Perceived need for mental health care in Canada: Results from the 2012 Canadian Community Health Survey–Mental Health (September 2013)

By Adam Sunderland and Leanne C. Findlay

From this webpage:

Background

Past research and national survey data on Canadians’ perceived need for mental health care (MHC) have focused on unmet needs overall, and have not considered specific types of MHC needs or the extent to which needs are met.

Data and methods

Using data from the 2012 Canadian Community Health Survey–Mental Health, this article describes the prevalence of perceived MHC needs for information, medication, counselling and other services. The degree to which each type of need was met is explored. Associations between risk factors for having MHC needs and the extent to which needs were met are investigated.

Results

In 2012, an estimated 17% of the population aged 15 or older reported having had an MHC need in the past 12 months. Two-thirds (67%) reported that their need was met; for another 21%, the need was partially met; and for 12%, the need was unmet. The most commonly reported need was for counselling, which was also the least likely to be met. Distress was identified as a predictor of perceived MHC need status.

Interpretation

Many Canadians are estimated to have MHC needs, particularly for counselling. People with elevated levels of distress are significantly more likely to have unmet and partially met MHC needs than to have fully met MHC needs, regardless of the presence of mental or substance disorders.

Keywords

Mental illness, mental disorder, distress

Findings

Many Canadians experience a need for mental health care (MHC), but not all of those needs are met. In fact, the presence of mental illness has repeatedly been associated with an MHC need, despite evidence-based practices suggesting that mental illness can be successfully treated. Rates of unmet needs were higher among people with the criteria for mental illness, especially those with depression. This is relevant considering that, in 2012, an estimated 10% of Canadians experienced a mental disorder (depression, bipolar disorder, generalized anxiety disorder, or alcohol, cannabis or substance abuse or dependence) in the past year. [Full Text]

Authors

Adam Sunderland and Leanne C. Findlay (1-613-951-4648; leanne.findlay@statcan.gc.ca) are with the Health Analysis Division at Statistics Canada, Ottawa, Ontario, K1A 0T6.

What is already known on this subject?

Many Canadians experience a need for mental health care (MHC), but not all of those needs are met.

Past research and national survey data on Canadians’ perceived need for MHC have focused on unmet need overall, and have not considered specific types of MHC needs or the extent to which needs are met.

What does this study add?

Based on data from the 2012 Canadian Community Health Survey–Mental Health, an estimated 17% of the population aged 15 or older reported having had an MHC need in the past 12 months.

Two-thirds (67%) of them reported that the needs were met; for another 21%, the needs were partially met; and for 12%, the needs were unmet.

The most commonly reported need was for counselling, which was also the least likely to be met.

Distress was associated with perceived MHC need status.

To download the entire article (PDF), please click here.

Also see:

Mental and substance use disorders in Canada (September 2013) (PDF)

Mental Health Profile, Canadian Community Health Survey - Mental Health (CCHS), by age group and sex, Canada and provinces (2013)

Response to the release of Canadian Community Health Survey: Mental Health 2012 by the Mental Health Commission of Canada

Case for Funding Mental Health and Social Services in Canada

Please click on the image to magnify it.

Source:

http://strategy.mentalhealthcommission.ca/about/case-for-investment

To download the entire document (PDF), please click here.

Key facts and trends in mental health: Updated figures and statistics

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To download the entire document, please click here.

Also see:

The NHS Confederation

Grand challenges in global mental health

An article published in the July 7th edition of the journal, Nature:

Schizophrenia, depression, epilepsy, dementia, alcohol dependence and other mental, neurological and substance-use (MNS) disorders constitute 13% of the global burden of disease (Table 1), surpassing both cardiovascular disease and cancer (ref. 1). Depression is the third leading contributor to the global disease burden, and alcohol and illicit drug use account for more than 5% (ref. 2). Every seven seconds, someone develops dementia (ref. 3), costing the world up to US$609 billion in 2009 (ref. 4). By 2020, an estimated 1.5 million people will die each year by suicide, and between 15 and 30 million will make the attempt (ref. 5).

