What is the Cost of Mental Illness to Society?

Mental illness has significant social and economic costs in Canada. People with mental illness are more likely to experience social and economic marginalization, including social isolation, inability to work, and lower educational attainment and income, compared to Canadians who do not have a mental illness (Burczycka, 2018). People with mental illness also have a higher risk of being victimized. One in ten people with mental health-related disabilities in Canada report experiencing violence over the past year, a rate that is double that found in the general population (Burczycka, 2018). Moreover, mental illness can significantly impact people’s ability to work. It is estimated that 2 out of 9 workers suffer from a mental illness that affects their work performance, and this amounts to an annual wage loss of over $6.3 billion (Smetanin et al., 2011).

Each year, the economic burnout of mental illness in Canada is estimated at $51 billion (Smetanin et al., 2011). Mental illness significantly impacts the health care system directly and indirectly. Directly, there are costs of about $21.3 billion due to hospitalizations, medical visits, and support staff (Smetanin et al., 2011). There are also indirect costs to the justice system, social service and education systems, and other costs due to losses in quality of life. The personal and economic costs of mental illness will further increase due to greater numbers of Canadians expected to be impacted by mental health problems, combined with our aging population and growth of the Canadian population over the next 30 years (Smetanin et al., 2011). By 2041, annual costs of mental illness are expected to be $307 billion (Mental Health Commission of Canada, 2010).

In terms of worldwide impact, the World Economic Forum used 2010 data to estimate $2.5 trillion in global costs of mental illness in 2010 and projected costs of $6 trillion by 2030. The costs for mental illness are greater than the combined costs of cancer, diabetes, and respiratory disorders (Whiteford et al., 2013).

Though there is no one behavior that we can use to classify people as abnormal, most clinical practitioners agree that any behavior that strays from what is considered the norm or is unexpected within the confines of one’s culture, that causes dysfunction in cognition, emotion, and/or behavior, and that causes distress and/or impairment in functioning, is abnormal behavior. Armed with this understanding, let’s discuss what mental disorders are.

Definition of Abnormal Psychology and Psychopathology

The term abnormal psychology refers to the scientific study of people who are atypical or unusual, with the intent to be able to reliably predict, explain, diagnose, identify the causes of, and treat maladaptive behavior. A more sensitive and less stigmatizing term that is used to refer to the scientific study of psychological disorders is psychopathology.  These definitions beg the questions of, what is considered abnormal and what is a psychological or mental disorder?

Defining Psychological Disorders

It may be surprising to you, but the concept of mental or psychological disorders has proven very difficult to define and even the American Psychiatric Association (APA), in its publication, the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5 for short), states that though “no definition can capture all aspects of all disorders in the range contained in the DSM-5” certain aspects are required. While the concept of mental or psychological disorders is difficult to define, and no definition will ever be perfect, it is recognized as an extremely important concept and therefore psychological disorders (aka mental disorders) have been defined as a psychological dysfunction which causes distress or impaired functioning and deviates from typical or expected behavior according to societal or cultural standards. This definition includes three components (3 Ds). Let’s break these down now:

