The Cost of Mental Health

MondayMaintaining your mental health is expensive. Medicine is expensive. Many of the antidepressants are generic now, but still cost about $1/pill without insurance. Lithium is much cheaper at 30 cents a pill. Prices on anxiety meds vary depending on if they are generic or not. But the antipsychotics… woah! I take Geodon, which recently went generic, and without insurance the cost is $379/month! Fortunately I only have to pay $76 because I have insurance. Even Lamictal runs $170/month generic. These are only some prescription prices. What do you pay in supplements that aren’t covered by insurance?

Sadly, most of us can’t live without medications. Many of us have had breakdowns, hospital stays, and near death experiences and have come to accept that we need to live on medications. But medication is only one cost we pay. What about the costs associated with our personal finances, relationships, family and friends, our work, our future?

First, let’s examine the financial impact of mental illness on society. Severe mental illness costs American society in $193 billion dollars in lost wages 2002, according to the American Journal of Psychiatry. It costs employers to provide mental health coverage, which some do not provide. It costs employers in lost work hours while we sort out our meds, or find ourselves too depressed to get out of bed. NAMI (the National Alliance of Mentally Ill) reports workplace costs of depression are over $34 billion per year. The National Institute of Mental Health (NIMH) reports $57.5B in 2006 for mental health care in the U.S.

Numbers can be thrown around about financial costs to society. But consider what it costs us as human beings living with these conditions?

There are financial costs, beyond medications, the costs of therapy, insurance, and employers. Hundreds, even thousands, of dollars come out of our own pockets to pay for treatments to keep ourselves stable. And if we are not stable… the cost of “retail therapy” or manic spending sprees can land us in deep financial debt.

What about the cost of our careers? Some individuals have difficulty staying in college, leading to lower income potential. What if we need to take a lower paying job because we can’t effectively deal with the stress of a job that pays well but grinds our mind into dust? So many mentally ill individuals are highly educated, yet don’t reap their full economic potential because of the high stress levels that accompany high paying jobs. Many government jobs cannot be held by persons with severe mental health issues since they can’t qualify for a high level security clearance. This is the situation that I am faced with and I don’t like it. I feel like a failure because I couldn’t handle a high paying job with eccentrically abusive coworkers and the stress to constantly perform well under those conditions. This is a cost to me personally, both financially and emotionally.

What is the cost of stigma? I don’t dare tell an employer that I have a mental illness. I lost one job that way. They felt they couldn’t count on me to be in the office, even though I had hardly missed a day in the three years I worked there before my breakdown. What does it cost me personally because I am too afraid to tell my friends? I fear I will lose them. Maybe I just don’t have enough faith in them, or faith in myself, or perhaps just in general, but I am losing out on a valuable resource by not telling my friends. I feel isolated from them, and no matter how much I might want to, I feel like it would change something permanently between us. What am I losing to stigma?

There are costs to our relationships too.  How does your spouse handle it when you are manic/depressed/OCD/have anxiety or panic attacks.  For those of you who are spouses to someone with a severe mental illness, how do you handle it?  What about friends?  Do they know about your mental illness or not?  How do they react when you are in an abnormal state? My friends tell me now that when I was extremely manic, they were afraid of me. How do you come across at work?  I remember a conference one time where I embarrassed myself in front of a room full of scientists because my presentation was accidentally on automatic and my slides kept changing every 30 seconds.  Worst of all, I just laughed.  I was manic at the time and I thought it was funny.  I wonder now what the audience thought.

What is the cost to myself? The cost to my self-esteem? The knowledge that I have a chronic illness that can never be cured, will progress as I age, and impacts what I say, what I do, and how I interact with people. It’s a heavy blow some days. Some days I have to fight to get out of bed. Some days I am hypomanic or so anxious I can’t think straight. Some days it’s just… what it is. A chronic illness that I have to deal with. The medications, the doctor’s appointments, the therapy. It’s my life.

What has mental illness cost you?