The absence of cures, and the dearth of preventive interventions for MNS disorders, in part reflects a limited understanding of the brain and its molecular and cellular mechanisms. Where there are effective treatments, they are frequently not available to those in greatest need. In 83% of low-income countries, there are no anti-Parkinsonian treatments in primary care; in 25% there are no anti-epileptic drugs (ref. 6). Unequal distribution of human resources — between and within countries — further weakens access: the World Health Organization’s European region has 200 times as many psychiatrists as in Africa (ref. 7). Across all countries, investment in fundamental research into preventing and treating MNS disorders is disproportionately low relative to the disease burden (ref. 8).

To address this state of affairs, the Grand Challenges in Global Mental Health initiative has identified priorities for research in the next 10 years that will make an impact on the lives of people living with MNS disorders. The study was funded by the US National Institute of Mental Health (NIMH) in Bethesda, Maryland, supported by the Global Alliance for Chronic Diseases (GACD), headquartered in London. Answers to the questions posed will require a surge in discovery and delivery science. We use the term ‘mental health’ as a convenient label for MNS disorders. We exclude conditions with a vascular or infectious aetiology (such as stroke or cerebral malaria), because these fell within the scope of the two previous grand challenges initiatives — in global health and in chronic non-communicable diseases (ref 9).

This initiative differs from previous priority-setting exercises for mental health (refs. 10–12) in four ways. First, its scope is global. Second, it is the first to employ the Delphi method (ref. 13), a structured technique using controlled feedback to arrive at consensus within a dispersed panel of many participants. Third, it covers the full range of MNS disorders. Finally, the effort hopes to build a wide-ranging community of research funders — much as the challenge for non-communicable diseases led to the creation of the GACD.

Bold emphasis above is mine.

References

1. World Health Organization The Global Burden of Disease: 2004 Update (WHO, 2008).
2. WHO Atlas on Substance Use (WHO, 2010).
3. Ferri, C. P. et al. Lancet 366, 2112–2117 (2005).
4. Wimo, A., Winblad, B. & Jönsson, L. Alzheimer’s & Dementia 6, 98–103 (2010).
5. Bertolote, J. & Flieschmann, A. Suicidologi 7, 6–8 (2002).
6. WHO Country Resources for Neurological Disorders 2004 (WHO, 2004).
7. WHO Mental Health Atlas (WHO, 2005).
8. Saxena, S., Thornicroft, G., Knapp, M. & Whiteford, H. Lancet 370, 878–889 (2007).
9. Daar, A. S. et al. Nature 450, 494–496 (2007).
10. Lancet Mental Health Group Lancet 370, 1241–1252 (2007).
11. Sharan, P. et al. Br. J. Psychiatry 195, 354–363 (2009).
12. Tomlinson, M. et al. Bull. WHO 87, 438–446 (2009).
13. Jones, J. & Hunter, D. Br. Med. J. 311, 376–380 (1995).

To download the entire article, please click here (PDF).

Also see:

Thinking Globally to Improve Mental Health

Mental Health: Think Globally, Act Locally

Image credit

2010 Federal Disability Report

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To download the entire report, please click here (PDF).

National survey reveals 45.1 million adults in the U.S. experienced mental illness in the past year

A November 18th media release from the Substance Abuse and Mental Health Services Administration (SAMHSA):

Study shows that nearly 1 in 5 people suffering from mental illness also have a substance use disorder

According to new results from a national survey, 19.9 percent of American adults in the United States (45.1 million) have experienced mental illness over the past year. The survey conducted by the Substance Abuse and Mental Health Services Administration (SAMHSA) indicates that 11 million adults (4.8 percent) in the U.S. suffered serious mental illness in the past year -- a diagnosable mental disorder has substantially interfered with, or limited one or more major life activities.

SAMHSA’s 2009 National Survey on Drug Use and Health (NSDUH) reveals that 8.4 million adults in the U.S. had serious thoughts of suicide in the past year, 2.2 million made suicide plans, and one million attempted suicide.

