Mental health costs are actually a very small portion of total healthcare spending and will continue to grow more slowly than other costs, due in part to the continuing impact of managed behavioral healthcare organizations (MBHO’s). Mental health spending was $33 billion in 1986 and $100 billion in 2003. The total cost of mental illness and substance abuse – including treatment costs, law enforcement costs, mortality, and decreased productivity – has been estimated to be $190 billion per year (NAMI, 2013). With these figures in mind, experts predict the following trends. First of all, mental health spending is projected to reach $203 billion by 2014 but will account for a progressively smaller share of overall health spending, dropping from 7.5% in 1986 to 6.2% in 2003, and to only 5.9% in 2014 (Levit et al., 2008). Secondly, the share of spending for psychologists, counselors, and social workers for 2014 will remain at the 2003 rate of only 8% of all mental health spending, which is down from 9% in 1986. Ironically enough, fees for psychotherapy are only .047% of all healthcare expenditure dollars. Thus, a third trend projected is that spending for mental healthcare provided by physicians will increase from 11% in 1986 to 16% in 2014, with 70% of those services performed by psychiatrists. And finally, it is estimated that prescription medications, which were only 7% of mental health expenditures in 1986, will rise to 30% by 2014.
One also cannot discuss national expenditures for mental health services without mentioning how the development and marketing of antidepressant medications has impacted the practice of psychotherapy. From 1998 to 2007, the percentage of individuals in the general population receiving outpatient psychotherapy decreased from 15.9% to 10.5%. There was also a reduction in the percentage receiving a combination of psychotherapy and medication, decreasing from 40% to 32.1% (Olfson & Marcus, 2010). In contrast, the percentage of individuals prescribed medications alone increased from 44.1% to 57.4%. Health insurance plans, which typically cover psychotropic medications while significantly limiting coverage for psychotherapy, have been a major factor contributing to the treatment of larger numbers of individuals with mild to moderate disorders in primary care environments, as compared with specialty care environments (Olfson & Marcus, 2010). This is a fancy way of saying that people now tend to talk to their primary care physician about psychological symptoms or to inquire about psychotropic medication, rather than seek out a psychologist or psychiatrist in private practice. These numbers also suggest that individuals tend to reach for the anti-depressant BEFORE it occurs to them to find a psychotherapist, especially because their insurance company probably covers the visit to the family doctor, rather than a visit to a private practice psychologist.