Mental health inequities cost $477B annually, and could reach trillions

The United States is spending nearly half a trillion dollars in avoidable expenses due to mental health inequities, and that may be just the tip of the iceberg, a new report suggests.

Because of failures to provide access to the mental health needs of Americans, the country is spending an estimated $477 billion annually, according to a new report released today by Deloitte and Meharry School of Global Health. Unchecked, the cost could rise to $14 trillion by 2040, the report estimates.

Jay Bhatt, managing director of the Deloitte Center for Health Solutions and Health Equity Institute, says those figures should spark a conversation about finding ways to help Americans get the care they need.

“Mental and behavioral health is a national challenge that affects millions of Americans of all ages, backgrounds and walks of life, and particularly, really impacting youth at this time, too,” Bhatt tells Chief Healthcare Executive®.

"The cost of mental health inequities that we're facing today is an urgent challenge," he adds. "And it's unaffordable, as you see if we continue on the path that we are today."

It’s also an issue affecting employers and economic productivity as well, Bhatt notes. Mental health issues, combined with other health complications, lead to greater absenteeism. “There's an outsized impact of mental health on the well-being of employees,” he says.

“Addressing equity in mental health is an important factor for thriving individuals, families, communities, and business,” he says. “I think that this issue around addressing mental health inequity is not just a moral imperative, it's a business imperative.”

Bhatt spoke with Chief Healthcare Executive® about the failures to address mental health struggles, how these inequities are affecting hospitals, and potential remedies. (See part of our conversation in this video. The story continues below.)

Exacerbating chronic conditions

The COVID-19 pandemic worsened inequities in healthcare, including mental health, Bhatt says.

“The pandemic exacerbated the mental health crisis and exposed the stark inequities that exist in access, quality and outcomes of care for different populations,” he says.

As a primary care internist working in a community health system, Bhatt sees how mental health issues combine with other health complications.

“My patients that I care for, I know when I see them that if I don't think about mental health and their physical health together and collaborate with our mental health professionals, we're losing an opportunity to get them to better health,” Bhatt says.

Mental health challenges can exacerbate problems for those with chronic conditions.

“There are a whole set of chronic conditions that are more likely to be associated with mental health conditions,” he says. “We also see that if you have trouble managing a chronic condition, it may lead to a mental health condition, because of the repeated impact on your experience.”

A patient with diabetes is also going to have a harder time managing that condition if there are also ongoing mental health struggles, he notes.

“That can lead to a hospital visit, can lead to worsening of the chronic condition, lead to complications, and poor outcomes and further inequities,” Bhatt says.

Hospital executives say they are seeing more patients arriving in emergency departments due to mental health emergencies. Children’s hospitals in particular have seen more kids presenting with mental health emergencies.

Emergency department utilization for mental health inequities is now costing $5.3 billion annually, and that could rise to $17.5 billion by 2040 if unaddressed, according to the report.

Potential solutions

More patients need to have easier access to mental health, the report states.

“There's no denying that there is an urgent need to make mental health more visible, prioritize actions to improve health outcomes, reduce costs, for all populations, and it’s particularly striking for youth,” Bhatt says.

Healthcare organizations should look to implement models of care that increase behavioral healthcare access through integrated care, he says.

Healthcare organizations have called for greater integration of primary care and behavioral health. Rady Children’s Hospital has been placing more mental health professionals in primary care practices, and that approach has seen some success in reducing the number of young people arriving in the emergency department for mental health issues.

Whether it’s primary care or other services, connecting individuals with care for mental health or a screening could help identify patients who need assistance before they reach a crisis point.

Healthcare organizations may need to look at “equipping the workforce with upskilling and support for primary care to help them address it,” Bhatt says.

Health systems also must look at reducing the administrative burdens on doctors, and Bhatt says using technology, including AI, could help ease the workload on some clinicians.

While acknowledging that primary care physicians already have a heavy workload, Bhatt says identifying mental health needs earlier can lead to more effective interventions, and reduce costs.

“I practice in a high volume, community health center, serving historically underserved communities where we have a workflow designed to support people, even in situations where we may be moving from one patient to another every 15 minutes,” Bhatt says.

But even in that environment, Bhatt touts the importance of checking on the mental health of patients. “We know that the impact of it will be tremendous in terms of outcomes and lower costs,’ he says. 

Bhatt also points to the value of telehealth options for patients with behavioral health needs. Some providers have found patients are more likely to pursue behavioral health if there’s a virtual care option.

Health systems and hospitals need to think more holistically about the problem of mental health.

“Leadership needs to prioritize their approach to integrated care delivery,” Bhatt says.

Health systems also need to invest in the well-being of their clinicians, to ensure they aren’t overwhelmed.

“We've got to make it easier, so that clinicians are caring for patients, and they're not bogged down by the administrative burdens that delivering care may come with, so the teams are working effectively together, and clinicians are working to at the top of their game focused on caring for patients,” Bhatt says.

Read more: How hospitals can improve the well-being of workers