The survey also reveals that in many cases those experiencing mental illness, especially those with serious mental illness, also have a substance use disorder (abuse or dependence on alcohol or an illicit drug). Nearly 20 percent (8.9 million) of adults in the U.S. with mental illness in the past year also had a substance use disorder. Among those with serious mental illness in the past year, 25.7 percent had a substance use disorder in the past year -- approximately four times the level experienced by people not suffering from serious mental illness (6.5 percent).

"Too many Americans are not getting the help they need and opportunities to prevent and intervene early are being missed," said SAMHSA Administrator Pamela S. Hyde, J.D. [pictured] "The consequences for individuals, families and communities can be devastating. If left untreated mental illnesses can result in disability, substance abuse, suicides, lost productivity, and family discord. Through health care reform and the Mental Health Parity and Addiction Equity Act we can help far more people get needed treatment for behavioral health problems."

Administrator Hyde announced the survey’s findings during an address before the 6th World Conference on Promotion of Mental Health and Prevention and Mental and Behavioral Disorders in Washington, D.C. sponsored by the Education Development Center, Inc., The Clifford Beers Foundation, The Carter Center and the World Federation for Mental Health.

The survey provides other insights into the nature and scope of mental illness, including information on those segments of the population who may be at greater risk of experiencing mental illness. For example, the survey shows that mental illness is more likely among adults who were unemployed than among adults who were employed full time (27.7 percent versus 17.1 percent).

There is a marked difference in the percentages with mental illness between men and women as well, with 23.8 percent of women experiencing some form of mental illness, as opposed to 15.6 percent of men. In terms of age, young adults (ages 18 to 25) had the highest level of mental illness (30 percent), while those aged 50 and older had the lowest (13.7 percent).

Less than four in ten (37.9 percent) of adults in the U.S. with mental illness in the past year received mental health services. Service use was higher for adults with serious mental illness (60.2 percent); however, 4.4 million adults with serious mental illness in the past year did not receive mental health services.

Results from the 2009 National Survey on Drug Use and Health: Mental Health Findings is based on the 2009 NSDUH -- the latest in a series of scientifically conducted annual surveys of approximately 67,500 people throughout the country. Because of its statistical power, it is a primary source of information on the levels of a wide range of behavioral health matters including mental health and substance abuse issues.

A copy of the report is accessible at: http://oas.samhsa.gov/NSDUH/2k9NSDUH/MH/2K9MHResults.pdf


SAMHSA is a public health agency within the Department of Health and Human Services. Its mission is to reduce the impact of substance abuse and mental illness on America’s communities.

Sources of Revenue for Nonprofit Mental Health and Addictions Organizations in Canada

The abstract of an article published in the October 2010 edition of Psychiatric Services:

By Carissa Escober-Doran, B.S.N., M.P.A., Philip Jacobs, D.Phil., C.M.A. and Carolyn Dewa, M.P.H., Ph.D.

Ms. Escober-Doran and Dr. Jacobs are affiliated with the Institute of Health Economics, 10405 Jasper Ave., Suite 1200, Edmonton, Alberta T5J 3N4, Canada (e-mail: escober@ualberta.ca). Dr. Dewa is with the Centre for Addiction and Mental Health, Toronto, Ontario.


OBJECTIVE:

In Canada charitable or nonprofit organizations provide government-contracted mental health and addictions services, and they augment government funding by raising charitable revenues. This study estimated by source the revenues of nonprofit mental health and addictions organizations in Canada.

METHODS:

A list of nonprofit, service-providing organizations in Canada was developed, financial returns to the Canada Revenue Agency (CRA) in 2007 were obtained, and data were analyzed in aggregate.

RESULTS:

Information was obtained from 369 Canadian organizations, which had $915.4 million (Canadian dollars [CAD]) in total revenues: 85% were from the government, 4% were from charitable giving, and 11% were from other sources.

CONCLUSIONS:

The ratio of charitable giving to government funding of mental health care was about 0.55% ($35 million to $6.3 billion CAD). This charitable giving level cannot compensate for the relatively low levels of total government mental health spending identified in government reports.

