How to make money off the mentally ill

by Dennis Grace

Recognize the title? It’s from Steve Martin’s 1978 stand-up album, Wild and Crazy Guy. Martin lists How to Make Money Off the Mentally Ill as one of the many books he’s written. The joke is supposed to be on Martin himself, inviting us to ask, “What kind of disreputable jerk takes advantage of the mentally ill?”

But it’s just a crude joke, isn’t it?

According to the U.S. Department of Health and Human Services, from 1996 to 2006 the cost of treating mental health disorders in the U. S. rose from $35 million to $58 million dollars, annually. Clearly, someone in the U.S. is making money off the mentally ill. Such a dramatic increase—nearly double in a decade—would be bad news for victims of any serious medical condition, but it’s even worse for mental health patients.

Why worse?

Well, think about it in personal terms. Most folks don’t consider possible mental health problems when deciding on health care coverage options. Unless we have a family history of mental health problems, most of us think of them as “other peoples’ problems.” We see mental illness and think of delusional folks who can’t fend for themselves. In a minority of cases, that might even be accurate, but modern mental health services cover a lot of far more common, down-to-earth conditions: ADHD, depression, any number of addictions, and PTSD, to name a few. If you decide you have to hospitalize yourself or a family member for mental health reasons—your daughter to keep her from injuring herself, your son to keep him from injuring others, yourself because you’re too overwhelmed to get out of bed—the immediate and long-term consequences can be far more severe than hospitalization for a physical ailment.

In immediate terms, mental health patients are typically locked in for the duration of in-patient care. Even voluntarily hospitalized mental health patients need a psychiatrist’s concurrence before they can leave the hospital. In addition, many mental health hospitals limit quite a few other freedoms that most of us take for granted. Mental health patients typically lose access to cell phones, personal items that have cords and straps, and any kind of blade. If you go to jail, you get your one phone call immediately. Not so if the police take you to the mental hospital.

In immediate financial terms, mental health hospitalization and other mental health treatments are not universally covered by medical insurance programs. Mental health treatment costs—psychotherapy, hospitalization, medication—mount up fast, and insurance, if it covers mental health hospitalization at all, typically covers only 80%. Sure, 80% is a lot of money, but with room and board costs alone being over $2000 per day, a ten day stay is guaranteed to cost over $4000 after insurance. In the long term, those mental health treatment costs keep on climbing. Most patients need a psychotherapist to help them through workable problems and a psychiatrist to manage medication. Patented psychotropic drugs—which might be some patients’ only hope of stability—can run as high as $400 per month. That’s for one medication. Personality disorders often require six or seven simultaneous medications to obtain stability. That’s quite a chunk of change.

For the patients, the stigma attached to mental health problems can be even more devastating than the costs. If my boss finds out, will I lose my job? Will my kids trust me? Will I lose my insurance? Can it affect my credit ratings? And what if a mental health patient disputes the costs of her own mental health care? Doesn’t that just prove she’s being paranoid? Certainly it’s not the kind of dispute a patient wants to undertake during a hospital stay. It is fortunate, (sure, I have a vested interest in the topic) that medical billing advocates are available to take on cases like this to prevent the fleecing of mental health patients. I’m not sure the word has gotten out on that front, though (well, until now).

Mental health is health. Mental illness can be as debilitating as any other form of illness. It can even be fatal. Insurance companies shouldn’t be allowed to decide that one whole category of health deserves the closet.

It’s time to bring mental health coverage into the mainstream.

Dennis Grace is co-founder of and blogs at The BillDog Blog.

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  • Jackie Fox

    Hear, hear!

  • SteveBMD

    As a psychiatrist who works part-time in community mental health, I can say confidently that a large part of the $58 million annual cost of “treating mental health disorders” is misspent. Diagnosing “depression” or “anxiety” in people who are struggling with economic stress, broken families, crime, drug abuse, etc., is startlingly easy, and medications are largely ineffective. And yet there is an enormous and stoic bureaucracy supporting the turnover and processing of patients in the Medicaid and Social Security Disability system who, almost as a rule, do not get “better,” because we’re not treating mental illness, we’re practicing social re-engineering.

    Regarding your main argument, though, I agree that coverage should be expanded and mental illness should be destigmatized. However, your comment that “personality disorders often require six or seven simultaneous medications to obtain stability” is not exactly true. Prescribing six or seven medications at a time is usually irresponsible and a mindless misuse of resources; it’s a safe bet that one or two (or maybe none) would work just fine.

  • Libby

    I totally agree with everything you said above.!

  • soloFP

    My local hospital loses $1 million or more annually on the free treatment of the mentally ill. Many of the inpatients have no insurance and do not stick around for Medicaid coverage.

  • Citizen K.

    I wonder whether some mental illness of the low level kind described by Steven is in effect created: You can’t turn on the television without hearing how sick you are. whether it be sleeplessness (he wrote at 1:11 AM), erectile dysfunction, or depression.

    This isn’t to downplay the benefits of short-term treatment, but the fact is that antidepressants are mass marketed and advertised, and we ought to have a better understanding of the impact. Have the resulting increased expenditures improved mental health as measured by such variables as less lost productivity? Have people quit smoking, reduced alcohol intake, eaten better and less? Without answers, the possibility that pharmaceutical companies make money off of mental illness without providing better overall mental health is in play.

  • Patrick W. Hisel MD

    “More money is spent on antipsychotics than any other class. That’s because these drugs are being used more for bipolar disorder, depression, autism, etc. Plus most cost $15 to $20 per day.” -Prescriber’s Letter, Feb 2011

  • horseshrink

    There’s something fundamentally wrong with a MH system that REQUIRES severely mentally ill persons to commit crimes in order to receive adequate services (true story.)

    (Have worked several years in jails, prisons, and a forensic hospital.)

    This “transinstitutionalization” into the criminal justice system is real enough to prompt a token act by the U.S. Congress in 2004:

    Also read E. Fuller Torrey’s “Out of the Shadows.”

    Community MH systems need to be empowered to take care of severely mentally ill persons effectively, especially those with anosognosia and substance abuse problems. Guardians, outpatient commitment, involuntary treatment regimens, outreach, and housing all need to be easily accessible resources.

    Current policies and funding are antithetical to this. Limited resources are thus diverted from the sickest (who cannot see their illness) to the voluntary patients who are willing to show up for appointments. And many of these voluntary patients have problems of living for which psychotherapeutic medication is NOT a first line intervention, no matter what the drug rep says.

    The result of a few decades of well intentioned, naive laws and policies?

    Needless and extensive criminal justice system involvement and protracted institutionalization in the correctional sector and forensic institutions. The criminal justice system has, de facto, picked up where the civil/community MH system has failed, to an extent now that new processes, e.g., Mental Health Courts, have been created to compensate.

    Jail waiting lists of severely mentally ill persons have blossomed in two states in which I’ve worked, Texas and Florida. These people are awaiting forensic institutional beds, usually for competency restoration, so they can then proceed to trial. However, police, the unwitting, new MH front line social workers, breathe collective sighs of relief to know that their wards are finally out from beneath the bushes in the park (where legal activists insist they have a “right” to live by their own free will.) We don’t treat grandpa with Alzheimer’s like this, even though the level of neuropsychiatric debility is the same.

    The states’ responses? Open new institutional beds … forensic beds now, reserved for those charged with crimes (usually felonies.) Had these people received appropriate, realistic services in the civil sector, incarceration usually could have been avoided.

    It’s in society’s best interest to focus on severe mental illness … the sickest first. If there are resources available for addressing the nebulous concept of “mental health” afterward, OK. But, for a change, we should do a good job of tending first to the sickest.

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