If you tend to put more importance on treating your diabetes than your depression, you're in good company with many other Americans.
A new study from the American Psychiatric Association has suggested that people are more willing to put their money toward avoiding medical illnesses than mental illnesses.
“People are less willing to pay to avoid mental illness than medical illness, even though they recognize that severe mental illnesses can dramatically lower quality of life,” according to a news release from the American Psychiatric Association.
There were 710 participants in the study. The participants answered questions in reference to the mental illnesses depression and schizophrenia, compared to the medical illnesses diabetes, below-the-knee amputation, and partial blindness.
The question posed to participants was, “Suppose a pill existed that would allow you to permanently and completely avoid ever having [health condition] ... Please estimate the maximum dollar amount you would be willing and able to pay monthly for this treatment?” They also had to rate the burdensomeness of the conditions.
“The researchers found that even though respondents rated the two mental illnesses as relatively more burdensome than the other [medical] conditions, the amount they were willing to pay to avoid them was 40 percent lower,” according to the news release.
Although the authors recognize the limitations of the study, they think the results show a need to address certain beliefs about mental illnesses and the importance of treatment.
“While the study had a number of limitations, it did demonstrate that people were willing to pay significantly less to avoid mental illnesses than they were to avoid other medical illnesses, and that this was not the result of minimizing the burden and impact of mental illness,” according to the news release.
Experts and individuals who have experience with mental illness share their insight into the issue presented by the study.
Prakash Masand, the founder, chairman and CEO of Global Medical Education, and previously a consulting professor of psychiatry and behavioral sciences at Duke University Medical Center, said in an email that people are possibly less likely to pay to avoid mental illnesses because they think it’s less likely they will suffer from them. They may also not want to think about the possibility of even having a mental illness because of the stigma attached.
“People still misperceive mental illnesses as more psychological rather than biological, and have a false sense that they are more capable at preventing mental illnesses on their own versus say diabetes or heart disease, [which] they perceive as being out of their control more than mental illnesses,” said Masand, who is also a distinguished fellow of the American Psychiatric Association.
“Hence they do not value interventions to prevent mental illness as highly. Another reason is because of the stigma that still exists around having mental illnesses, people are less able to confront the possibility that they may develop a mental illness, even though the lifetime prevalence rates are high, which leads to a false perception that since they will not develop mental illness they do not need to work as hard to prevent it, and interventions to prevent it are less valuable.”
Cinda Johnson, a professor and director of the special education graduate program at Seattle University, and co-author of the book “Perfect Chaos,” which is a memoir about her daughter’s battle with bipolar disorder, said in an email that although it’s disheartening to know the results of the study, she is not that surprised because she doesn’t think the general public knows how many people are actually suffering from a mental illness, and how common it can be to have mental health issues.
Johnson, who is also the principal investigator and director of the Center for Change in Transition Services, said that after she and Linea, her daughter, share the story of Linea’s struggle with bipolar disorder with different audiences, people have the reaction that Linea doesn’t look like a person with a mental illness.
“Mental illness cannot readily be seen in someone who is living well with a chronic disease, but if their medical bills were scrutinized I believe most people would be shocked,” Johnson said. “Without excellent health care (and for those not in the top 2 percent, excellent insurance coverage), living on the streets is a mere step away.”
This is because some medication for mental illnesses can be hundreds of dollars, along with expensive psychiatrist and psychologist appointments.
“Medications and treatment for chronic depression and anxiety can add the equivalence of a car payment to one’s monthly budget,” Johnson said.
“Staying stable and therefore productive, contributing members of society takes treatment, support, most often medications, and a medical team that can be trusted and consistent enough to learn the patient’s needs.”
She said she believes medical illnesses generally are given more attention and money than mental illnesses because more support is available for people with medical illnesses.
“Neighbors and friends rally around someone with breast cancer while the doctors determine which treatment option is best based on sophisticated diagnostics,” Johnson said. “I do not believe the same level of support exists for a woman who is hiding in her home battling the overwhelming [effects] of depression.”
“Bills go unpaid, phones aren’t answered; she calls in ‘sick’ to work or shows up late and leaves early,” she added. “Friends quickly turn away because they don’t understand, and it is lasting much longer than the ‘blues’ from losing a boyfriend or a job. There are no bandages, there are no stitches, and there is no wheelchair. A sad, irritable woman who in fact has chronic depression, can live a full and happy life with treatment, not simply by pulling herself up by her boot straps.”
Johnson’s daughter has gone on to intern for the World Health Organization, and currently works as a research assistant at a university while living independently. She also takes medication and sees a psychiatrist and psychologist in order to live her life to its fullest.
“The public is constantly exposed to families who are in danger of losing everything because their child has a brain tumor or leukemia,” Johnson said.
“The public understands and steps up to the plate for fundraising when a family is on the brink of financial catastrophe due to a ‘physical illness.’ I have never seen the same media campaign and outpouring of financial support for a family whose child is spiraling into bipolar disorder. It is time to merge ‘mental’ and ‘physical’ together into treatable illness.”
American Psychiatric Association. 2012 News Releases. New Research: Public is Less Willing to Pay to Avoid Mental Illness than General Medical Illness. Web. April 3, 2012.
Smith DM, et al. What's It Worth? Public Willingness to Pay to Avoid Mental Illnesses Compared With General Medical Illnesses.Psychiatr Serv. 2012 Mar 1. [Epub ahead of print]
Johnson, Cinda. Email interview. April 3, 2012. http://www.lineacinda.com/
Masand, Prakash. Email interview. April 3, 2012.
Reviewed April 4, 2012
by Michele Blacksberg RN
Edited by Jody Smith