Posting of this abstract is for the purposes of research into funding of nonprofit mental health organizations.

The Continuum of Psychotic Symptoms in the General Population: A Cross-National Study

The abstract of an article published online on September 13th by Schizophrenia Bulletin:

By Roberto Nuevo (1,2), Somnath Chatterji* (3), Emese Verdes (3), Nirmala Naidoo (3), Celso Arango1 (4), and José Luis Ayuso-Mateos (1,2)

Author Affiliations

1. Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Spain
2. Department of Psychiatry, Universidad Autonoma de Madrid, Hospital Universitario de la Princesa, Madrid, Spain
3. Department of Health Statistics and Informatics, World Health Organization, Avebue Appia 20, Geneva 27, CH 1211, Switzerland
4. Adolescent Unit, Department of Psychiatry, Hospital General Universitario Gregorio Marañón, Madrid, Spain
   

* To whom correspondence should be addressed; tel: +41-227913609/3202, fax: +41-227914328, e-mail: chatterjis@who.int.

Abstract

Objective:

To identify the cross-national prevalence of psychotic symptoms in the general population and to analyze their impact on health status.

Method:

The sample was composed of 256,445 subjects (55.9% women), from nationally representative samples of 52 countries worldwide participating in the World Health Organization's World Health Survey. Standardized and weighted prevalence of psychotic symptoms were calculated in addition to the impact on health status as assessed by functioning in multiple domains.

Results:

Overall prevalences for specific symptoms ranged from 4.80% (SE = 0.14) for delusions of control to 8.37% (SE = 0.20) for delusions of reference and persecution. Prevalence figures varied greatly across countries. All symptoms of psychosis produced a significant decline in health status after controlling for potential confounders. There was a clear change in health impact between subjects not reporting any symptom and those reporting at least one symptom (effect size of 0.55).

Conclusions:

The prevalence of the presence of at least one psychotic symptom has a wide range worldwide varying as much as from 0.8% to 31.4%. Psychotic symptoms signal a problem of potential public health concern, independent of the presence of a full diagnosis of psychosis, as they are common and are related to a significant decrement in health status. The presence of at least one psychotic symptom is related to a significant poorer health status, with a regular linear decrement in health depending on the number of symptoms.

Keywords: World Health Survey, extended phenotype, schizophrenia

Posting of this abstract is for the purposes of research into psychosis and schizophrenia.

The Cost of Mental Health and Substance Abuse Services in Canada

From the Institute of Health Economics, Edmonton, Alberta:



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To download the entire report (PDF), please click here.

Putting a Price on Mental Illness

An article published in today's edition of The Globe and Mail:

Mental illness costs the Canadian economy a staggering $51-billion annually. That number includes:

• $5-billion in direct medical costs

• $9.3-billion in lost productivity due to short-term sick leave

• $8.5-billion in lost productivity due to long-term disability

• $28-billion is attributed to "reductions in health-related quality of life" - a method used to put a dollar figure on pain and suffering.

The World Health Organization estimates that by 2020, depression will be the leading cause of disability on the planet. Employers see the impact of mental illness every day:

• 500,000 Canadians daily are absent from work because of psychiatric and psychological problems.

• 40 per cent of all disability claims, short-term and long-term, involve mental-health conditions.

• 18 per cent of workers in Canada have had a diagnosis of clinical depression.

• 8 per cent of workers currently on the job are taking drugs for a mental-health condition.

• 6 per cent of all workers are under the care of a physician for treatment of a psychiatric or psychological condition.

Sources: Centre for Addiction and Mental Health; Great-West Life Centre for Mental Health in the Workplace; World Health Organization

Also see:

When the office gives back

Breaking Through

Mental health wrangle

A letter to the editor published in today's edition of The Chronicle Herald:

Most major psychiatric disorders begin in adolescence and early adulthood. The World Health Organization (WHO) has predicted that by 2020, major depression will rank first among all medical illnesses accounting for more of the global burden of disease than AIDS, war or traffic accidents, while bipolar disorder, schizophrenia and substance use disorders are in the WHO top 10.

