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U.S. Spending On Mental Illness Drops

The United States spent less money on treating mental illness and substance abuse during the 1990s, even as more costs shifted from the private sector to the government, a study released Tuesday said.

In 1997, spending on treatment for mental illnesses and drug and alcohol abuse totaled $85.3 billion, or 7.8 percent of total health care costs. In 1987, the percentage was 8.8 percent, according to the study released by the federal Substance Abuse and Mental Health Services Administration.

And the government is picking up a bigger tab for treating mental illnesses and substance abuse, while private insurers are spending less.

The study says Medicare, Medicaid and other federal and state health programs spent 37 billion dollars – or 56 percent - treating mental health disorders and drug abuse in 1997. Private insurers spent 23 billion in 1997. In 1987, the government paid 53 percent of the tab and the private sector picked up the rest.

The study also says the disparity in public versus private spending is even greater when researchers looked at just funding substance abuse treatment.

Those figures are troubling when coupled with a surgeon general's report last year showing millions of Americans who need mental health services do not receive them, officials said. Each year, an estimated 28 percent of the U.S. adult population are treated for a mental illness or substance abuse.

"There is an increasing gap between what people need and the services available and what is being paid for," said Bernard Arons, director of the government's Center for Mental Health Services.

Trends in coverage included a shift toward prescription drug treatment rather than more costly psychotherapy. Prescription drug costs were 7.5 percent of the total bill in 1987 but rose to 12.3 percent in 1997, fueled by wider use of antidepressants and new medications for psychotic conditions, the study said.

"Many of those medications are highly effective, but we must not forget that they often need to be used in conjunction with psychotherapy," Arons said.

Other factors were a trend toward outpatient treatment instead of in hospitals, limits by health maintenance organization coverage and the stigma felt by some patients who do not seek treatment, officials said.

Officials said the new figures supported their push for insurance companies to provide parity of coverage for mental health services compared to other services.

The government study is published in the latest edition of the journal Health Affairs.

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