Mental Illness and Health Care Policy

Abstract

administrators get together. Perhaps this is a reflection on how separately mental health issues have been viewed from the mainstream of health care policy formulation. ze, e And perhaps this explains to some extent the slower development of responses to the needs of the mentally ill and their families. Yet, by almost any yardstick, mental health is an extremely important public policy issue. In 1980, according to the Department of Health and Human Services statistics, mental illness was the third most expensive class of disorders, accounting for more than $20 billion in health care expenditures, ranking behind only the circulatory disorders and all disorders of the digestive system. And these figures are probably understated because much of the utilization of health care associated with mental illness is delivered under a variety of other diagnostic categories. But costs alone do not make the problems of mental illness as important as they are. Mental illness has a substantial impact on the organization and structure of state governments, where agencies serving the mentally ill are typically among the largest in state government. Mental illness has a substantial impact on housing policy, on the criminal justice system, on the general health care system, on the child welfare system, and so on. The President's Commission on Mental Health estimated that 15 percent of the population may need mental health services at any one time. And for each person that requires mental health services, there are probably at least four others who are indirectly affected by that mental illness. Given these dimensions of the problem of mental illness, it is difficult to imagine another public health problem, not similarly isolated from mainstream public health policy formulation, about which we know so little or are doing as little to correct our state of ignorance. It is obviously not possible in a forum such as this to comprehensively examine all of the facets of the public policy issues which challenge us in