To Help People with Mental Illness, Keep Them in School

Originally posted by CalMatters

One of the great tragedies of serious mental illness is how early it strikes.

The median age that doctors diagnose its components—psychoses, mania, and major depression—ranges from 15 to 30. Without help, millions of these young adults will be disabled for the rest of their lives. And many do not realize that help is possible.

Safe and effective treatments can enable people to manage their disease and live full and productive lives.

Early diagnosis and intervention is essential to attaining better outcomes. But in the struggle to help people with mental illness cope with their affliction, a powerful long term tool has been overlooked: school.

Education is of course important to anyone seeking a better life. But it has an outsized impact on the prospects for people with serious mental disorders.

A recent USC study published in Health Affairs found that lifetime earnings quintupled for individuals over age 25 with serious mental illness when they received more than a high school education, compared to those who did not graduate from high school.

Also, people with serious mental disorders who achieved more than a high school education could expect 49 years of life after age 25, compared to 39 years for those who did not graduate from high school. They could expect to be able to work for another 23 years compared to 9 years for non-graduates.

Using an economic model, the authors of the Health Affairs study conservatively estimated that the lifetime financial burden of serious mental illness to individuals and society combined is nearly a quarter of a trillion dollars, or approximately $1.85 million per patient in the United States.

Two of the most striking components are 10 years of lost life expectancy per patient and $537,000 in lost earnings. Significantly, this burden is unequally distributed with the largest losses accruing to those with the worst educational outcomes.

Interventions that identify and treat young adults who are first starting to struggle with serious mental illness, and that support their continuation in school and successful graduation, are a true bargain.

A large randomized trial found that the cost of helping a struggling student stay in school would be approximately $34,224 per student. The study estimates this intervention would produce $73,600 in lifetime benefits, mostly in higher earnings, a return on investment of 2 to 1.  Obviously, this return is only realized over decades. We need the patience and foresight to take that step.

Those kind of numbers should help policymakers focus on mental health solutions.

In a recent poll by the California HealthCare Foundation and Kaiser Family Foundation, Californians’ top health priority was making sure people with mental illness can get treatment.  Gov. Gavin Newsom’s budget proposed many programs aimed at meeting the crisis. Most are designed to have immediate impact in housing, treatment and counseling. One, however, takes a long view that dovetails with the findings in the Health Affairs study.

Newsom proposes to spend $25 million on early detection and treatment for young people in the first stages of psychosis-related illness. It is that kind of investment that holds the promise of paying dividends over time.

By spending more now to expand the behavioral health system’s capacity, including the hiring and training of additional providers, we may be able to spot mental disorders early and give patients the opportunity that all Americans deserve:  an education that can serve them for a lifetime.

Dr. Thomas Insel, is former director of the National Institute of Mental Health and current president of Mindstrong Health, Seth A. Seabury, Ph.D., is an associate professor at the School of Pharmacy and the Leonard D. Schaeffer Center for Health Policy & Economics at the University of Southern California, wrote this commentary for CalMatters.