• Dysfunction – includes “clinically significant disturbance in an individual’s cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning” (pg. 20). In other words, dysfunction refers to a breakdown in cognition, emotion, and/or behavior. For instance, an individual experiencing delusions that he is an omnipotent deity would have a breakdown in cognition because his thought processes are not consistent with reality. An individual who is unable to experience pleasure would have a breakdown in emotion. Finally, an individual who is unable to leave her home and attend work due to fear of having a panic attack would be exhibiting a breakdown in behavior. Abnormal behavior has the capacity to make our well-being difficult to obtain and can be assessed by looking at an individual’s current performance and comparing it to what is expected in general or how the person has performed in the past.
• Distress or Impairment –  Distress can take the form of psychological or physical pain, or both concurrently. Simply put, distress refers to suffering. Alone though, distress is not sufficient enough to describe behavior as abnormal. Why is that? The loss of a loved one would cause even the most “normally” functioning individual pain and suffering. An athlete who experiences a career-ending injury would display distress as well. Suffering is part of life and cannot be avoided. And some people who display abnormal behavior are generally positive while doing so. Typically, if distress is absent then impairment must be present to deem behavior abnormal. Impairment refers to when the person experiences a disabling condition “in social, occupational, or other important activities” (pg. 20). In other words, impairment refers to when a person loses the capacity to function normally in daily life (e.g., can no longer maintain minimum standards of hygiene, pay bills, attend social functions, or go to work). Once again typically distress and/or impairment in functioning are required to consider behavior abnormal and to diagnose a psychological disorder.
• Deviance – A closer examination of the word abnormal shows that it indicates a move away from what is normal, typical, or average. Our culture – or the totality of socially transmitted behaviors, customs, values, technology, attitudes, beliefs, art, and other products that are particular to a group – determines what is normal and so a person is said to be deviant when he or she fails to follow the stated and unstated rules of society, called social norms. What is considered “normal” by society can change over time due to shifts in accepted values and expectations. For instance, just a few decades ago homosexuality was considered taboo in the U.S. and it was included as a mental disorder in the first edition of the DSM; but today, it is generally accepted. Likewise, PDAs, or public displays of affection, do not cause a second look by most people unlike the past when these outward expressions of love were restricted to the privacy of one’s own house or bedroom. In the U.S., crying is generally seen as a weakness for males but if the behavior occurs in the context of a tragedy such as the Vegas mass shooting on October 1, 2017, in which 58 people were killed and about 500 were wounded, then it is appropriate and understandable. Finally, consider that statistically deviant behavior is not necessarily negative. Genius is an example of behavior that is not the norm, but it is generally considered a positive attribute rather than a negative one.

Though not part of the DSM 5’s conceptualization of what abnormal behavior is, many clinicians add a 4th D – dangerousness to this list. Dangerousness refers to when behavior represents a threat to the safety of the person or others. Individuals expressing suicidal intent, those experiencing acute paranoid ideation combined with aggressive impulses (e.g., wanting to harm people who are perceived as “being out to get them”), and many individuals with antisocial personality disorder may be considered dangerous. Mental health professionals (and many other professionals including researchers) have a duty to report to law enforcement when an individual expresses an intent to harm themselves or others. Nevertheless, individuals with depression, anxiety, and obsessive-compulsive disorder are typically no more a threat to others than individuals without these disorders. As such, it is important to note that having a mental disorder does not automatically deem one to be dangerous and most dangerous individuals are not mentally ill. Indeed, a review of the literature (Matthias & Angermeyer, 2002) found that only a small proportion of crimes are committed by individuals with severe mental disorders, that strangers are at a lower risk of being attacked by a person with a severe mental disorder than by someone who is mentally healthy, and that elevated risks to behave violently are limited to a small number of symptom constellations. Similarly, Hiday and Burns (2010) showed that dangerousness is more the exception than the rule.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

Bridley, A., & Daffin, L. W. Jr. (2018). Understanding Abnormal Behavior. In C. Cuttler (Ed), Essentials of Abnormal Psychology. Washington State University. Retrieved from https://opentext.wsu.edu/abnormalpsychology/.

Burczycka, M. (2018). Violent victimization of Canadians with mental health-related disabilities, 2014. Retrieved from https://www150.statcan.gc.ca/n1/pub/85-002-x/2018001/article/54977-eng.htm.

Hiday, V. A., & Burns, P. J. (2010). Mental illness and the criminal justice system. In T. L. Scheid & T. N. Brown (Eds.), A handbook for the study of mental health: Social contexts, theories, and systems (pp. 478–498). Cambridge University Press.

Matthias, C., & Angermeyer, C. (2002). Schizophrenia and violence. Acta Psychiatrica Scandinavica, 102, 63-37.

Mental Health Commission of Canada (2010). Making the case for investing in mental health in Canada. Retrieved from https://www.mentalhealthcommission.ca/sites/default/files/2016-06/Investing_in_Mental_Health_FINAL_Version_ENG.pdf.

Smetanin, P., Stiff, D., Briante, C., Adair, C. E., Ahmad, S. & Khan, M. (2011). The Life and Economic Impact of Major Mental Illnesses in Canada: 2011 to 2041. RiskAnalytica, on behalf of the Mental Health Commission of Canada 2011.

Whiteford, H. A., Degenhardt, L., Rehm, J., Baxter, A. J., Ferrari, A. J., Erskine, H. E., …Vos, T. (2013). Global burden of disease attributable to mental and substance use disorders: findings from the Global Burden of Disease Study 2010. Lancet, 382(9904), 1575-1586. doi:10.1016/S0140-6736(13)61611-6.