FORUM-Translating Research into Quality Health Care for Veterans: June 2002

Mental illness exacts enormous costs — both financial and human — on this country. The 1999 Surgeon General’s report on mental health documents ample evidence of these costs. Approximately 28 percent of the U.S. population has a mental illness, but only 15 percent uses any mental health care services. People with mental illness suffer in very real terms. Four of the 10 leading causes of disability in the U.S. are mental disorders: major depression, bipolar disorder, schizophrenia, and obsessive-compulsive disorder. Mental illnesses frequently strike more vulnerable members of our society. Post-traumatic stress disorder (PTSD), for example, is common among war veterans and victims of rape, mugging, domestic violence, terrorism, and natural disasters. Approximately 5.2 million Americans ages 18 to 54 — about 3.6 percent of people in this age group — have PTSD. Alzheimer’s disease, the most common cause of dementia among people 65 and older, affects an estimated 4 million Americans. The duration of the illness from onset of symptoms to death averages eight to 10 years. Mental illness also plays a huge role in suicide: More than 90 percent of people who kill themselves have a diagnosable mental disorder. This terrible level of human suffering also carries a huge price tag. In 1996, direct costs of mental health care totaled $69 billion. The indirect costs of mental health care were not measured at that time, but were later measured in 1990 totaling $78.6 billion. Most indirect costs were due to disability, as opposed to mortality. The care of veterans with mental illnesses is of great concern to the VA. According to the VA’s North East Program Evaluation Center (NEPEC), in FY00 452,890 veterans had a service-connected psychiatric disorder and 677,519 veterans received some type of mental health treatment in the system. Total mental health care costs in the VA for FY00 exceeded $1.5 billion. Given the magnitude of the problem and the costs associated with it, mental health services research has become a priority for the VA. To help address this priority, the VA’s Serious Mental Illness Treatment Research and Evaluation Center (SMITREC) has developed the ongoing National Psychosis Registry (NPR) to monitor the care of veterans with these debilitating conditions and provide information to help answer a variety of questions related to practice and policy. SMITREC reported that 192,982 patients with psychosis were treated in the system in FY00, with $2.8 billion spent on their medical and mental health care combined. In addition to their financial C OMMENTARY DIRECTOR’S LETTER