Psychiatric illnesses have a strong genetic contribution associated with neurobiological abnormalities. While education, family and individual psychological support are an important part of the recovery plan, acute and preventative treatment is pharmacological.

Nova Scotia is in desperate need of a strategy for the identification and treatment of patients with psychiatric disorders. The specialists responsible for the care of these patients, along with research to improve diagnosis and develop effective and tolerable treatments, have had unprecedented difficulty negotiating with the Department of Health for funding to sustain and develop psychiatric services.

In fact, members of the Department of Psychiatry at the IWK Health Centre sent a detailed letter of concern to the Department of Health, detailing the resulting crisis in psychiatry service for patients and their families.

Therefore, it is concerning to read in your June 5 article about this topic from high-ranking government officials that "spending has increased by 63 per cent" – it certainly has not translated into funding for specialists or that "wait times stem from a shortage of psychologists and other mental health professionals rather than psychiatrists (physician specialists) alone." I wonder if cancer patients and their families or the specialists responsible for their care would accept this.

Anne Duffy, MD, FRCPC [pictured]
Professor and Clinical Research
Scholar, Department of Psychiatry, IWK Health Centre

Photograph courtesy of the Mood Disorders Centre of Ottawa.

Grading the States 2009

From the National Alliance on Mental Illness (NAMI):

A Report on America’s Health Care System for Adults with Serious Mental Illness

Mental health care in America is in crisis. The nation’s mental health care system gets a dismal D. As the nation confronts a severe economic crisis, demand for mental health services is increasing -- but state budget cuts are creating a vicious cycle that is leaving some of our most vulnerable citizens behind. We must move forward, not retreat ...

For more information, please click here.

For a video, please click here (Windows Media Player).


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New Report: Poverty line is being cracked, but not broken

Cross-Canada action needed as economy worsens, National Council of Welfare says


A December 10th press release from the National Council of Welfare:

Toronto, December 10 – While incomes for most Canadians on welfare were stuck far below the poverty line, some cracked that line in 2007, the newest report by the National Council of Welfare says. But tough economic times mean it will be tough to really break through, unless comprehensive, nationwide action is taken, says the advisory body to the federal government.

Welfare Incomes, 2006 and 2007 looked at the circumstances of Canadians on welfare in all provinces and territories. The study by the National Council of Welfare found that in the case of the lone parent with a pre-school age child living in Quebec, welfare income for 2007 reached 100 per cent of the Market Basket Measure (MBM), a poverty line measurement that takes into account the cost of meeting basic needs in different parts of Canada.

In the case of the lone parent with a pre-schooler in Newfoundland and Labrador, welfare income slightly surpassed the MBM, at 103 per cent.

“This information is considered significant because welfare incomes in Canada have historically been only a fraction of the real costs of survival and far below the poverty line”, said John Rook, Chair of the Council. “This means that lone-parent incomes, which include social assistance and federal child benefits, have reached a level that begins to give these families a reasonable chance in life. Even more encouraging, Quebec and Newfoundland and Labrador have poverty reduction strategies in place where social assistance is part of a larger, integrated framework with links to child care, health, education, and labour market policies. This can truly help people to get ahead.”

At the same time, however, the report found that single employable people receive welfare incomes at less than half of the MBM in most provinces, far below any measure of poverty or decency.

These incomes range from a low of 27 per cent of the MBM to a mere 67 per cent even in the best of cases. The Council is also concerned about the maze of rules and regulations that can trap welfare recipients and often discourages or even prohibits them from helping themselves out of poverty.

For example, people on welfare can keep little or none of their earnings if they can find some employment, which can discourage them from looking for work. Administrative rules vary throughout the country, but the new report details consistently how qualifying for welfare is a complicated, cumbersome and stigmatizing process.

As the economy deteriorates, the National Council of Welfare is concerned that the number of Canadians facing hardship will likely grow. In addition to welfare recipients, there are people who manage to leave the welfare system on their own, and others who can’t qualify, have been cut off or won’t sacrifice their assets or dignity to apply, Rook noted. While some may get ahead, others may be trading one form of poverty for another, and that is not good news for Canada anytime, especially not now.

