Over the past few decades, mental health has not received enough financial support. According to Mark et al. (1), mental health and substance abuse spending grew more slowly than all health spending from 1986-2005. I’d like to highlight the prevalence of mental health disorders and the absence of appropriate treatment usage. In 2007, close to a third of American adults suffered from a mental health disorder (2). Of people suffering from a behavioral health disorder, over 60% do not receive treatment. Out of these untreated individuals, over 50% claim that the price deters them from receiving mental health care in 2011.
These statistics are very scary to me. The lack of support for mental health services particularly upsets me because of my involvement in the mental health field as a researcher in Helen Mayberg’s Laboratory for Treatment Resistant Depression. In this lab, extremely sick patients with Major Depressive Disorder turn to Deep Brain Stimulation (DBS), a type of invasive brain surgery, in hope of achieve remission from their depression. These patients have failed over 4 different antidepressant treatment options such as antidepressant medication, electric convulsive therapy and psychotherapy (3). The patients who agree to partake in this clinical research receive this service for free—their surgical and hospital costs are covered by the Woodruff and Stanley Funds, while their clinical fees are covered by the DANA foundation. Over half of the patients who have received Deep Brain Stimulation in this lab have become significantly less depressed according to their scores on the Hamilton Rating Scale for Depression. Watching these patients who have tried so many different therapies without achieving remission finally get well has made me very hopeful that this surgery can be expanded as a common treatment for depression in the future.
I find it extremely interesting to draw parallels of DBS for Depression to DBS for Parkinson’s disease. DBS for Parkinson’s disease was approved by the FDA in 2002 and costs around $125,000 (4). It has proved very effective in alleviating the tremor in Parkinson’s Disease. Luckily, the surgery is covered by Medicare or private insurance, although there is often a large co-pay. Given the cost of DBS, even if DBS gets approved, will it ever be an affordable therapy for Treatment Resistant Depression?
I’m particularly thankful for the Mental Health Parity and Addiction Equity Act (MHPAEA) signed in 2008. Basically, this act made it illegal for insurance to finance mental health any differently from physical health treatment (5). In addition, I am excited about the changes set forth by the Affordable Care Act to expand mental health coverage. The ACA will expand mental health coverage to 62 million Americans because now, insurance from individual or small group markets will also need to abide by the MHPAEA. Moreover, these plans will cover preventative mental health services and cannot cost more to insure an individual with a preexisting behavioral disorder.
I am hopeful that more people will receive mental health treatment because the cost will no longer be a deterrent from receiving the appropriate care. I am optimistic that these advancements will continue, and that there will come a day when people with severe depression receive the FDA approved DBS without the severe bill.
- Mark, T. L., Coffey, R. M., Vandivort-Warren, R., Harwood, H. J., King, E. C., & MHSA, S. E. T. (2005). US spending for mental health and substance abuse treatment, 1991-2001. HEALTH AFFAIRS-MILLWOOD VA THEN BETHESDA MA-, 24, W5.
- Mayberg, H. S., Lozano, A. M., Voon, V., McNeely, H. E., Seminowicz, D., Hamani, C., & Kennedy, S. H. (2005). Deep brain stimulation for treatment-resistant depression. Neuron, 45(5), 651-660.