The Devaluing of Mental Health Treatment

An analysis of a nationally representative sample of 710 adult respondents reveals that the public is less willing to pay to avoid mental illnesses compared with paying for the treatment of medical conditions. The study, led by Dylan M. Smith, PhD, of Stony Brook University School of Medicine in New York, also found that participants recognized mental illnesses as burdensome—in fact more burdensome than some general medical illnesses—yet were willing to pay 40% less than what they would pay to avoid medical illnesses. The research results were published in the April issue of Psychiatric Services.

The study respondents were recruited from an Internet panel managed by Knowledge Networks, a U.S. survey research firm that maintains a panel of more than 60,000 households that are a representative sample of adults aged 21 and older. The respondents were presented with five health conditions: three medical illnesses or conditions (diabetes, below-the-knee amputation, and partial blindness), and two mental illnesses (depression and schizophrenia). Participants rated each health condition for severity and level of burden in relation to quality of life. Then they indicated how much they would pay, out of pocket, to avoid the condition.

“Our results showed that participants understood that mental illness clearly has a very negative impact on quality of life yet were significantly not as willing to pay for effective treatments for these illnesses,” says Smith, lead study author and an associate professor of preventive medicine in Stony Brook’s Center for Medical Humanities, Compassionate Care, and Bioethics.

“The findings mirror the general pattern of healthcare spending, with less resources going to treat mental illnesses than might be expected given the overall level of burden they impose on society,” Smith explains. He cites current World Health Organization statistics that indicate mental illnesses account for 15.4% of the total burden caused by all disease in industrialized countries, yet mental illnesses account for only 6.2% of U.S. healthcare expenditures.

“All else equal, the general public doesn’t think it is as valuable to treat mental illness as other types of illness,” says senior author Peter Ubel, MD, of Duke University. “There is a fundamental disconnect between how bad they think it would be to experience depression and their willingness to spend money to rid themselves of the illness.”

Respondents generally considered the medical illnesses or conditions as less severe compared with the mental illnesses. Yet when respondents were asked to rate the “burdensomeness” of each condition, schizophrenia received the highest mean burden score, but it did not have the highest willingness-to-pay value. Similarly, despite a relatively high burdensomeness rating, depression received the lowest median willingness-to-pay value.

According to the authors, the results suggest that efforts to “eliminate the gap between mental health conditions and general health conditions will likely require targeting specific beliefs that people have about mental illnesses and the value of treatments for mental illness.”

They also point out that “public attitudes influence how much payers for healthcare are willing to spend to treat mental illness and how likely federal agencies are to invest in research on mental illness.”

The researchers conclude that a priority for additional investigation should be to “explore the deeper underlying attitudes that reduce people’s willingness to spend money to avoid mental illness.”

— Source: Stony Brook Medicine