“A comprehensive, pan-Canadian strategy to solve poverty is needed”, Rook added. “It should have targets and timelines, a plan of action, accountability and measurable indicators.” Many partners must be involved. Canada is not unique. “For any nation to solve poverty or foster prosperity there must be government action, political will and a real recognition of the human face of poverty.”

Media contact:
Carrie Breckenridge (613) 552-3527

The report and additional documentation are available at www.ncwcnbes.net.

For hard copies of the report, contact:
The National Council of Welfare
112 Kent Street, 9th Floor
Place de Ville, Tower B
Ottawa, Ontario K1A 0J9

Telephone: (613) 957-2961
Fax: (613) 957-0680

The National Council of Welfare is an independent body established to advise the federal government on issues related to poverty and social development.

Welfare Incomes, 2006 and 2007 estimates total welfare incomes in the 13 provinces and territories for four types of households: a single employable person; a single person with a disability; a lone parent with a two-year old child, and; a two-parent family with two children aged 10 and 15. There are 53 scenarios in all because Alberta has an additional program for persons with disabilities. The NCW has produced similar estimates since 1986.

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Also see:

2007 Provincial Welfare Rates Compared to the MBM (National Council of Welfare Fact Sheet)

Governments must 'step up’ on poverty

Welfare recipients poorer than Canadians imagine: report

Economy hits poor hardest

Welfare inadequate to meet needs: report

Mentally ill being 'set up for failure' with short hospital stays

From the August 22nd edition of The Province:

By Becky Rynor, Canwest News Service

OTTAWA - Hospitals may be discharging patients with chronic mental conditions like schizophrenia too quickly, suggest new statistics released Thursday by the Canadian Institute for Health Information.

"We're kind of setting people up for failure," said Schizophrenia Society of Canada president Pamela Forsythe. "If we send people out before there's been a chance to arrange appropriate follow-up services or address issues around inadequate housing or access to appropriate supports and treatments . . . the gains that may be starting to appear from the time in hospital are very quickly lost."

To read the entire article, click here.

Schizophrenia: Twice as Common as HIV/AIDS, But Survey Shows Americans Misinformed

From the National Alliance on Mental Illness (NAMI), June 9, 2008:

Arlington, VA — Twice as many Americans live with schizophrenia than with HIV/AIDS, but a major report by the National Alliance on Mental Illness (NAMI) reveals most Americans are unfamiliar with the disease.

"Americans are not sure what to think about schizophrenia," said NAMI executive director Mike Fitzpatrick. "They know schizophrenia is a medical illness affecting the brain, but it is largely misunderstood. There are gaps in knowledge— and access to treatment. Misinformation, misperceptions, and misunderstanding represent a public health crisis."

The report is available at www.nami.org/schizophreniasurvey. It is based on an on-line survey conducted by Harris Interactive among the general public, caregivers and individuals living with schizophrenia.

Approximately two million Americans live with schizophrenia. Two-thirds do not receive treatment, even though the disease can be managed successfully.

The survey found the average age at onset was 21, but a nine-year gap exists between symptoms and treatment.

• 85% of Americans recognize schizophrenia as an illness, 79% believe that with treatment, people with the diagnosis can lead independent lives, but only 24% are familiar with it. Many cannot recognize symptoms or mistakenly believe they include “split” or multiple personalities (64%).


• 79% want friends to tell them if they have schizophrenia, but only 46% say they would themselves. Even with treatment, 49% are uncomfortable with the prospect of dating a person with schizophrenia.


• Among people living with schizophrenia, 49% said doctors take their medical problems less seriously, even though the report notes that the death rate from causes like heart disease or diabetes is 2-3 times that of the general population.


• A vast majority believe that better medications (96%) and health insurance (82%) would be most helpful to improving their condition.


• Caregivers agree better medications are needed. Approximately 80% have difficulty getting services for loved ones, 63% have difficulty finding time for themselves, and 41% have provided care for more than 10 years.
  

