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CONSEQUENCES OF NON-TREATMENT
An estimated 4.5 million Americans today suffer from the severest forms of mental
illness, schizophrenia and manic-depressive illness (2.2 million people suffer from
schizophrenia and 2.3 million suffer from bipolar disorder). The National Advisory Mental
Health Council estimates that 40 percent of these individuals, or 1.8 million people,
are not receiving treatment on any given day.
The consequences of non-treatment are devastating:
- Homelessness
People
with untreated psychiatric illnesses comprise one-third, or 200,000 people, of the
estimated 600,000 homeless population. The quality of life for these individuals is
abysmal. Many are victimized regularly. A recent study has found that 28 percent of
homeless people with previous psychiatric hospitalizations obtained some food from garbage
cans and eight percent used garbage cans as a primary food source.
- Incarceration
People
with untreated serious brain disorders comprise approximately 16 percent of the total jail
and prison inmate population, or nearly 300,000 individuals. These individuals are often
incarcerated with misdemeanor charges, but sometimes with felony charges, caused by their
psychotic thinking. People with untreated psychiatric illnesses spend twice as much time
in jail than non-ill individuals and are more likely to commit suicide.
- Episodes of Violence
There are approximately 1,000 homicides – among the estimated 20,000 total
homicides in the U.S. – committed each year by people with untreated schizophrenia
and manic-depressive illness. According to a 1994 Department of Justice, Bureau of Justice
Statistics Special Report, "Murder in Families," 4.3 percent of homicides
committed in 1988 were by people with a history of untreated mental illness (study based
on 20,860 murders nationwide).
The Department of Justice report also found:
- of spouses killed by spouse – 12.3 percent of
defendants had a history of untreated mental illness;
- of children killed by parent – 15.8 percent of
defendants had a history of untreated mental illness;
- of parents killed by children – 25.1 percent of
defendants had a history of untreated mental illness; and
- of siblings killed by sibling – 17.3 percent of
defendants had a history of untreated mental illness.
A 1998 MacArthur Foundation study found that people with
serious brain disorders committed twice as many acts of violence in the period immediately
prior to their hospitalization, when they were not taking medication, compared with the
post-hospitalization period when most of them were receiving assisted treatment. Important
to note, the study showed a 50 percent reduction in rate of violence among those treated
for their illness.
- Victimization
Most
crimes against individuals with severe psychiatric disorders are not reported; in those
instances in which they are reported officials often ignore them. Purse snatchings and the
stealing of disability checks are common, and even rape or murder are not rare.
- Suicide
Suicide
is the number one cause of premature death among people with schizophrenia, with an
estimated 10 percent to 13 percent killing themselves. Suicide is even more pervasive in
individuals with bipolar disorder, with 15 percent to 17 percent taking their own lives.
The extreme depression and psychoses that can result due to lack of treatment are the
usual causes of death in these sad cases. These suicide rates can be compared to the
general population, which is approximately one percent.
- Clinical Outcomes More Severe – Recovery
Uncertain
The longer individuals with serious
brain disorders go untreated, the more uncertain their prospects for long-term recovery
become. Recent studies have suggested that early treatment may lead to better clinical
outcomes, while delaying treatment leads to worse outcomes. For example:
- A 1997 study from California (Wyatt et. al.) compared people
with schizophrenia who received psychotherapy alone (89 patients) versus those who
received antipsychotic medications (92 patients); those who received medications had much
better outcomes three and seven years later.
- A 1998 study from England (Hopkins et. al.) revealed that
delusions and hallucinations among patients suffering from psychosis increased in severity
the longer treatment was withheld from the time of the initial psychotic break (51
patients were included in the study).
- A 1994 study from New York (Liebeman et. al.) showed that
the longer a patient waited to receive treatment for a psychotic episode, the longer it
took to get the illness into remission (70 patients were included in the study).
- A 1998 study from Italy (Tondo et. al.) demonstrated that
the sooner patients were started on lithium for their manic-depressive illness, the
greater their improvement became (317 patients participated in the study).
- 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.
- In sum, severe psychiatric disorders such as schizophrenia
and manic-depressive illness are costly three times over: Society must raise and educate
the individual destined to become afflicted; people with the illnesses are often unable to
contribute economically to society; and many require costly services from society for the
rest of their lives.
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The information on Mental Illness Policy Org. is not legal advice or medical advice. Do not rely on it. Discuss with your lawyer or medical doctor. Mental Illness Policy Org was founded in February 2011 and in order to maintain independence does not accept any donations from companies in the health care industry or government. That makes us dependent on the generosity of people who care about these issues. If you can support our work, please send a tax-deductible donation to Mental Illness Policy Org., 50 East 129 St., Suite PH7, New York, NY 10035. Thank you. Contact office@mentalillnesspolicy.org Contact Mary Ann Bernard, of counsel. Contact DJ Jaffe, founder http://mentalillnesspolicy.org.
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