Fiscal Costs Schizophrenia
and manic-depressive illness are expensive diseases. A recent study found that the cost of
schizophrenia alone was comparable to the cost of arthritis or coronary artery disease
(D.J. Kupfer and F.E. Bloom, eds., Psychopharmacology: The Fourth Generation of
Progress, 1995):
- schizophrenia costs $33 billion per year;
- arthritis costs $38 billion per year; and
- coronary artery disease costs $43 billion per year.
The costs included both direct costs of treatment as well
as indirect costs such as lost productivity:
Federal Benefits
A significant percentage of government income benefits also go to people with severe
mental illnesses. For example:
- Fifteen percent of Medicaid recipients have a serious
psychiatric disorder;
- Thirty-one percent of Supplemental Security Income (SSI)
recipients have a serious psychiatric disorder;
- Twenty-six percent of Social Security Disability Insurance
(SSDI) recipients have a serious psychiatric disorder;
- Thirteen percent of those receiving VA disability benefits
have a serious psychiatric disorder.
Schizophrenia and manic-depressive illness are thus major
contributors to the escalating costs of state and federal programs.
Incarceration and Related Costs
It is a mistake to think that money is saved overall by not treating individuals with
severe psychiatric disorders. Individuals who are untreated for their illness cost money
by being incarcerated. For example, the total annual cost for these illnesses in jails and
prisons is estimated by the Department of Justice Source Book on Criminal Justice
Statistics (1996) to be $15 billion (based on an estimated cost of $50,000 per ill inmate
per year, and 300,000 individuals with serious psychiatric disorders being incarcerated.)
Adding to this expense are court costs, police costs,
social services costs, and ambulance and emergency room costs. A study of schizophrenia
costs in England reported that "97 percent of direct costs are incurred by less than
half the patients" and concluded that "treatments which reduce the dependence
and disability of those most severely affected by schizophrenia are likely to have a large
effect on the total cost of the disease to society and may, therefore, be cost-effective,
even though they appear expensive initially." (Davies and Drummond, British Journal
of Psychiatry, 165 (Suppl. 25): 18-21, 1994).
When calculating the fiscal costs of untreated severe
psychiatric disorders, intangible costs must also be included: the deterioration of public
transportation facilities, loss of use of public parks, disruption of public libraries,
and losses due to suicide. The largest intangible cost, of course, is the effect on the
family.
