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SUNDAY READING

What Does the Great Craziness Really Cost? : The Hidden Price of Mental Illness

December 14, 1986|JON FRANKLIN

One of the more comprehensive attempts to quantify the costs of mental illness was recently undertaken by the Research Triangle Institute in North Carolina. The classic mental illnesses combined with drug addiction, the researchers concluded, cost this country $250 billion a year. That figure--$1,000 for each man, woman and child--is roughly equal to the annual budget deficit.

About $50 billion of the price tag goes for what statisticians call "direct core costs"--doctors, nurses, hospital rooms and drugs, disability payments and lost employment. Roughly four times that figure is attributed to documentable secondary costs, including social welfare programs aimed at the mentally ill, automobile crashes laid to alcoholism and direct losses to the victims of crimes linked to drug abuse and mental illness.

Yet, that $250-billion figure is conservative simply because it's skewed in favor of the documentable. There is no way to estimate, or even put a value on, the broad economic impact of the great craziness.

A secretary shows up for work on Monday preoccupied with her husband's weekend drunkenness and, her mind elsewhere, forgets to give her boss a critical message from an important client. We all pay for her mistake, but how much?

And how to calculate the economic damage done by a Detroit engineer who, wracked by obsessive jealousy over his wife, overestimates the efficiency of brakes that will ultimately appear in a quarter of a million automobiles?

Each time we write out a check for automobile insurance, a majority of the payment is earmarked to indemnify the victims of drunk or suicidal drivers. Health insurance payments are likewise inflated by illnesses that are rooted in emotional problems.

A large chunk of our federal and local taxes is destined to support social welfare bureaucracies and law enforcement agencies whose primary responsibilities are not officially mental health, but that, on careful examination, turn out to be precisely that.

We pay dearly each time we buy a product whose price is inflated by the effects of sick- leave abuse and hospitalization insurance--costs attributable, in the main, to emotional problems.

But we have still not reached the bottom line. The bulk of our automobile insurance payments may go to the secondary victims of mental illness, and be duly calculated by the statisticians and added to the big bill, but insurance doesn't pay the cost in full. Rarely do insurance settlements adequately compensate a family for, say, a dead father. And nothing compensates the rest of us for the loss of that man's skill and knowledge, which, had he not been broadsided by a drunk, would have been applied constructively over the course of a lifetime.

And what of the shattering effects on the children of alcoholics, depressives and schizophrenics? What of the children whose mentally ill fathers lead lives of crime and spend much of the time incarcerated?

Though criminality attributable to alcoholism is included in the mental illness costs, evidence is accumulating that criminality itself is as legitimate a category of mental illness as, say, depression.

Americans suffer direct crime losses in the neighborhood of $25 billion a year. It costs billions more to catch criminals and send them through the courts. About $50 billion is channeled into prison systems. Most criminals don't even go to prison; they are dealt with in probation programs, which, though less expensive per individual, cost more in aggregate than prisons.

The economic costs of criminality, in addition to the obvious expenses both to the victims and the state, also include the price of fear: the manufacturing, installation and maintenance of alarm systems; the wages of tens of thousands of security guards, and what is spent on the thousands of handguns purchased each year.

And so it goes, on and on. There aren't enough prisons, policemen, psychiatrists, mental institutions. It saps us, individually and collectively, and still there isn't enough.

And still we are only talking money, only dollars and cents. The real issue is contained in the tears of a family around the coffin of a victim of what we euphemistically call an "accident," in the hopelessness of a mother who watches a child sink deeper into the abyss of schizophrenia. The real issue is all these things, multiplied by that incomprehensible, but nonetheless brutally real, 250 million times.

As we consider the depth and breadth of the craziness in our society, we finally come to see mental illness for what it is: a tumor that metastasizes into every facet of our lives and economies. Its costs are by orders of magnitude greater than has ever been officially estimated.

Excerpted from the book "Molecules of the Mind: The Brave New Science of Molecular Psychology," by Jon Franklin, to be published next month by Atheneum Publishers. Copyright 1986 by Jon Franklin. Used by permission.

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