Healthcare Reform: Where does mental health fit in?

I was all set to write an article on various health disorders and their cost. Then I got frustrated. You see, I started reading the original articles upon which the news/opinion articles I was using as reference were based. I found very rapidly that the figures being used in the articles were comparing different things…some of the totals included reporting by consumers of care; some of the totals included services under multiple diagnoses; adding the totals together summed to much more than we spend on all health care all told. I wonder  how much of this misuse of data is occurring during our ongoing national discussion of health care reform. Apples and oranges are not the same and mixing data can result in sloppy conclusions.

On September 10, 2009, the New York Times published an Op-Ed piece by Michael Pollan in which he discusses the costs of health care in the U.S. Big Food vs. Big Insurance discusses the report of the Centers for Disease Control that chronic illnesses account for 70% of all U.S. deaths. The medical bills of those with chronic diseases result in 75% of the health care spending in the U.S. Pollan argues that some of those chronic diseases…obesity, diabetes, cardiovascular disease…are at least partially the result of America’s terrible diet and overeating. Just helping U.S. residents eat better could result in a dramatic reduction in the costs of health care.

Pollan’s position received some confirmation from a podcast of Science Friday on August 28, 2009. How Cooking Made Us Human focused on the hypothesis that humans evolved effectively and developed larger brains because we started cooking our food. Cooking begins breaking food down before it is eaten, so it is easier to digest. Raw food is harder for the body to digest, so one does not get as much nutritional benefit from the food eaten. The result for human evolution was that we were able to take better advantage of the food we ate by cooking it.

The corollary of this hyothesis is that highly processed foods are a big contributor to obesity because they are too easy to digest. The more processed the food, the easier it is for our bodies to use the caloric content of the food. The result is that those whose diets consist largely of processed foods are also heavier. Raw foods are likely good for some who want to lose weight because the body has to work harder to digest them and does not get all the caloric benefit from the food. One can eat more, feel more full, but consume fewer calories.

Pollan’s point that a change in one aspect of our lives could have huge impact on health care spending got me to wondering…is there a mental health issue that is analogous to food/eating related disorders like obesity, diabetes and heart disease?

According to Open Minds On-Line News for September 14, 2009, mental disorders jumped from fifth place among health expenditures in 1996 to third place in 2006 increasing from $35.2 billion to $57.5 billion. The number of people who sought treatment for mental conditions went from 19.3 billion in 1996 to 36.2 billion people in 2006. While the dollars expended per person for behavioral health care are many fewer than for heart conditions ($1591 vs. $3964), perhaps there is a way for behavioral health providers to dramatically reduce costs of care by addressing a single problem.

According to the U.S. Surgeon General, approximately 20% of the U.S. population experience some sort of mental health disorder in any given year. The best estimate is that 16.4% of the population experience some sort of anxiety disorder ranging from Simple Phobia to Post Traumatic Stress Disorder. A full 82% of those who experience a behavioral health disorder suffer from some sort of anxiety disorder.

Is it possible that education on stress reduction, prevention programs aimed at inoculating the U.S. population against anxiety and early treatment of anxiety disorders might decrease the cost of treating the disorders that do emerge? I have heard public health specialists argue that public education and prevention are the only way we will ever get our health care spending under control. I also have read that there is not yet compelling data to demonstrate that preventive care reduces costs at all.  Perhaps we should just focus our attention on the behavioral aspects of the chronic physical diseases? Or maybe behavioral health providers can work in both arenas and assist in dramatically diminishing the costs of health care across the board.

What do you think about this issue? Where should psychologists, psychiatrists, social workers, mental health counselors, community mental health centers and community behavioral organizations focus their energy? Where will our energies be most effectively spent?

Please enter your comments by clicking on the title of this article and typing your comment into the box below.

0 thoughts on “Healthcare Reform: Where does mental health fit in?

  • Kent Eichenauer says:

    I do a lot of work with folks with cardiovascular problems. There is abundant research that psychosocial risk factors play a significant contributing role in heart disease on par with cholesterol, obesity, smoking and diabetes. While there are some studies (at least one major one) that suggest psychotherapy does not help reduce the incidence further problems, there are other smaller ones that do.

    This is certainly a difficult area for most people to get their arms around partly because we have not done the same marketing of these risk factors that big pharma has about theirs. Patients I work with in cardiac rehab programs are astounded that they actually could have had a heart attack when their cholesterol is “normal”. High cholesterol is synonymous with heart disease (or vice versa)in the public mindset now. It is marketed that well. Of course it is marketed that well because there is much money to be made from these types of medications.

    The few national public awareness campaigns APA has sponsored about psychotherapy in general (let alone the health effects) pale compared to the money spent on marketing the other risk factors and the quickest, easiest, new and improved (and pricey) medications to cure the other risk factors.

    This is one reason to be concerned about health care reform proposals coming out now since there is already an “agreement” with big pharma to provide a significant role for them. Their ads dashed the first attempt at reform and Obama is certainly aware they can do it again. It just hampers real reform.

    I guess these blogs can really turn into rants can’t they? I suppose my cyncism is showing, and yes, I am aware that cynicism is one of the components of the psychological risk factors.

    • Hi Kent,

      Thanks for your well thought out comment. I have the cynicism risk factor as well as some familial ones, so other aspects of prevention are very important in my mind-set.

      Organized psychology will never have the money to market psychological services…there is not even adequate money to help inform psychologists that practice as usual will not be around forever. Each individual behavioral health clinician and organization will need to re-tool to provide relevant services. Having connections with your local cardiologists is obviously a great starting point.

      Back in the day when I was a clinician, I worked with a man who had severe cardiomyopathy and was waiting for a heart transplant. They would not do the surgery until he lost considerable weight. He could not exercise because of his disorder so diet and change of attitude were the only tools he had. He was highly motivated and we were successful at helping him learn weight loss techniques that allowed successful surgery. That was as satisfying an intervention as any of the purely psychological cases I had.

      You are on the cutting edge. Maybe you should start doing consultation and workshops for your colleagues!

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