Mental Health and Economics

This is a post about money and medicine, but not in the sense that immediately comes to mind. Those who study the epidemiology of psychiatric diseases note a really interesting fact. The prevalence of mental illness increases as a country's economic wealth increases. This happened in post-war America, and is happening now in China. There are a lot of potential reasons for this; as the average wealth of a society increases, the poor who previously did not seek medical care are able to enter the health care system. In poor countries, mental health is grossly underfunded; perhaps as countries gain wealth, they are able to build up those systems. Most likely, the prevalence of disease has always been the same, but the illnesses are better recognized and diagnosed. Maybe in an aging society, diseases like dementias become more pronounced. Although once proposed, I'm not sure that wealthier societies have a direct causal relationship to more psychiatric problems.

I wanted to write a post about this because the vast majority of medicine - doctors, hospitals, media spotlights, research, awareness - neglects mental health. Worldwide, the prevalence of these diseases is increasing and its economic impact is astounding. While illnesses like depression, anxiety, obsessive-compulsive disorder, PTSD, and schizophrenia may not cause that many deaths, it severely impairs patients. The burden on family is huge, and the costs to health care systems should not be underestimated.

Even so, pharmaceutical companies have made and are making fortunes from these diseases. Antidepressants represent an enormous market and will become even bigger as third-world countries become wealthier. Is this the right solution? Are these pills sufficient or necessary to the management of mental health? Are they effective enough to justify their cost? Are we devoting enough resources to research, awareness campaigns, support systems, and nonpharmacologic approaches to tackle this global problem?

It is easy, especially for me, to write about crazy anesthetics or cutting-edge surgery or life-and-death critical care cases. But if that's all I did, that would be missing the point. Even though we all specialize in some small sliver of medicine, we need to be cognizant of the big picture, thinking about diseases with the most burden, and promoting ways to mitigate their impact.