Medication prices from the prescription drug company Medco.
Thomas R. Insel, Assessing the Economic Costs of Serious Mental Illness, Am J Psychiatry 2008;165:663-665. doi: 10.1176/appi.ajp.2008.08030366

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7 thoughts on “The Cost of Mental Health

  1. This is brilliant. I’d like to answer a couple of your questions before I launch into my huge speech:

    1.) What do you pay in supplements that aren’t covered by insurance?

    I am blessed by the fact that my husband works for a nutraceutical company that makes Rx grade supplements. In short, high quality vitamins that would cost the end user upwards of $80 for a one month supply at a significant discount. And I have to take a lot of supplements now. Gingko to combat the aphasia, apparently unsuccessfully. I’m going to have to go up in dose again. Calcium, because I started to get some restlessness / akinesia. (Thank you, Ruby). Iron, because taking a calcium supplement can have an effect of depleting your iron stores. Omega’s with DHA / EPA. And a whole host of others.

    2.) The cost of mental health in a person’s life is high. It is the number one cause of missed time at work. It loses companies millions of dollars a year in productivity. (One reason why I will always hesitate before telling an employer). And for many people out there, if they miss work, then they miss pay. And that’s just the financial detriment.

    The divorce rate for people in a marriage containing one bipolar spouse is anywhere between 80-90%, more likely in a first marriage than any subsequent marriage. Imagine if you find yourself in a marriage containing two card carrying Dxers. But, they say it takes one to know one, you know? LOL.

    Children of people with mental illness will forever be considered to be in an at-risk population. Why does this not bother me? Because my son is a card carrying Dxer for a developmental disorder. I understand the reasons why they consider these children to be in an at-risk population, and why they are afforded special programs. In fact, Head Start is offered in Pennsylvania at no cost to certain populations, including those with a parent with a disability. That especially includes mental illnesses.

    But, here’ s a sad fact about the at-risk children of those with mental illness. They are more likely than other children to suffer abuse and neglect, due to their parent(s) maladaptive behaviors. It costs people their own mental health sometimes, when they are raised in a dysfunctional household where mental illness is the norm and is allowed to run rampant.

    3.) Stigma, this is always a great topic. What do we lose to stigma? I teeter on the chance that I will be found out, and I will not be hired in the Early Education and Primary Education career domain. I pose the question, openly and honestly right now, if you had read any of my prior blog posts about the self-injury, and wealth of maladaptive behaviors that accompany my BP at home, would you be comfortable putting your child into my care?

    It’s easy to say yes, because a lot of people know me here, and they would definitely say that I have a good nature. But, reading those posts alone, do you think any typical, non-Dx parent would be comfortable with that arrangement?

    What does stigma take from me? Unfortunately, I learned over the last year. Stigma really only takes as much as I allow it to take. However, I did not realize that I was allowing it to do so. In fact, there were parts of my life where I was practically encouraging it. It took my freedom almost entirely. The freedom to be myself was nearly extinct in every aspect of my life. It managed to take my identity from me. I was always cautious about my freedom of speech. I was confined, pacing the cage I had kept erecting tighter and tighter around myself.

    The funny thing about bipolar disorder is that you cannot go about caging it. For me, once some part of me becomes confined, pushed down, or dismissed, it begins to fight it’s way back out. It’s kind of like the joke that you see on TV about the faulty plumbing, one hole stopped up starts a leak in another hole, then another, and then finally all of them burst at once, creating this huge calamity that is hilarious to the viewers, but nearly tragic for the characters.

    Mental illness found a way to drive a wedge between my husband and I in our marriage for quite awhile. It just took some time to drive that stake through to the point of where it started to become painfully obvious and unavoidable. I’m glad for it, though. Sometimes, you can’t see the forest through the trees. It takes some pruning before you can get some perspective.

    It has cost me some really great friendships. I have actually been in the midst of writing my next Canvas post about friendships, function, and dysfunction. I feel like I am practically incapable of creating and maintaining friendships. I have an anecdote for that.

    About two weeks ago, our waitress was attempting to introduce us to her friends who were new in town. When she asked if they could join us, I froze. My brain went off and said, “Stranger Danger!!!!” I looked toward the others for help in the decision, knowing they had far more open minds than I did on this subject. We agreed. And we made a great new friend.

