The number of people treated and the total cost of their care increased
more for mental illness than for any other chronic health condition in a
recent 10-year span, according to government figures.
The 87 percent surge in the number of people seeking noninstitutional care
for psychiatric illness from 1996 to 2006 paralleled the 63 percent increase
in spending on such disorders within the same period, according to data
released in July by the Agency for Healthcare Research and Quality
The findings were based on an analysis of the Household Component of the
Medical Expenditure Panel Survey, which identified the five most costly
conditions in 1996 and 2006. Those conditions—heart conditions, cancer,
trauma-related disorders, mental disorders, and asthma—were determined
by totaling and ranking the expenses for the medical care delivered for the
diagnosis and treatment of acute and chronic conditions.
The survey found that the number of people who sought care for psychiatric
disorders nearly doubled in the 10-year period. In 1996, 19.3 million people
incurred expenses for mental health care, while 36.2 million sought such care
in 2006. The number seeking care for mental disorders was second only to the
48.5 million who sought asthma care in 2006.
The growth in the number of people receiving care for psychiatric
conditions is not due to an increase in the prevalence of mental illness but
rather reflects people's willingness to seek care instead of going untreated
as they did in the past, said Selby Jacobs, M.D., a member of the APA Council
on Healthcare Systems and Financing.
The recent AHRQ findings are "testimony to some extent on the
[effectiveness of the] strategy of mainstreaming mental health
benefits," Jacobs told Psychiatric News.
The survey found that the largest increase in spending for chronic and
acute health care conditions was for the category of mental disorders.
Spending related to psychiatric diagnosis and treatment rose 63 percent, while
the second-largest increase in spending—47 percent—occurred for
Jacobs credited the large jump in mental health spending to the combination
of a demand for care by more people with psychiatric disorders and to the"
soaring costs" of psychotropic drugs in recent years.
Other recent data also support the finding that treatment of mental illness
has increased. A study in the August Archives of General Psychiatry,
for example, concluded that antidepressant use among U.S. residents nearly
doubled in a similar period, 1996 to 2005 (see
Antidepressant Use Rises in
The researchers, who included Eric Caine, M.D., chair of the
Department of Psychiatry at the University of Rochester Medical Center,
reported that the number of U.S. residents prescribed antidepressants rose
from 5.84 percent, or 13.3 million people, in 1996 to 10.12 percent, or 27
million people, in 2005.
Spending on mental health care may further increase after implementation of
the 2008 law that mandates parity in mental health coverage in most private
insurance plans and another 2008 law that will make Medicare outpatient mental
health services more affordable by phasing out the discriminatory copay.
The AHRQ data, however, indicated that the jump in mental health spending
was not driven by the rising cost of an individual's treatment. In fact, the
average annual per-person spending by patients, government programs, and
private insurers fell in the 10-year span, from $1,825 in 1996 to $1,591 in
Despite the drop in the overall cost of mental health care, out-of-pocket
costs have risen for patients. Out-of-pocket payments for the treatment of
psychiatric disorders were among the highest for all disorders in both 1996
and 2006 (see chart). These payments rose from 23.1 percent of the
average amount individuals spent on mental health care in 1996 to 25 percent
That patient spending increase is consistent with the fact that many solo
mental health clinicians, including psychiatrists, practice outside of managed
care systems and are thus less likely to accept a managed care benefit, Jacobs
A summary of the "Five Most Costly Conditions, 1996 and 2006:
Estimates for the U.S. Civilian Noninstitutionalized Population" is