Racial Mental Health Disparities Cost US $278B in 4 Years

Racial mental health disparities cost the United States around $278 billion between 2016 and 2020, putting a price tag on a health equity issue that’s long plagued the nation, according to researchers from the Satcher Health Leadership Institute at Morehouse School of Medicine with support from Otsuka America Pharmaceutical, Inc.

The researchers looked at the national prevalence of mental health needs, care utilization, additional healthcare costs attributable to mental health disparities, and premature death across indigenous and racial or ethnic minorities. The analysis showed that, between 2016 and 2020, the US saw an excess of 117,000 premature deaths among indigenous and racial or ethnic minorities due to mental health needs.

All said, the excess cost due to these mental health disparities was $278 billion. That additional cost burden links back to mental illness, substance use disorder (SUD), and suicide, the researchers said.

These findings indicate that the healthcare industry needs to make more judicious investments in mental and behavioral healthcare, according to Daniel E. Dawes, JD, DHL (Hon).

“Investing in mental healthcare saves lives and dollars — we have known this for decades, but until now did not fully understand the monumental impacts of neglecting to act,” Dawes, a professor and the executive director of the Satcher Health Leadership Institute and author of the Political Determinants of Health, said in a statement.

“For the first time, there is tangible evidence demonstrating how decades of systemic health inequities have yielded significantly worse outcomes for racial and ethnic minoritized, marginalized, and under resourced populations.”

Those cost burdens impact various populations differently, the researchers added. Most of the excess cost burden is concentrated among Black and Hispanic individuals; in other words, if Black and Hispanic individuals experienced the same mental and behavioral healthcare as their White peers, there’d be a cost savings of $131.6 billion and $114.5 billion during the study period, respectively.

The researchers also found a $23 billion excess cost due to years of life lost among unhoused people.

Moreover, the team reported excess costs as a result of incarceration. Incarceration of those with mental illness or SUD results in a cost burden of more than $50 billion, mostly due to the high cost of incarceration itself. This is compared to the cost of delivering mental illness or SUD treatment or averting post-incarceration crime, the team said.

All said, adequate mental health and SUD treatment among unhoused or incarcerated folks could add up to between $60 and $90 billion annually, the researchers said.

Disparities in mental and behavioral health are usually the result of social determinants of health and lapses in health equity, the researchers reported.

“Structural barriers to accessing care, cultural differences to pursuing behavioral healthcare, biased delivery of care, and social and political determinants of health, including poverty and having health care insurance, all perpetuate systemic inequities,” they wrote. “Additionally, racism and racial incongruencies influence the collection of data and must be considered when interpreting the findings.”

The medical industry can start dismantling these inequities by making investments in behavioral health systems. The report's authors recommended these investments be sustainable and center on prevention, early detection, and prevention of mental and behavioral health diagnoses.

Additionally, investments need to center on mental and behavioral health infrastructure, namely the data collection, standardization, and reporting required. Standards and key performance indicators for mental health equity must be a part of that infrastructure.

Next, the report authors advocated for more culturally centered behavioral and mental healthcare.

Healthcare leaders must continue to focus on community health and tailored interventions, as opposed to one-size-fits-all solutions to mental and behavioral healthcare, the report authors said. That means auditing the existing resources available to a community and its partner healthcare organizations and leveraging them to create opportunities for better mental and behavioral health.

In doing so, leaders can ensure interventions are actually fulfilling and accessible for focus populations.

Finally, the report authors asserted that mental and behavioral healthcare systems need to address the systemic inequities and injustices that are baked in. By tackling political and social determinants of behavioral health, industry leaders may ensure more equitable access to-high quality care.

For example, addressing mental health stigma and acknowledging race and racism as social constructs can open opportunities for equity. Efforts should be intersectional, the researchers added, enhancing the ability to promote equity across all demographics.

Separate data have found health disparities to be costly for the medical industry. In January 2021, an assessment from Episcopal Health Foundation revealed that racial health disparities cost around $7.7 billion in excess health spending and lost productivity.

“These numbers are a glaring reminder of how non-medical factors like economic status and living conditions impact health and how COVID-19 is highlighting that in the worst way,” Elena Marks, president and CEO of the Episcopal Health Foundation, said of the report. “The human and economic costs of health disparities continue to grow during the pandemic and we’re learning why we can’t address them through medicine alone. Something has to change in Texas.”