Mental Health and Public Policy
Markowitz, Sara, NBER Reporter
Mental illnesses are debilitating diseases affecting millions of people each year. These conditions constitute five of the top ten leading causes of disability worldwide. Depression alone is responsible for more than one in every ten years of life lived with a disability. (1) Despite the severity of the burden of mental illness, many cases of mental disorders remain untreated. Estimates show that about 28 percent of the U.S. adult population in any year has a diagnosable mental or addictive disorder, yet only 8 percent seeks treatment. (2) The burden of depressive disorders lies not only with those afflicted, because others bear the costs as well. Maternal depression, for example, is associated with adverse outcomes for children, including children's behavioral and emotional problems. (3) In the workplace, mental disorders impose costs on both employers and employees, including unemployment, reduced labor supply, absenteeism, disability-related work leaves, lower perceived workplace productivity, and reduced earnings. (4)
My current research focuses on the ways in which public policy might intervene and improve mental health outcomes. The first set of studies summarized here examines one of the most serious outcomes associated with mental illness: suicide. The goal of this research is to identify policies that have the potential for reducing suicide attempts and completed suicides. The first paper I discuss examines the effectiveness of mandated mental health benefits in reducing suicide rates among adults in the United States. As many states have passed and continue to pass regulations regarding the provision of mental health insurance benefits, knowledge of the effectiveness of such legislation is vital to the policy debate. The second set of papers I describe focuses on youth suicidal behaviors and their relationship with alcohol. Alcohol consumption is known to be correlated with suicide, but the causal nature of that relationship is in question. If alcohol consumption indeed is a contributing factor to suicide, then policies that reduce alcohol consumption may also reduce suicides. Treatment for substance abuse and mental health disorders also may be effective in improving the lives of children. In the third section of this article, I discuss research on the propensity for substance abuse and mental health treatment to reduce mental disorders and criminal behaviors among a group of high-risk children in foster care. The last section focuses on another sub-population at high risk for mental disorders: new mothers. This research asks how the length of "maternity leave" influences maternal mental health.
Mandated Mental Health Benefits
In response to the increasing scope of the problems associated with mental illness, along with improvements in the diagnosis and treatment of mental disorders, a number of states and the federal government have taken steps in recent years to improve access to mental illness services via mandated mental health benefits. Among these mandates are mental health parity laws which prohibit insurance companies from offering plans that place greater financial burden on services for mental health conditions than for physical health conditions. Such laws are designed to lower the price of mental health services faced by insured individuals, improve access to treatment, and ultimately to improve mental health outcomes. However, it is possible that these laws might raise the cost of providing insurance, thereby reducing access.
In a recent study, Jonathan Klick and I examine the question of whether mental health mandates directly contribute to improvements in mental health. (5) The answer to this question is crucial to policymakers at the state and federal levels as they consider implementing and expanding mental health insurance mandates. We use state-level suicide rates as a measure of the mental health of the population, because numerous studies have shown suicide to be strongly correlated with mental illness. …