My younger son died in January 2015 following a lifelong battle with depression and anxiety. Twenty-five months later, the love of my life died from metastatic kidney cancer. So many of us have lost loved ones to cancer, heart disease, and diabetes. Fewer people have lost loved ones to mental health issues. We may, therefore wonder how important it is to use limited resources to provide good mental health care. We should be aware that mental health issues and substance use disorders are actually the leading cause of disability in the world. The most recent study of the global burden of disease was conducted in 2013 and revealed that the total number of years lost to illness, disability, or premature death (DALYs) due to mental and behavioral disorders was even larger than the disease burden caused by cancer and tumors. In addition, in 2018, suicide was the 10th leading cause of death in the U.S.: 48,344 died by suicide and there were 1.4 million suicide attempts. And yet, an estimated 56% of Americans don’t get the help they need for a variety of reasons:

• Shame and the fear of stigma prevent many from seeking treatment. As one researcher put it, patients may “attempt to distance themselves from the labels that mark them for social exclusion.”
• There is a woeful lack of trained mental health professionals. More than 115 million Americans live in areas that have been designated “Health Professional Shortage Areas,” areas having fewer than 1 mental health professional per 30,000 people.
• Treatment is exceedingly expensive. The average cost of treatment for depression is $6,990 for 8.4 days; for drug use disorder treatment, $4,591 for 5.2 days; for alcohol use disorder treatment, $5,908 for 6.2 days. No wonder 50 percent of those surveyed said they couldn’t afford mental health care, and an additional 15 percent said that their health insurance didn’t cover it or didn’t cover enough.
• People insured by Medicaid are often not insured for in-patient treatment. If the in-patient facility has more than 16 beds, patients under the age of 65 and not covered by Medicaid.

Does any of this matter to you if no one you care about is affected by a mental health disorder? Indeed it does. The personal, social and economic costs to all of us are enormous:

• Untreated mental illnesses in the U.S. costs more than $100 billion a year in lost productivity
• Those who cannot afford treatment often go to emergency rooms when they are in crisis. Emergency room care of the mentally ill causes backups that mean other patients have long waits.
• Domestic problems result from untreated mental health issues. Family members suffer severe emotional distress which can lead to physical and/or emotional abuse. Schools need more special education classes. Courts and jails must deal with an increased number of offenders.

Once we understand the problem, how can be a force for change?

• Advocate to extend Medicaid coverage for in-patient treatment, to increase the number of trained professionals and for government negotiation of prescription drug prices as in other countries
• Work to eliminate the stigma associated with mental illnesses, including substance abuse
• Be sure to listen to those who are experiencing difficulties. Empathetic listening is considered one of the most effective tools in a mental health crisis.