The burden of mental illness in the U.S. is among the highest of all diseases. In any given year, an estimated 18.1% (43.6 million) adults ages 18 years or older suffered from a mental illness and 4.2% (9.8 million) suffered from a seriously debilitating mental illness1.
Mental disorders also top the list of the costliest conditions afflicting the U.S. population, $201 billion—of which more than 40 percent is spending for institutionalized populations. The next costliest conditions are heart disease and trauma, with spending at $147 billion and $143 billion, respectively. Cancer is fourth at $122 billion, and pulmonary conditions round out the top five at $95 billion2.
The Affordable Care Act (ACA) was a turning point in terms of access to behavioral health coverage. The ACA eliminated medical underwriting in the individual and small group markets starting in 2014, so medical history — including mental health history —no longer results in enrollment denials or higher premiums. Additionally, the ACA advanced parity laws that required coverage of mental health disorders with no annual or lifetime limits. It mandated that all new individual and small-group plans cover mental health and addiction treatment, with benefits that are no less favorable than benefits for medical/surgical care3.
In spite of the progress made with the ACA, the infrastructure for mental health and addiction services in the U.S. continues to be fragmented, overburdened, and underfunded. The raging opioid epidemic brought to the forefront how neglected and underfunded behavioral health services were, as demand for drug treatment programs skyrocketed across the country.
The COVID-19 pandemic has created significant hardship for many patients suffering from mental disorders. For this vulnerable population, the pandemic imposed social isolation and increased anxiety while unemployment added extraordinary burdens. The pandemic-induced disruption has also proven to be extremely challenging for mental health delivery systems which have suffered significant reductions in patient volumes and consequent diminishing revenues. In our conversations with mental health systems some have shown considerable resilience and creativity in the face of these challenges. Many rapidly adopted telehealth visits and even began conducting activities such as group visits and methadone program supervision virtually.
A recent article in the Atlantic points out that the CARES Act, the $2 trillion relief bill, included only $425 million for the Substance Abuse and Mental Health Services Administration. For reference, $425 million is less than 1 percent of the total amount invested in the airline industry and an even smaller fraction of the $185 billion dedicated to healthcare providers as a whole4.
Models of integrated practice combining mental health services and traditional primary care are gaining momentum across the U.S. They offer patients a seamless continuum of care in a convenient, low stigma setting. It is this recognition that physical health and mental health are inexorably interconnected that will bring about the needed change in the funding and support for the treatment of mental health disorders. Until these necessary changes occur, we might need to designate every month as mental health month.