overall health status of the millions who don't get adequate treatment is threatened in ways we are just beginning to understand completely. Research has validated the link between depression and heart disease, for example. A Rand Corp. study found that patients with symptoms of depression spend more days in bed than those with diabetes, arthritis, back problems, lung problems or gastrointestinal disorders. Untreated depression often exacerbates drug or alcohol abuse. Depression can complicate a patient's recovery from a major illness. It's intuitively obvious that depression and other mental illnesses have a negative impact on overall health status or other diseases. Think about it. Which patient is more likely to be compliant with his or her medications and to be proactive in managing a disease or program of self-care: one who is optimistic or one who is depressed?
Patients with chronic or serious mental illnesses who do not have appropriate outpatient care can bounce in and out of inpatient facilities, while families and patients suffer from poor outcomes and insurance bills mount. Finally, lack of care can lead to the most serious outcome possible: death of the patient through suicide.
Untreated mental-health problems take a tremendous toll on workplace productivity. Depression is the No. 1 cause of workplace disability, costing employers billions of dollars a year. Yet studies have demonstrated that a few weeks of therapy can return most of these impaired individuals to productivity.
What can we in the healthcare industry do? To date, managed care's approach to reaching out to patients who might need behavioral healthcare has focused on educating and motivating primary-care physicians to identify patients who might be depressed. While this type of education is important, it's not enough.
Radical new approaches to reaching those in need of mental healthcare are needed. Fortunately, some are either in development or being tried already. They include:
* Disease-management programs that work with employers to reach out to employees with long-standing mental-health problems and with health plans to identify patients taking antidepressants who should also be receiving therapy. Some patients with other chronic diseases like diabetes or cardiac conditions may also suffer from co-morbid mental illness that must also be addressed.
* Outreach to people who want treatment but don't know how to access it or to find a therapist who is best for them. People often choose a therapist based on sketchier information than they use to choose a real estate agent. Offering information about clinicians online-even identifying those within a network with subspecialities or a track record of producing the best outcomes, can help people make more informed choices. Just as health plans publish physician "report cards" to educate consumers, so psychotherapist report cards can help people choose the best therapist for their needs.
* New ways of delivering therapy that are more accessible and cost-effective. For example, patients with mild to moderate levels of distress can benefit from a "coach" who offers counseling over the telephone or online. The Internet can also play an important role in promoting compliance with treatment and augment other treatment offerings.
* Tools to measure the patient's level of risk. The same approach to measuring and managing the patient's need for treatment that is used in a primary-care doctor's office should be used in mental-health treatment. These tools are available and have been demonstrated to improve therapist detection of suicide risk and substance abuse, document improvement in depressed patients and their degree of work impairment, and identify which patients need short-term or longer-term treatment.
We are entering a new age of behavioral healthcare. We have the tools to improve treatment outcomes and enhance productivity for people with mental illnesses. We can leverage new and emerging technologies that deliver services more cost-effectively and conveniently. Instead of waiting for people to call us, or relying on old, reactive, non-data-driven approaches, we're able to tap into a new outreach-based system of behavioral healthcare built on accountability for results. Our system of care is poised to create a healthier workforce and a measurable return on healthcare purchasers' investments.
Jerry Vaccaro is president and chief executive officer of PacifiCare Behavioral Health, Santa Ana, Calif.