The Cost of Mental Illness: Side Effects

In developed countries, mental illness causes more disability than any other disease group, including cancer. In 2004, 25% of adult Americans reported having a mental illness in the previous year2. As a consequence, the cost of mental illness is astronomical; it was approximately $300 billion in 2002 in the US alone2, accounting for 6.2% of US healthcare spending. That amounts to about $1,000 a year for every American5. However, if that price is the prescription for mental illness, it’s got plenty of side effects, because the sum, while staggering, only represents a fraction of the actual cost of mental illness. The true tally is much higher and harder to calculate, and includes the toll of mental illness on society, the ill and their families.

Social side effects

Mental illness and resulting discrimination impair the abilities of the ill to participate in society, and rob communities of their contributions. The cost of the work hours and wages lost due to the absence of the ill is referred to as productivity loss. In the UK, depression results in productivity losses that are 23 times as great as the associated healthcare costs, and is the most important cause of absenteeism from the workplace4. Mental illness can also relegate the suffering to the outskirts of society, with severe consequences. In the US, 22% of the incarcerated and 1/3 of the adult homeless population are mentally ill5, and it is estimated that for every £1 of healthcare spending on those referred for addiction treatment in the UK, £3 is spent on them by the criminal justice system, and £10 by the victims of crime4. The mentally ill are also less likely to be hired or be rented to, and more likely to be falsely charged with a violent crime3.

mental illness
For reference: this is what $1 billion in $100 bills looks like.

This social segregation has insidious effects. Working is not just a means to an economic end; it also imparts self-esteem to the employee, and expands their social network4. The benefits of social inclusion are sorely needed by the mentally ill, and could aid in their treatment and recovery. Being ostracized may actually prolong illness or contribute to relapse by lowering self-worth, perpetuating the cause of unemployment and exclusion, and creating a terrible feedback loop.

Personal side effects

While the cost of mental illness to society is very dear, it pales in comparison to the price paid by the afflicted and their families. The mentally ill shoulder physical, emotional, and social burdens as a result of their illness. Serious mental illnesses, such as schizophrenia, cause poor personal care and lifestyle choices (e.g. a high fat diet), which can negatively affect overall health and self-esteem, and act as barrier to social acceptance. The seriously mentally ill smoke 44% of cigarettes used in the US5, and are more likely to be overweight; 40-60% of people with schizophrenia are overweight or obese, which in turn makes them more likely to suffer from diabetes and cardiovascular disease7.

Unfortunately, seeking help isn’t without its own consequences. The treatment for mental illness often includes medication that can have serious side effects. Antidepressants can cause gastrointestinal (e.g. nausea, vomiting) and neuropsychiatric (e.g. drowsiness and dizziness) issues, and negatively interact with other drugs8. Antipsychotics can contribute to weight gain, and those that do put the patient at a greater risk for type II diabetes. Some antipsychotics may also increase the risk of movement disorders, cataracts, and cardiac dysfunction, such as arrhythmias7. Depression and schizophrenia, as well as their respective treatments, are also associated with negative sexual effects, meaning they impair sexual function and satisfaction1.

Stigma and its corollaries, prejudice and discrimination, are pervasive issues for the mentally ill, and mental illnesses have become increasingly stigmatized over the past few decades. These interactions depend on an ‘us’ and ‘them’ mentality perpetuated by stereotypes, and a social, economic, or political power imbalance between the groups. With that dynamic in place, the mentally ill are subjected to both everyday and structural discrimination. Stigma can also be internalized by the ill, a phenomena called self-stigmatization. Stigma strains familial ties; 20% of respondents to a family survey reported lower self-esteem and tenser relationships with other family members as a result of stigma3. The impact of stigma is profound, and can cause the ill to shun treatment, in order to avoid the label of mental illness and its resulting social repercussions6.

The social backlash against mental illness is contingent in part on the idea that it is rare. It isn’t; it’s incredibly common. And while the burden of its symptoms and their treatment is unavoidable, the sting of stigma is not. Acceptance and understanding of mental illness can lighten the load. Mental illness will never be painless, but we might be able to make it a little less expensive.

References

1. Baldwin, D, & A Mayers. (2003). Sexual side-effects of antidepressant and anti-psychotic drugs. Advances in Psychiatric Treatment, 9:202-210.

2. CDC Mental Illness Surveillance. Centers for Disease Control and Prevention. 2 December 2013. Web. 27 April 2014. http://www.cdc.gov/mentalhealthsurveillance/faqs.html

3. Corrigan, PW. (1998). The impact of stigma on severe mental illness. Cognitive and Behavioral Practice, 5:201-222.

4. Knapp, M. (2003). Hidden costs of mental illness. British Journal of Psychiatry, 183:477-478.

5. Insel, TR. (2008). Assessing the economic costs of serious mental illness. American Journal of Psychiatry, 165(6):663-665.

6. Rüsch, N, MC Angermeyer, & PW Corrigan. (2005). Mental illness stigma: concepts, consequences, and initiatives to reduce stigma. European Psychiatry, 20:529-539.

7. Üçok, A, & W Gaebel. (2008). Side effects of atypical antispychotics: a brief overview. World Psychiatry, 7(1):58-62.

8. Wilson, K, & P Mottram. (2004). A comparison of side effects of selective serotonin reuptake inhibitors and tricyclic antidepressants in older depressed patients: a meta-analysis. International Journal of Geriatric Psychiatry, 19:754-762.

Image source: http://www.moneybagsfull.com/2010/08/what-does-1-billion-dollars-in-cash.html

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Suzi Claflin

I am a postdoctoral fellow studying chronic disease epidemiology.

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