"We know what to do to increase recovery, but it requires public support, which depends on public attitudes," Fitzpatrick said.

The report offers five recommendations:

• Public education


• Closing the gap between symptoms and treatment


• A welcoming healthcare system


• Education and support for caregivers and individuals living with the illness


• Greater investment in medical research
  

# # #

Mental Disorders Cost Society Billions in Unearned Income

Press Release from the U.S. National Institutes of Health - May 7, 2008:

Major mental disorders cost the nation at least $193 billion annually in lost earnings alone, according to a new study funded by the National Institutes of Health’s National Institute of Mental Health (NIMH). The study was published online ahead of print May 7, 2008, in the American Journal of Psychiatry.

“Lost earning potential, costs associated with treating coexisting conditions, Social Security payments, homelessness and incarceration are just some of the indirect costs associated with mental illnesses that have been difficult to quantify,” said NIMH Director Thomas R. Insel, M.D. “This study shows us that just one source of these indirect costs is staggeringly high.”

Direct costs associated with mental disorders like medication, clinic visits, and hospitalization are relatively easy to quantify, but they reveal only a small portion of the economic burden these illnesses place on society. Indirect costs like lost earnings likely account for enormous expenses, but they are very difficult to define and estimate.

In the new study, Ronald C. Kessler, Ph.D., of Harvard University, and colleagues analyzed data from the 2002 National Comorbidity Survey Replication (NCS-R) , a nationally representative study of Americans age 18 to 64.

Using data from 4,982 respondents, the researchers calculated the amount of earnings lost in the year prior to the survey among people with serious mental illness (SMI). SMI is a broad category of illnesses that includes mood and anxiety disorders that have seriously impaired a person’s ability to function for at least 30 days in the year prior to the survey. It also includes cases of any mental disorder associated with life-threatening suicidal behaviors or repeated acts of violence.

Eighty-six percent of respondents reported earning income in the previous year. But those with SMI reported earning significantly less—around $22,545—than respondents without SMI, who averaged $38,852. Although men with SMI took a greater hit in earnings than women with SMI, men still earned more overall than women with and without SMI.

By extrapolating these results to the general population, the researchers calculated that SMI costs society $193.2 billion annually in lost earnings. The researchers attributed about 75 percent of this total to the reduced income that people with SMI likely earn, while 25 percent is attributed to the increased likelihood that people with SMI would have no earnings.

“The results of this study confirm the belief that mental disorders contribute to enormous losses of human productivity,” said Kessler. “Yet this estimate is probably conservative because the NCS-R did not assess people in hospitals or prisons, and included very few participants with autism, schizophrenia or other chronic illnesses that are known to greatly affect a person’s ability to work. The actual costs are probably higher than what we have estimated.”

The researchers concluded by recommending that future studies on the effectiveness of treatments should consider measuring employment status and earnings over the long term to document the effects of mental disorders on a person’s functioning and ability to remain productive.

Reference

Kessler, RC, Heeringa S, Lakoma MD, Petukhova M, Rupp AE, Schoenbaum M, Wang PS, Zaslavsky AM. The individual-level and societal-level effects of mental disorders on earnings in the United States: Results from the National Comorbidity Survey Replication. American Journal of Psychiatry, published online ahead of print May 7, 2008.

###

The National Institute of Mental Health (NIMH) mission is to reduce the burden of mental and behavioral disorders through research on mind, brain, and behavior. More information is available at the NIMH website.

The National Institutes of Health (NIH) — The Nation’s Medical Research Agency — includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. It is the primary federal agency for conducting and supporting basic, clinical and translational medical research, and it investigates the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit the NIH website.

Canada Spends Less to Treat Mental Illness Than Most Developed Countries: Funding Uneven Across Provinces

Canadian Journal of Psychiatry - MEDIA ADVISORY - May 2008:

Canada lags behind most developed countries when it comes to mental health spending, an article in the May issue of The Canadian Journal of Psychiatry found. Dr. Philip Jacobs and authors’ research shows that only 4.8% of total health care spending in Canada (or $197 annually per Canadian) goes to mental health, which is slightly below the 5% that the European Health Economics Network considers to be the minimum acceptable amount. Canada is at the bottom of the barrel along with Italy—almost 2.5% behind the United States. At 12.1%, the United Kingdom spends the largest proportion of its health budget on mental health, although that includes social services costs.