    Dill is a great guy. We all hit it off quickly with him. He’s passionate, open-minded, soulful, and sensitive, almost everything I’d ever want in a male friend. No, he’s straight, I assure you. Oh, and Ruby, he thinks you’re hot. At the end of the first week, Xan pointed it out to me.

    “Have you texted Dill?” he asked.

    “No, why? Was I supposed to?” was my answer.

    Somewhere along the way, I must have lost my social rule book. I drop off in communication, often unintentionally, and for various reasons. Most of the time, it’s just because I forgot. That does not mean that my friends are not a priority. It’s because if someone isn’t directly in my face, it doesn’t occur to me to contact them.

    I neglected to comment our waitress friend the next week. I also neglected to keep contact with our new friend from the Friday before. This Friday, I felt like a jackass asking everyone on the same day if they’d like to join us out at the Sandbar.

    I said in a comment today, “My vision, literal and figurative, is bad. My nearsightedness is so bad that I can’t see my hand in front of my face.” And that’s it entirely. Sometimes, I find it difficult to get outside of myself. Not an egotistical thing. Mental illness has a way of tangling me up in this web of introspection. I relate to people through that context, which sounds like maybe the most self-centered thing that I’ve ever written about myself.

    Sometimes, the cost to my own self-esteem is unbearable. But, do you know what? I know that I have to do right by myself and then others. That’s the best thing I can do for everyone involved with me.

  2. It’s a huge cost when you see all the stats lined up, but at the end of the day, it is the personal cost to those suffering that is the most important. A wonderful but sad post. Lots of love, Jen xxxx (sorry I’m not very coherent tonight)

    • I hadn’t meant for it to be a sad post, although perhaps the truth of it is sad. I was hoping to write a post that would be an ‘eye opener’ for someone without a mental health condition. I wanted to post about the indirect costs of mental illness because this is something that isn’t mentioned in the media. When researching costs, I came across some very critical and negative translations of the financial burden of mental illness. I think many individuals without mental illness in their lives are unaware of these indirect costs, which are higher than any dollar sign.

  3. As someone who is soon facing losing insurance, I have a couple of thoughts about this. Lamictal is $170/a month? Not good. Generic Wellbutrin (something I also take) cots $90 a month without insurance. I’ve saved some money, but there are those times when I’ve spent recklessly, and I’m just afraid that my mental health will deplete my savings.

    I work part-time right now, but I work as often if not more than a full-time employee would. Well, why can’t I just go get a full-time job then? There are several reasons. One, I like my job, and I like that I get variety. That’s probably not a mental illness thing, though, and I could suck it up. Besides just plain old scarce availability, there’s the fact that my social anxiety starts paralyzing me when I think of interviews and asking for references, etc. Of even applying sometimes, really. I’m just afraid of asserting my existence a lot of the time, like I’m a bother. I know anyone who’s looking for employees wants people to apply and that people expect to act a references, but that doesn’t make me feel like any less of a bother. It’s me in particular that I feel like people don’t want asserting my existence.

    I contemplate mentioning my mental health, but I’m afraid it would bias people against me. I probably am one of the most thorough workers where I work. I think an observer might say I’m pretty decent, although of course my timidity is a detractor. So, if I appear to be good at my job, will people judge me based on that or my mental health? Also, one reason I did quit with my Master’s was a breakdown. I know I wouldn’t ever have to mention that even if I did talk about my mental health issues, but if I did say something about it, would it make me look unreliable?

    • Your monthly cost is based on a per pill basis, and the cost of a pill is based partially on the dosage. The number I quoted was for 150mg of Lamictal 2x/day. I could take a 300mg pill 1x/day and save a bit of money, but I’d rather take it twice a day in case I forget one of the doses. (Also, I have insurance so the price difference is not as significant.) Always check with your doctor about dosage options. Also, you may want to look into your options for private health insurance.

      With HIPPA, all medical issues are meant to be private. If you chose to tell someone, well, in my experience, secrets aren’t kept long in a work environment. On the other hand, if you choose to reveal your illness, then if something were to happen, then you have a case of discrimination. I chose not to tell people of medical things anymore. It’s come back to bite me one too many times.

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