Bloomberg Businessweek - USA (2019-06-24)

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◼ REMARKS Bloomberg Businessweek June 24, 2019

Almost 60 yearslater,it’sclearthingshaven’tworked

outthatway.“Peoplewithseverementalillnesscanstillbe

foundindeplorableenvironments,medicationshavenotsuc-

cessfullyimprovedfunctioninallpatientsevenwhenthey

improvesymptoms,andtheinstitutionalclosingshavedel-

ugedunderfundedcommunityserviceswithnewpopulations

theywereill-equippedtohandle,”DanielYohannawrotein

“DeinstitutionalizationofPeoplewithMentalIllness:Causes

andConsequences”intheAMAJournalofEthicsin2013.That’s

leftpeoplewithoutthecomprehensivecaretheywouldneedto

recoverfromdrugaddictionorsuicidalthinking.Yohannacites

a pollofexpertswhosaythat 50 bedsper100,000wouldmeet

Americans’acuteandlong-termcareneeds.Insomestatesthe

numberis aslowas 5 per100,000.“I’dliketosaythingshave

improveda lot,buttheyhaven’t,”hesaystoday.

Peoplewithlesssevereissuesalsofacehurdleswhen

theyneedhelp.Mostpeopleareatthemercyoftheircom-

pany’shealthplanswhenit comestoseekingcare;a person

withfewerbenefitssimplywouldn’thaveaccesstothebest

resourcesforeithercrisiscareorchronicmentalhealthtreat-

ment.Evenforthosefortunateenoughtobeabletopayout

ofpocket,availabilityofprovidersrangeswildlyacrossthe

U.S.,from 50 psychiatristsper100,000peopleinWashington,

D.C.,forexample,to5.3per100,000inIdaho,accordingto

researchfromtheUniversityofMichigan’sSchoolofPublic

HealthBehavioralHealthWorkforceResearchCenter.And

despitelawsrequiringinsurerstooffermentalhealthbenefits

atthesamelevelasothermedicalcoverage,manymakeit

difficulttofindappropriatetreatmentandlimitresidential

care.Ina majorclassaction,Witv.UnitedBehavioralHealth,

oneofthecountry’sbiggesthealthinsurerswasheldliable

fordenyingmentalhealthbenefits.Thecompanysaysit’s

changeditsguidelines.

Thisisn’ta uniquelyAmericanexperience.InIndiaand

China,whichcombinedarehometoone-thirdoftheworld’s

population,morethan80%ofpeoplewithmentalhealth

orsubstanceabusedisordersdon’tseekcare,accordingto

a reportbytheLancetcommissiononglobalmentalhealth

releasedinOctober2018.InSouthAfricatheclosureofa

2,000-bedmentalhospitalsentpatientstounlicensedcom-

munityfacilitiesandresultedinmorethan 140 deaths,the

reportshows.Thestudyalsopokedholesintheideathatdrugs

havehelpedsolvetheproblem:Theuseofantidepressantsin

Australia,Canada,England,theU.S.,andotherwealthycoun-

triesdidn’tleadtoa declineintheprevalenceandsymptoms

ofmooddisordersdespitesubstantialincreasesintheuseof

thedrugsfrom 1990 to2015.TheLancetcommissionwarns

thatmentalhealthdisorderscouldcosttheglobaleconomy

asmuchas$16trillionfrom 2010 to 2030 if governmentsand

businessesdon’tdomoretoaddressthem.

Somecountrieshavestartedtograpplewiththeproblem.

NewZealandPrimeMinisterJacindaArdernunveiledthe

world’sfirstWellbeingBudgetinMay,earmarkingNZ$1.9bil-

lion ($1.2 billion) for mental health, which should also

improve services for people living with the type of anxiety

and depression that doesn’t require hospitalization but still

has a major effect on their everyday life. “You have a limited

budget, and you have to try and balance the need to grow

the economy, create jobs, balance the books, and look after

our people and our environment,” Ardern said in comments

reportedintheNewZealandHerald. “Thisbudgetshowsyou

candoallofthosethings.”

Onlyweeksaftermorethan 50 peoplewerekilledon

March15 in mosque shootings in Christchurch, Ardern

demonstratedherwillingnesstotackleproblemsother

governments havesidestepped bybanning almost all

military-style guns in the country. Shortly after the Virginia

Beach shooting, President Donald Trump’s acting chief of

staff,MickMulvaney,warnedagainstwadingintothepoli-

ticsofguncontrol“toosoon.”U.S.lawmakershavefailedto

enactmeaningfulguncontrol measures despite an onslaught

of mass shootings in the past five years.

The spending proposed by Ardern’s government far

outpaces what the U.S. spends on its Substance Abuse and

Mental Health Services Administration, the main agency

thatprovidesfundingforstatestoimplementservicesthat

addressthesetypesofproblems.Ardern’sproposedoutlay

is 15times as high as SAMSHA’s $5.6 billion budget request

for the U.S. in 2020 on a per-capita basis.

In the U.K., the Office for National Statistics released data

for the first time in February that combine personal and eco-

nomic well-being, showing measures of “happiness” and “life

satisfaction” in addition to more traditional metrics such as

household debt and disposable income. The data collection

effort dates to 2010, when Prime Minister David Cameron

announced the government was going to start measuring peo-

ple’s well-being. That directive spawned initiatives such as the

Green Book, which is used to evaluate new policies to ensure

they improve not only economic output but also social welfare

and well-being, says Gueorguie Vassilev, who heads the eco-

nomic well-being and digital transformation team at the Office

for National Statistics. The country also created a Minister of

Loneliness in January 2018 in response to its findings on social

isolation. This month the government announced a campaign

to alleviate the stigma of loneliness.

These countries are saying that improving the physical

well-being of their citizens isn’t enough. Seeing the limitations

of traditional statistics, economist Joseph Stiglitz published

“Beyond GDP” in the magazine Project Syndicate in December,

a decadeafterStiglitzco-authoredthereport“Mismeasuring

OurLives:WhyGDPDoesn’tAddUp.”

“Whatwemeasureaffectswhatwedo,andif wemeasure

the wrong thing, we will do the wrong thing,” Stiglitz

wrote. “If we focus only on material well-being—on, say,

theproductionofgoods,ratherthanonhealth,educa-

tion,andtheenvironment—webecomedistortedinthe

samewaythatthesemeasuresaredistorted;webecome

morematerialistic.”Traditionalnumbers have failed us. It’s

timefora newapproachbefore America’s mental health

deteriorates even further. <BW>