The research also shows significant differences in mental health spending between the provinces. These ranged from an average annual low of $146 per person in Saskatchewan (3.5% of total spending) to a high of $258 in British Columbia (6.4%). The other provinces were: Newfoundland and Labrador, $200 (4.8%); PEI, $231 (5.8%); Nova Scotia, $203 (4.9%); New Brunswick, $242 (6.0%); Quebec, $166 (4.5%); Ontario, $185 (4.3%); Manitoba, $219 (4.9%); and Alberta, $242 (5.6%).

The research also highlights the important need for clear reporting of a consistent set of public and private mental health care expenditures across the provinces, as well as Western countries, so that meaningful comparisons can be made.

Further information:

Expenditures on Mental Health and Addictions for Canadian Provinces in 2003/04 (PDF)

Longer initial hospital stays positive for individuals diagnosed with schizophrenia

From today's edition of The Chronicle Herald:

By John Gillis, Health Reporter

The longer a person’s initial stay in hospital for schizophrenia, the less likely they are to be readmitted, says a new report from the Canadian Institute for Health Information.

The report found 38 per cent of people hospitalized for schizophrenia are readmitted to hospital within a year.

That figure shows a majority of people with the illness actually fare well outside hospital, said Stephen Ayer, executive director of the Schizophrenia Society of Nova Scotia.

"The amazing part, quite frankly, for me is that 62 per cent are not (readmitted)," he said. "When you have a first episode of schizophrenia or psychosis, it’s very, very scary."

Mr. Ayer said the report does not examine what care patients are getting while in hospital and what supports are available to them in the community.

Those people who were in hospital between a week and two weeks were 21 per cent less likely to be readmitted unexpectedly within 30 days than those whose initial stay was a week or less, the report says.

It notes the average length of hospital stays has been declining.

A week in hospital would be considered quite a short stay for someone admitted with schizophrenia, said Dr. Ian Slayter, clinical director for general psychiatric services for the Capital district health authority.

He said an admitted person would often be psychotic and needs time to stabilize.

"Someone who is (in) three or four weeks, they can often be helped to settle down and one can arrange things in the community."

Dr. Slayer said the length of stay for people hospitalized for schizophrenia in the Capital district averaged 28 to 30 days.

A person returning to hospital shouldn’t be assumed to be a bad thing, he said.

"Obviously, if they’re having problems, readmission is a good and necessary thing."

The services available to people after discharge include community mental health clinics and clubhouses, an assertive community treatment team, private psychiatrists and general practitioners.

Dr. Slayter said Capital Health also offers supportive services to check in with people in their homes and do things like drop off medication.

"That’s an area that we’re actively growing."

He said people who are hospitalized for very long periods are also likely to be readmitted due to instability.

Capital Health has recently changed the way it compiles statistics, so local readmission rates are unavailable.

Also see:

Schizophrenia patients with short hospital stays soon readmitted: report

Statement: The Schizophrenia Society of Ontario Supports CIHI's Findings on the Relationship Between Hospital Length of Stay and Readmission for Individuals with Schizophrenia

Short hospital stays failing schizophrenic patients

Schizophrenia Facts and Statistics

An excellent summary from Schizophrenia.com. To read the summary, click here.

Painkillers Pass Pot as Drug of Choice

Eve Bender writes in the October 19th issue of Psychiatric News:

Government officials express concern at the rising use of prescription painkillers among young adults, especially since the drugs are easily obtained through friends and family.

The use of illicit drugs is down among the nation's youth, according to the results of a government survey released last month, but officials cautioned that they must remain vigilant about continuing to pursue drug-prevention efforts due to rising rates of prescription drug use among young adults.

To read the entire article, click here.