(Mar. 8, 2017) Spending on mental health treatment averages only 5% of all health spending in rich countries. In a new paper, two researchers from the London School of Economics and Political Science make the case that the "strikingly absent" study of how mental illness affects life satisfaction is one of the reasons mental health investment gets left behind.
"Studies of deprivation usually ignore mental illness," they say, and that needs to change.
The Causes of Misery
"There are many causes of misery," Sarah Flèche and Richard Layard write in "Do more of those in misery suffer from poverty, unemployment or mental illness?" "But mental illness is one important cause, even holding constant all other causes." For this reason, they say, "Treating mental illness directly is one way to reduce misery."
Flèche and Layard say they undertook their study "to remedy the omission of mental health from the analysis" at a time when policymakers increasingly consider life satisfaction of the population in decision-making. They also make the argument that raising life satisfaction with treatment is cost-effective, though the analysis is limited to the cost of cognitive behavioral therapy for depression or anxiety, which are less costly to treat than serious mental illness.
To develop their findings, the authors analyzed surveys collecting data on both life satisfaction and mental health in four countries: the United States, Germany, Britain and Australia. They defined "misery" as being roughly in the bottom 10% of life-satisfaction measures. (In the United States, the scale is being in the bottom 5.6%; it is higher in the other countries.)
"We ask first how many of those in the lowest levels of life-satisfaction suffer from unemployment, poverty, physical ill health, and mental illness," Flèche and Layard write. "The largest proportion suffers from mental illness. Multiple regression shows that mental illness is not highly correlated with poverty or unemployment, and that it contributes more to explaining the presence of misery than is explained by either poverty or unemployment."
Mental illness was measured in the surveys by either "objective" data (e.g., being in treatment for a mental health condition, being diagnosed with depression/anxiety) or self-reporting symptoms of mental illness. Information on income, employment, family status, education and physical health also were collected by the surveys, which allowed the effect of mental health conditions to be isolated from other circumstances.
Public Policy Implications
Both at a single point in time and over multiple points of time, mental illness showed a bigger influence on misery than either income or employment. In the United States, for example, "many more of the least-satisfied segment of the population have mental health problems than are poor or unemployed," according to the analysis. Physical health also produced more misery than poverty or unemployment, but the effect was less pronounced.
"Though we do not claim anywhere to have a fully causal analysis, our results suggest that mental illness is an important form of deprivation, which receives far too little attention, even within the health sector," the authors say.
They cite corroborating studies that have found "mental pain" to have a greater influence on life satisfaction than physical pain, with authors hypothesizing that "mental pain is more difficult to adapt to - it occupies more of a person's mental space."
"For too long the debate on deprivation has focused mainly on poverty, jobs, education and physical sickness," Flèche and Layard conclude. "It needs broadening to include the inner person."
Doris A. Fuller
Chief of Research and Public Affairs
References:
- Flèche, S. & R. Layard. (February 2017). Do more of those in misery suffer from poverty, unemployment or mental illness? Kyklos.
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