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The Rising Toll of Depression

The Rising Toll of Depression Measured in Disability, Death and Dollars. A landmark mental health report from a patient advocacy group offers concrete measures to help America overcome devastating illness

Depression drains more than $83 billion annually from the American economy, affects 19 million Americans, and results in thousands of preventable suicides, reported a landmark new paper that was released today by the Depression and Bipolar Support Alliance
(DBSA).

The State of Depression in America report reveals a “crisis-oriented and reactionary” mental health system “focusing on crises, such as suicide attempts, rather than on prevention, proactive treatment and long-term wellness.”

The DBSA report is a first-of-its-kind, comprehensive analysis on depression that combines a thorough review of published literature with extensive interviews involving a broad spectrum of stakeholders – including patient advocates, policymakers, government agencies, health care providers,insurers, pharmaceutical manufacturers and employers.

“The state of depression in America is a national disgrace,” said Lydia Lewis, president of DBSA, the nation’s leading patient-directed national organization focusing on the most prevalent mental illnesses. “By almost any measure, the U.S. is failing to provide adequate, coordinated, and effective care to the millions of individuals with depression and as a result, the entire country, from employers to family members, to those of us living with depression are paying an enormous price.”

The State of Depression in America documents the pervasive impacts of depression. Among them:

Depression is the leading cause of disability in the U.S., resulting in more days of disability than other
chronic medical conditions like heart disease, hypertension, diabetes and lower back pain.
People with depression are at a greater risk of heart disease (the leading cause of death in the U.S.)
and studies have shown a causal link between depression and stroke.
The economic burden of depression in the U.S. is estimated at $83.1 billion annually.
Of the 35 million Americans age 65 and older, an estimated two million have depression. Given the
high prevalence of depression among older adults, as the baby-boomer generation ages, this illness
will contribute to the continued financial strain on the Medicare program.
Depression is the principal cause of suicide in the U.S. With 30,000 suicides and over 500,000
emergency room visits due to suicide each year, suicide is the 11th leading cause of death overall and
the 3rd leading cause of death among youg people 15 to 24 years of age

“Despite the devastating impact of depression, it often remains undiagnosed or untreated,” said Ellen Frank, Ph.D., Professor of Psychiatry and Psychology at the University of Pittsburgh School of Medicine and chair of DBSA’s Scientific Advisory Board. According to the DBSA report, only 57 percent of individuals with a major depressive disorder receive any treatment and only 22 percent receive adequate treatment. “The problem is particularly severe in rural areas and among ethnic minorities, where the growing number of depressed patients has far outpaced the number of mental health providers,” Dr. Frank noted. “The mental health safety net has huge gaps.”

“The consequences of inadequate access to mental health services for depression can be devastating,” Lewis added. Parents surveyed in 19 states surrendered custody of more than 12,700 children over to the juvenile justice system just so that their children could have access to mental health services.

“Depression and other mental illness are literally tearing American families apart,” Lewis said.

Mike Wallace, veteran CBS journalist and patient advocate who was a keynote speaker at today’s briefing, echoed these sentiments. “People with depression can and do get better,” Wallace said. “It’s an illness people can live with – like diabetes or heart disease – provided they receive the right diagnosis, treatment and support. It is up to us – our duty – to make sure that proper treatment and support are available to those who need it.”

The report makes a number of recommendations to improve the mental health care system and access to care. In reviewing these recommendations, Lewis said DBSA was proposing immediate action on five key steps that it believes will go a long way to provide hope and help to the millions of individuals coping
with depression and their families.

The Five First Steps:

Congress must equalize Medicare reimbursement coverage to patients for mental health care services.Currently, Medicare provides reimbursement for only 50 percent of mental health outpatient services compared to 80 percent of non-mental health outpatient services. Ending this disparity would not only
provide greater access to mental health services for more people, it would set a marker for private insurers to similarly provide equal coverage for mental health benefits.
Private insurers must provide greater incentives for primary care physicians (PCPs) to identify and treat depression. Current reimbursement procedures do not give providers incentives to take the time to identify new cases of depression or manage complex cases of chronic depression. Since
reimbursement for many providers is based on the number of patients they see, the system creates disincentives to screen patients for depression. Providers also are more reluctant to take on new patients if reimbursement for a mental health evaluation is lower than for other standard medical care
procedures.
The government and private sector must enact loan forgiveness programs to provide incentives for students to specialize in mental health care. The growing number of mental health consumers has far outpaced the number of medical students graduating with a specialty in psychiatry. The lack of available providers, particularly psychiatrists and other mental health providers that specialize in children, adolescents, minority populations and the elderly, is one of the most critical needs of the mental health care system. As a result of this shortage, many patients wait weeks or even months before receiving treatment.
Academic and private researchers must expedite biologic and genetic research to develop better treatments. Research must increasingly focus on genetic and brain-imaging studies to understand the physical and chemical causes of depression. This is one of the most promising areas of research into
the effective treatment of depression and, therefore, should be a major funding priority.
The government and private sector must support and promote increased access to peer support services. Both the Substance Abuse and Mental Health Services Administration (SAMHSA) and the President’s New Freedom Commission Report emphasize the need to shift towards a consumer-driven
treatment model. In particular, peer support services will address the needs of minority groups in seeking treatment. In addition, peer support is proven to be a cost-effective and beneficial component of treatment.

DBSA is the leading patient-directed national organization focusing on the most prevalent mental illnesses. The organization fosters an environment of understanding about the impact and management of these life-threatening illnesses by providing up-to-date and scientifically-based tools and information written in language the general public can understand. DBSA supports research to promote more timely diagnosis, develop more effective and tolerable treatments, discover a cure, and to show the effectiveness
of peer-based services. The organization works to ensure that people living with mood disorders are treated equitably.

To contact DBSA, please call (800) 826-3632 or visit www.DBSAlliance.org

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