Monday, January 26, 2009

Op- Ed from the News and Observer

Point of View:
Better mental health care, better N.C. economy

John H. Gilmore

CHAPEL HILL - Everyone has a hand out in anticipation of receiving some of
the massive economic stimulus package expected from President Barack Obama's
administration. Bankers, automobile makers, road and bridge builders,
mortgage holders, small business owners and green energy suppliers are all
in line.

I would propose another, perhaps unusual addition to the list of things that
will stimulate the economy in North Carolina -- good mental health.

There has been much debate about how to fix our state's devastated mental
health system. Using the economic stimulus package to build a better mental
health system would actually go a long way toward improving the economic
future of North Carolina.

A recent study in the American Journal of Psychiatry found that in 2002
alone, serious mental illness cost the United States $193 billion in lost
earnings -- that's about 25 percent of the $750 billion economic stimulus
package being proposed by Obama.

Lost earnings are just the tip of the economic iceberg of mental illness.
The National Institute of Mental Health has estimated the total annual
economic cost of mental illness in the United States to be about $317
billion, when the additive costs of psychiatric care and disability benefits
are considered. This does not include the costs of prison and jails, in
which an estimated 16 percent to 22 percent of inmates have mental
illnesses. It also does not include the higher costs of medical care and
early mortality associated with mental illness.

While mental illness accounts for more days of disability than all physical
illnesses combined, North Carolina invests much less in its mental health
system than other states; we rank 43rd in the nation in per capita spending
on the treatment of mental illness.

A recent N.C. Institute of Medicine report found that fewer than 1 in 10
residents who abuse alcohol or other substances get treatment, even though
substance use costs North Carolina's economy more than $12 billion a year.

We should spend a portion of the stimulus package to rebuild North
Carolina's crumbling mental health infrastructure. Stable, publicly run
safety-net mental health clinics or clinical homes should be established in
every community and provide modern treatments that are scientifically based
and easy to access.

These safety-net clinics, needed before, are even more critical now that the
faltering economy and state budget cuts will further disintegrate the
already fragmented privatized public mental health system. Investment in a
statewide mental health electronic medical records system would ultimately
reduce costs and improve the quality of care.

All money should be invested wisely, with a solid business plan based on
accountability, reduced paperwork and administrative costs and with a clear
understanding between the state and local communities about who is
responsible for what.

The Government Office for Science in London has recently suggested that to
prosper economically amid the demands and pressures of complex and rapidly
changing times, countries must maximize their "mental wealth." A critical
part of the "mental capital" that a country or a state uses to build a
better financial future is good mental health.

A decent mental health system that addresses the basic needs of the
residents of North Carolina will pay for itself in reduced disability,
improved earning potential and lower costs for medical care and
incarceration. A decent mental health system will stimulate our economy by
helping us all apply our mental capital to the challenges that lie ahead in
these uncertain times.

(John H. Gilmore, M.D., is Thad and Alice Eure distinguished professor of
psychiatry at UNC-Chapel Hill and director of the UNC Center for Community
Mental Health.)

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